1. Lower Back Pain John D. Peralta Family Medicine Resident PGY 3
Cook County-Loyola-Provident

2. Objectives Teach resident how to: 1. Classify lower back pain
2. Performed efficient interview and physical exam during initial evaluation
3. Narrow differential diagnosis based on clinical evaluation

3. Types of Lower Back Pain
Acute 0-4wks
Sub acute 4-12wks
Chronic >12 wks

4. History:

5. Task to be complete during HPI
Rule out possible potential serious life treating conditions
Rule out organic causes or referral back pain

6. Potential Serious Spinal Conditions
Possible etiology
History findings
Physical examination
CANCER
History of cancer, unexplained weight loss
Others ( pain at night, age <20 or >50)
Lymphadenopathy
Cauda Equina Syndrome
Bladder or bowel incontinence, urinary retention, progressive motor or sensory loss
Major motor weakness or sensory deficit, loss of anal sphincter tone, saddle anesthesia

7. Potential Serious Spinal Conditions
Possible etiology
History findings
Physical examination
FRACTURE
Significant trauma related to age, prolonged used steroids
Others age >70, h/o osteoporosis
Vertebral tenderness
INFECTION
Lumbar spine surgery during last year, IV drug used, immunosuppression
Fever, infected wound in spinal region

8. Screening for :
Anxiety
Depression
Panic disorders
Addiction

9. Pain Specifics: Quality: sharp, dull, shooting, burning, etc.
Location / Distribution:
Radicular: Dermatomal distribution
Radiating: Nondermatomal
Onset:
Gradual:
Acute: Disc abnormality, strain, compression fractures
Severity / Intensity
Frequency: Constant vs. Intermittent
Duration
Exacerbating and Alleviating Factors
Time of Day: If nocturnal, consider malignancy

10. Physical Exam:

11. Summary Pain can be classify in acute, sub-acute and chronic
Potentially Serious Spinal Conditions most be rule out during initial evaluation
At the end of our initial encounter we most differentiate the LBP in:
Serious Spinal Back pain
Sciatic Back pain
Nonspecific Back pain

12. Reference
Assessment and Management of Acute Low Back Pain. AAFP article
Chronic Lower Back Pain: Evaluation and Management. AAFP article
Diagnosis and Treatment of Low Back Pain; A joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society
Tarascon Sports Medicine 2010