Low Back Pain Prevalence, Cost, & Duration

You are working with Dr. Lee today. She hands you a triage note from the nurse regarding your next patient, Mr. Payne:

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

Dr. Lee provides you some background information about low back pain.

TEACHING POINT

Low Back Pain Prevalence, Cost, & Duration

Low back pain (LBP) is the fifth most common reason for all doctor visits. In the U.S., lifetime prevalence of LBP is 60% to 80%. The direct and indirect costs for treatment of LBP are estimated to be $100 billion annually. Fortunately, most LBP resolves in two to four weeks.

Dr. Lee continues: “There are many causes for LBP. For presenting symptoms that have a broad differential diagnosis, I find it helpful to think of systems of etiologies in which diseases or conditions can be categorized.”

TEACHING POINT

Common Causes of Back Pain

Musculoskeletal (MSK) and Non-MSK Causes of Back Pain

MSK Causes

Axial:

  • Degenerative disc disease
  • Facet arthritis
  • Sacroiliitis
  • Ankylosing spondylitis
  • Discitis
  • Paraspinal muscular issues
  • SI dysfunction

Radicular:

  • Disc prolapse
  • Spinal stenosis

Trauma:

  • Lumbar strain
  • Compression fracture

Non-MSK Causes

Neoplastic:

  • Lymphoma/leukemia
  • Metastatic disease
  • Multiple myeloma
  • Osteosarcoma

Inflammatory:

  • Rheumatoid Arthritis

Visceral:

  • Endometriosis
  • Prostatitis
  • Renal lithiasis

Infection:

  • Discitis
  • Herpes zoster
  • Osteomyelitis
  • Pyelonephritis
  • Spinal or epidural abscess

Vascular:

  • Aortic aneurysm

Endocrine:

  • Hyperparathyroidism
  • Osteomalacia
  • Osteoporosis
  • Paget disease

Dr. Lee suggests, “Now, let’s look a bit more at the risk factors for mechanical low back pain that you can review with Mr. Payne during your history.”

Dr. Lee continues, “The major task in treating back pain is to Now that you have a diagnosis of disc herniation with radiculopathy for Mr. Payne, let’s discuss what would you like to do for him distinguish the common causes for back pain (95% of cases) from the 5% with serious underlying diseases or neurologic impairments that are potentially treatable.”

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