Low back pain is pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists for 12 weeks or more.

1. LOWER BACK
PAIN
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Institution
Date
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2. Definition
• Low back pain is pain,
muscle tension, or
stiffness localized below
the costal margin and
above the inferior
gluteal folds, with or
without sciatica, and is
defined as chronic when
it persists for 12 weeks
or more.

3. Incidence and
Prevalence
About 25% of American adult sreports to have a
lower back pain lasting in a whole day.
7.6% of the adults report to have had at least 1
episode of severe lower back pain.
Lower Back Pain is estimated at 60% to 70%
prevalence in industrialized countries.
The prevalence rate is lower in children and
adolescents compared to that of adults.

4. Pathophysiology
There are many causes of low back pain some
resulting to a migrant and severe pain.
Infections such as the pelvic inflammatory
disease in women’s reproductive organs causes
back pain during urination or sex.
Also, a slipped disc on the spine from the neck to
the lower back is a common cause of the low back
pain.
The major cause of the low back pain among the
American adults is overweight and lack of enough
exercises. Also, old age has been found to be a
reason why low back pain affects most American
adults..

5. Clinical
Presentation-
Prodromal
Symptoms
Gradual increase of pain to a point where a
person begins to feel sharp pain in the lower
back especially during sports or lifting
weights.
Loss of bowel or bladder control, numbness in
the groin, weakened legs, fever and pain when
a person is coughing or urinating.
If not managed, lower back pain decreases
physical performance and increases depression
symptoms especially to the elderly adults.

6. Differential
Diagnosis and
Rule Out
• Diagnosis : back strain as pain increases with
bending and activity.
• Acute disc herniation: r/o by absence of pain in
lower leg
• Osteoarthritis: r/o by absence of sharp shooting pain
and parasthesia in leg
• Spondylolisthesis: r/o by absence of tight hamstrings
• Ankylosing spondylitis: r/o by no pain in Sacroiliac
joints and lumbar spine

7. Treatments -
Pharmacologic
Acetaminophen as a first line of treatment
Nonselective NSAIDS should be prescribed after
gastrointestinal and renovascular risks have been
ruled out

8. Treatments -
Non
Pharmacologic
Weight reduction, good siting posture, and
physical exercises.
Massage on the lower back using a heat press
has been found to be a good lower back pain
reliever
Sitting posture and not sitting down for a long
time is a good management that reduces the
chances of having low back pain.
Engaging in activities that reduces the chances
of back injury is a sure way of reducing
accidents that may lead to lower back pain.
Wear the right shoes and reduce standing for
long time.
Avoid sleeping on a firm bed, let id be medium

9. Evidence-
based
guidelines
Perform an examination and take the history of
the patient to help categorize the low back pain
Imaging and diagnostic tests should only be
performed on patients with specific low back pain
Diagnostic and imaging tests should only be
performed when the physical examination and
history establish progressive neurologic deficit or
an underlying condition
Evaluation of low back pain with magnetic
resonance imaging should only be done if the
patient is a candidate fro surgery or epidural
steroid injection

10. Current
Evidence-
based
treatment
management
plan
Provide evidence-based information on low back pain and
at the same time encourage physical activity and
informing of self-care measures such as application of
heat using a heating pad and avoid sleeping on firm
mattresses
Use proven beneficial medications such as acetaminophen
and nonselective NSAIDS though they pose a
gastrointestinal and renovascular risk, in combination
with credible information on self-care
Non-pharmacologic treatment such as the straight-leg-
raise test should also be considered

11. References
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., & Shekelle, P. (2007). Diagnosis
and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the
American College of Physicians and the American Pain Society. Annals of Internal
Medicine, 147(7), 478. doi:10.7326/0003-4819-147-7-200710020-00006
Dorsey, S. G., Renn, C. L., Griffioen, M., Lassiter, C. B., Zhu, S., Huot-Creasy, H., …
Starkweather, A. R. (2019). Whole blood transcriptomic profiles can differentiate
vulnerability to chronic low back pain. PLoS ONE, 14(5), 1–20.
https://doi.org/10.1371/journal.pone.0216539
Hasegawa, T., Katsuhira, J., Oka, H., Fujii, T., & Matsudaira, K. (2018). Association of low
back load with low back pain during static standing. PLoS ONE, 13(12), 1–12.
https://doi.org/10.1371/journal.pone.0208877
French, S. D., Green, M. E., Bhatia, R. S., Peng, Y., Hayden, J. A., Hartvigsen, J., …
Norman, K. E. (2019). Imaging use for low back pain by Ontario primary care
clinicians: protocol for a mixed methods study - the Back ON study. BMC
Musculoskeletal Disorders, 20(1), 1–10. https://doi.org/10.1186/s12891-019-2427-1