Name: Diagnosing Low Back Pain
Uploaded: 2017-02-11T03:35:48.000Z
Duration: 9 min 57 s
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Dr. Stiles: Hello. My name is Dr. Melissa

Stiles. I'm with the UW Department of Family

Medicine, and I'm joined today by Dr. Jeff Patterson,

Professor of Family Medicine, and today we're going to

be talking about low back pain and focusing on

Dr. Patterson: Thank you. It's great to be

complaints to the primary care office is low back

Dr. Patterson: Well, you're right, it is,

and of course, there are two areas. One is acute low

back pain, which is not so bad when you see it on your

schedule and the other is chronic low back pain which

gives you a pain in the back when you see it on your

schedule. And so we can talk about both of those

issues. The second one probably is the more difficult

to deal with, actually. The first thing is, seeing an

acute low back pain, I think one needs to be careful

to rule out any bad things that might be there, and

that's done pretty quickly with your history and

physical. And I would say that the history and

physical in both acute and chronic low back pain are

probably the most important features of diagnosing and

treating a low back problem. With the acute low back

pain, I think the things that we want to make sure are

not there are any neurological problems that might

indicate a herniated disc, might indicate cauda equina

syndrome or advanced cancer or something like that,

and again, that can be done fairly quickly in your

examination. And once you've done that, infection

probably would be the other issue that, again, history

would give you an indication about. Once you've done

that, then you really have time and can you buy time

in terms of your treatment and working with the

patient to get them through this acute episode of

their low back pain. The chronic low back pain is

another story, and generally, those people have been

through all kinds of treatment and diagnostic things,

consideration in the differential diagnosis which is

common things coming from the most common, just strain

and sprain, and again what those mean is an

interesting question. The person leans over or

they've done some activity and their back tightens up

and they can't straighten up, can't move, and so

that's probably again the most common thing that

happens. If we look beyond that, obviously we need to

worry about herniated discs and the nerve compromise

that might occur with that. We need to worry about

cancer, metastatic cancer, and certainly if there is a

history of cancer, one needs to have a heightened

awareness of that. Infection would be another thing

that is really pretty rare in the spine area unless

there's been some intervention that's been done maybe

somewhere else in the body but certainly can occur

that way. Then arthritis and typically osteoarthritis

is probably the most common, degenerative arthritis,

which is similar to that, and things like

spondylolisthesis and spondylolysis, but now we move

into the area in what really causes the pain, the back

pain. And again, with acute problems, the most common

thing is just going to be, quote, lumbar strain and

Dr. Stiles: You touched on some of what I

term, the red flags, things that you need to really

ask in the history, can you expand on that?

history finding out how this started and what

happened. If you have a history of a lifting injury,

trauma, mild trauma of some sort, then I think you can

be fairly reassured that you may not need an urgent

MRI or X rays. If there has been more acute trauma

than that then certainly we want to think about

getting X rays, think being a fracture, compression

fracture, or other type of injury like that.

Obviously, signs of infection, talking about fever,

chills, and probably recent infection elsewhere in the

body because certainly I've seen infections spread

into the spinal column where the abscesses that form

there secondary to infections elsewhere, but that's

not real common. And then in the history asking about

neurological symptoms, do you have weakness, numbness,

tingling, but realizing that weakness, numbness and

tingling can all occur just from the sprain and

strain, and the weakness most frequently is what I

call just pain weakness. It hurts and so I can't do

these things, and it's hard for patients to

differentiate is this true weakness versus is this

pain weakness. But I think those, and then any

history of cancer, of course, would heighten my

suspicion that I might need to get a scan sooner

rather than later here, thinking of metastatic

disease. But most of the time, with the history, and

sort of the nature of the pain, you can get a pretty