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Low Back Pain (Lbp)

  1. Classification (based on duration)
    1. Acute <4 weeks
    2. Subacute 4-8 weeks
    3. Chronic >8 weeks
  2. Management (Most of the patients can be treated conservatively)
    1. Proven Efficacy
      1. Analgesic (NSAIDs) and muscle relaxants are used to manage acute & subacute exacerbation of chronic LBP
      2. Exercise programs or work hardening regimens can reverse atrophy in paraspirial muscles and strengthen extensor of trunks In patients who fail conservative treatment as a mean of avoiding surgery
      3. Epidural injection
      4. Facet joint injection
    2. Unproven Benefit
      1. Trigger point sclerosant
      2. Facet joint/ligamentous injection
      3. Acupuncture
      4. Traction
      5. Manipulation
      6. TENS
      7. Hydrotherapy

Avoided/ Harmful


Prolonged bed rest is avoided as graded return to normal activities is more effectiveQ.

Red flags in back pain:


Features, signs and symptoms in a patient with back pain which indicate serious spinal pathology


  • Previous history malignancy (however long ago)
  • Age 16< or >50 with NEW onset pain
  • Weight loss (unexplained)
  • Previous longstanding steroid use
  • Recent serious illness
  • Recent significant infection

In contrast yellow flag signs are condition usually associated with psychosocial factors or depression, doesn’t warrant follow up with advance imaging/investigations.

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