The assessment and management of chronic lower back pain in General Practice.
Since I am planning to become a General Practitioner, I wanted to write about a relevant topic within general practice. Surveys done in a lot of countries shows, that 60-80 % of the population will experience lower back pain with or without radiation, many times during their lifetime(1). 2-3 percent has chronic back problems in Norway. Back problems make up 5 % of all GP consultations, and is the single most expensive non-lethal illness for the Norwegian welfare system. (2) In spite of these numbers, back pain problems have been poorly understood, and the assessment and management has not always been satisfactory. Still, in recent years many countries have made evidence based guidelines for management of acute back pain, this has yet to come for chronic lower back pain.
In the first part of the paper I decided to write about the natural anatomy of the lower back. Then it goes on to describe the different back illnesses in children and the adult. The assessment part outlines key points in history taking, clinical examination and further investigations. This is followed by a chapter describing red and yellow flags. The final chapter is a summary of the current evidence based management for chronic back pain.
Unfortunately there is still a lot of uncertainties concerning the low back patient. There are a lot of theories, especially among the patients with idiopatic lower back pain that lacks evidence. Yet, the development within the field is astonishing, and I do believe that the primary care of chronic lower back patients will improve much in the years to come.
Ref:1. Waddel G The back pain revolution,19982. Brage S og Lerum E.Rygglidelser i Norge en epidemilogisk beskrivelse. Tidskriftet 1999,119