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back pain
INTRODUCTION
Back pain a common problem and a
leading reason for all physician visits.
Most cases are attributed to
musculoligamentous injury or skeletal
degenerative changes.
although the differential diagnosis is
broad.
PROGNOSIS
The prognosis for acute low back
pain is excellent.
Only about a third of patients with
back pain seek medical care, so most
apparently improve on their own.
PHARMACOTHERAPY
Nonsteroidal antiinflammatory drugs
- Global symptomatic improvement
after one week was greater for patients
treated with NSAIDs compared to
placebo
- There was moderate evidence that
NSAIDs were not significantly more
effective than acetaminophenfor
symptom relief of acute low back pain.
Acetaminophen
a reasonable option for most patients
with acute low back pain
with perhaps less efficacy than NSAIDs
risk of hepatotoxicity with higher doses
dosing of 4 g per 24 hours
patients with a history of heavy alcohol
acetaminophen dose to 2 g per day or
less.
Opioids
widely acknowledged to be among the
therapeutic options for low back pain,
Most recent studies focus on chronic
back pain
Adverse effects of opiates include
sedation, confusion, nausea, and
constipation
Glucocorticoids
A subsequent trial found only transient
pain reduction with bolus intravenous
methylprednisolonefor patients with
radicular findings
adverse effects, particularly insomnia,
mood lability, and poor glycemic control
in those with diabetes.
Other medications
Several other medications, including
gabapentinand other anticonvulsants,
tricyclic antidepressants, and
lidocainepatches, have been used in
the setting of chronic back pain.
Spinal manipulation
Manipulative therapy
Massage and yoga
Acupuncture
Cold and heat
OTHER NON-DRUG
TREATMENTS
Traction, corsets and braces
Mattress recommendations
Patient education
PREVENTION
Ergonomic design of strenuous job
tasks in the workplace is an
intuitively attractive preventive
measure.
THANKS