ABSTRACT: Purpose of Review: This article provides an overview of evaluating and treating low back pain in the outpatient setting.
Recent Findings: As most cases of acute low back pain have a favorable prognosis, current guidelines on imaging studies recommend conservative treatment for 6 weeks prior to obtaining an MRI if no red flags are present. Of these red flags, a prior history of cancer is the strongest risk factor for a malignant etiology and requires urgent evaluation with MRI. Management of acute low back pain is mainly conservative with oral non-narcotic analgesics and mobilization as the initial recommendations. For patients with radiculopathy, epidural steroids may result in short-term pain relief, but long-term effects are still unclear.
Summary: A systematic, evidence-based approach to the patient with low back pain is key to providing safe and cost-efficient care.
Address correspondence to Dr Jinny O. Tavee, Cleveland Clinic, Department of Neurology, S-90, 9500 Euclid Ave, Cleveland, OH 44195, firstname.lastname@example.org.
Relationship Disclosure: Dr Tavee has received personal compensation for lectures from Mallinckrodt Pharmaceuticals and has received grant/research support for work in clinical trials from Araim Pharmaceuticals, Inc and Mallinckrodt Pharmaceuticals. Dr Levin receives personal compensation for serving as director of the American Board of Psychiatry and Neurology, serves on the editorial boards of Continuum and Muscle & Nerve, and receives publishing royalties from Elsevier and UpToDate, Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Tavee and Levin report no disclosures.