I agree with all red flags discussed by Aimee and would like to add that any history of trauma could help determine whether the patient has a strain or a sprain or a more severe condition. Urinary incontinence can be present relatively often in patients with lower back pain, especially if it is chronic. For example, Bush et al. (2013) notice that “women who report CBP have an increased odds of having SUI” (p. 11). This information is helpful to clinicians because they can use it when they plan and prescribe treatment to patients with lower back pain. Both cancer history and unexplained weight loss coupled with lower back pain can be signs of malignancy or cancer recidivism. In this case, it is important to educate the patient about the need for a cancer screening, performed as soon as possible.
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Local application of cold or hot packs is a good option because research demonstrates that patients with acute or subacute low back pain improve in time, and the type of treatment rarely has any specific effect on it. Thus, researchers recommend using nonpharmacologic interventions and heat packs or a pharmacologic intervention that includes the use of nonsteroidal anti-inflammatory drugs or muscle relaxants (Qaseem, Wilt, McLean, & Forciea, 2017). Although paracetamol is sometimes recommended to treat lower back pain, there is evidence that it is ineffective (Machado et al., 2015). Thus, in order to help the patient, evidence-based recommendations should be used. Complementary therapies such as massage and acupuncture are also sometimes used, but their effectiveness needs to be proven by well-organized randomized controlled trials. Daily stretching exercises and relaxation techniques are good alternatives to complementary therapies.
Response to Maria
I would like to thank Maria for mentioning that patient’s psychological history and satisfaction or dissatisfaction with work can also play a significant role in the development of lower back pain. Research indicates that depression is related to the occurrence of lower back pain in patients; if depression is severe, the chance that the patient will experience lower back pain also increases (Pinheiro et al., 2015). Thus, if the cause of lower back pain was not found, patient’s psychological well-being and recent stresses should be considered. However, there are study findings that show that the level of perceived support from coworkers is not a risk factor for back pain (Campbell, Wynne-Jones, Muller, & Dunn, 2013). Nevertheless, the overall support coming from colleagues can increase patient’s satisfaction with the place of employment, decreasing experienced stress. An important role here would play safety regulations and patient’s ability to take sick leave. If there are problems with both factors, further incidents of lower back pain are also possible.
Patient education is an integral part of lower back pain prevention. I agree that exercise and frequent rest periods can be of use to this patient. Furthermore, there is also evidence that exercise combined with education can reduce the risk of lower back pain (Steffens et al., 2016). Exercise alone can be useful in preventing an episode of lower back pain, but it is not as effective in preventing the development of this condition once again. One should also remember that education alone or back belts and other ergonomic adjustments are not effective in preventing the risk of the condition (Steffens et al., 2016). Thus, the patient should be aware of how exactly exercise and education can help him avoid further aggravation of his condition.
Campbell, P., Wynne-Jones, G., Muller, S., & Dunn, K. M. (2013). The influence of employment social support for risk and prognosis in nonspecific back pain: A systematic review and critical synthesis. International Archives of Occupational and Environmental Health, 86(2), 119-137.
Pinheiro, M. B., Ferreira, M. L., Refshauge, K., Ordoñana, J. R., Machado, G. C., Prado, L. R.,… Ferreira, P. H. (2015). Symptoms of depression and risk of new episodes of low back pain: A systematic review and meta‐analysis. Arthritis Care & Research, 67(11), 1591-1603.
Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M.,… Hancock, M. J. (2016). Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine, 176(2), 199-208.
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Bush, H. M., Pagorek, S., Kuperstein, J., Guo, J., Ballert, K. N., & Crofford, L. J. (2013). The association of chronic back pain and stress urinary incontinence: A cross-sectional study. Journal of Women’s Health Physical Therapy, 37(1), 11-18.
Machado, G. C., Maher, C. G., Ferreira, P. H., Pinheiro, M. B., Lin, C. W. C., Day, R. O.,… Ferreira, M. L. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: Systematic review and meta-analysis of randomised placebo controlled trials. BMJ, 350, 1225-1242.
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530.