Acute low back pain: assessment and management

Abstract

Background: Back pain is a common presenting problem in Australian general practice. Serious causes, however, are rare. Tumours, infections and fractures account for less than 1% of cases and can usually can be recognised or excluded by taking a careful history. Patients should expect a good outcome.

Objective: This article summarises the management of acute low back pain and sets out the key points in history taking including alerting factors for serious disorders, and psychosocial factors that enable a rational management plan.

Discussion: A specific cause of pain need not be established for appropriate management to be instituted, with the active engagement of the patient as partner. Although no pattern of pain is diagnostic, a sudden onset of unremitting pain should be regarded as a 'red flag' to a serious underlying disorder. In accordance with evidence based principles, clinicians need to take into account previous experience, personal preferences, and cultural factors when recommending therapy for individual patients.