Acute Lower Back Pain and Primary Care Providers

Patients who visit primary care physicians with symptoms of acute lower back pain are not likely to have a serious underlying disease, according to new research that confirms what is understood about such short-term pain and also reveals the danger of sometimes placing too much emphasis on isolated warning signs.

As detailed in the October issue of Arthritis & Rheumatism, an Australian study involved 170 primary care physicians, physiotherapists and doctors of chiropractic initially screening roughly 1200 patients with acute back pain for “red flags” that were possibly indicative of an underlying pathology.

Red flags included 25 questions incorporating age, gender, weight, significant trauma and other factors, while pathologies referred to vertebral fracture, infection, arthritis and cancer. Acute lower back pain was not defined, although this type of back pain is described on Spine-health as lasting less than 3 to 6 months and typically being related to soft tissue damage that heals quickly.

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The patients were monitored for approximately one year after the initial consultation to determine if any of these pathologies was actually at the root of the acute pain. According to the study:

  • Only 11 of the 1,172 patients (less than 1 percent) were believed to have a serious pathology, thus indicating the rare likelihood of a pathology being present with acute back pain in the lumbar spine (lower back)
  • 8 of those 11 patients were suspected to have a vertebral fracture, with these cases sharing several red flags, including patients being females over the age of 70 with significant trauma and prolonged corticosteroid use
  • 5 of the 11 pathologies were correctly identified during the initial consultation
  • 6 of the diagnosed pathologies were false-positive (in other words, the clinician initially believed that a pathology was present when it in fact was not, as determined at the 12-month follow up)
  • Approximately 80% of all patients had at least one red flag.

These last two points reveal how red flags, especially when used individually, can lead to inaccurate diagnoses, and ultimately confirm the preference for multiple red flags to be present in those rare instances when a pathology is believed to be the source of acute lower back pain, which is usually related to minor muscle sprains or strains.

When considering that patients with acute back pain are likely to see a primary care provider first about their symptoms, this idea is especially important to these practitioners in the course of determining future treatment.

Sources: Arthritis & Rheumatism; Medical News Today

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