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“Oh, My Aching Back!” An Evidence-Based Review of One of Mankind’s Oldest Afflictions


A majority of adults suffer from at least one episode of low back pain (LBP), which is second only to upper respiratory infection as a reason to visit a physician. Most of these episodes are due to a variety of muscular and ligamentous strains and sprains, but in a minority of cases, LBP heralds a life threat or a spinal cord threat. Identifying the few serious conditions that lead to LBP among all the benign causes is a daunting task. The evaluation and treatment of LBP is also quite expensive. Total costs of low back pain in the United States exceed $100 billion per year, with two-thirds of these costs indirect, due to lost wages and reduced productivity. In order to effectively and efficiently evaluate LBP in the ambulatory care setting, a practitioner needs an organized approach to risk stratification, testing, and treatment. This article strives to present such an approach. By using history and physical examination to identify “red flags” for serious disease in patients with LBP and then utilizing testing and imaging selectively, both the patient and the practitioner will be well served. Evidence-based treatment of LBP is reviewed, and several well-entrenched myths regarding pharmaceutical and physical therapies for LBP are discussed.