The American College of Physicians (ACP) and the American Pain Society (APS) today released joint guidelines on diagnosing and treating low back pain.
About one in four Americans reported having low back pain in the past three months and about l7.6 percent of all adults reported at least one episode of severe acute low back pain within the previous year, according to several studies. Other studies show that most people's low back pain will improve within one month, regardless of treatment. Treatments range from doing nothing to spinal surgery.
In 2006, ACP and APS convened a multidisciplinary panel of experts to develop questions and the scope of an evidence report on low back pain, to review its results and come up with recommendations for primary care physicians to diagnose and treat low back pain.
The recommendations, published in the Oct. 2, 2007, issue of Annals of Internal Medicine, include an algorithm to guide clinicians in obtaining and interpreting information during the first patient visit and place patients into one of three general categories:
- Nonspecific low back pain (85% of patients fall in this category) - Back pain potentially associated with spinal conditions, such as spinal stenosis, sciatica, vertebral compression fracture - Back pain potentially associated with another specific cause, such as cancer.
The recommendations say that clinicians should not routinely order imaging or other diagnostic tests such as X-rays, CAT scans, and MRIs, for patients with nonspecific low back pain. They should reserve these tests for patients who have severe or progressive neurologic deficits or suspected underlying conditions, such as cancer or infection.
The joint ACP-APS guidelines are designed for primary care physicians and other clinicians and do not address invasive therapies performed by specialists. The American Pain Society will publish a separate guideline covering invasive procedures for low back pain in 2008.