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Management of Chronic Low Back Pain

Grabois, Martin MD

American Journal of Physical Medicine & Rehabilitation: March 2005 - Volume 84 - Issue 3 - p S29-S41
doi: 10.1097/01.PHM.0000154908.76436.C2
Literature Review: Chronic Pain
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Grabois M: Management of chronic low back pain. Am J Phys Med Rehabil 2005;84(suppl):S29–S41.

Chronic low back pain is common. It presents a clinical challenge with widespread implications for resource utilization on a national scale. The causes of chronic low back pain may be mechanical or nonmechanical, nociceptive or neuropathic. Diagnosis is problematic because available tools lack both specificity and sensitivity. In rare instances, the cause of chronic low back pain can be attributed to an identified cause. Comprehensive pain management relies on the use of pharmacotherapy, physical therapy, and a multidisciplinary approach to treatment. Recent studies have shown a benefit for traditional adjunctive therapies and interdisciplinary treatment. Antidepressants and opioids have been and remain key elements for medical management, and some recently developed therapies have shown promising results in clinical trials. The following article presents an overview of evidence-based management for chronic low back pain, with an emphasis on pharmaceutical therapies.

From the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.

All correspondence and requests for reprints should be addressed to Martin Grabois, MD, Baylor College of Medicine, Physical Medicine and Rehabilitation, 1333 Moursund Avenue, Suite A-221, Houston, TX 77030.

© 2005 Lippincott Williams & Wilkins, Inc.