User:Saltrabook/Clinical diagnostic guidelines/Ocupational musculoskeletal diseases/Low back pain

Low back pain

A herniated disc as seen on MRI, one possible cause of low back pain.

Low back pain or lumbago is a common musculoskeletal disorder disorder involving the muscles and bones of the back. It affects about 40% of people at some point in their lives. Low back pain (often abbreviated as LBP) may be classified by Pain duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.

Wikipedia Low Back Pain

Definition

Pain, muscle tension or stiffness with no recognized underlying pathology located in the area between the lower ribs and the lower limit glutealfold with or without radiation to the lower limbs (1, 2).

Diagnostic criteria

The diagnosis is based on the combination of pain localisation and exclusion of pathology in the form of root compressions, infection, malignancy, fracture or inflamatorisk joint disorder (3).

Incidence / prevalence

More than 70% will in their lifetime experience at least one episode of low back pain, and between 15 and 45% have had an episode in the past year. In 2-7% to the cases stretching painful process for more than 3 months (4).

Work-related etiology

By systematic review of 28 gradient and 3 case-control studies found good evidence that "manual lifting" (relative risk estimates (RR) based on the three best studies between 1.5 and 3.1), work in bent / twisted positions (RR lit only in a case-control study to 8.1) and exposure to whole-body vibration (RR 4.8 based on two case-control studies) increases the risk of low back pain. The definition of "manual lifting" is often based on qualitative self-reported information. There is no information on threshold or dose-response relationships. 3 studies of poor quality found that the person handling was related (RR of 1.7 to 2.7). There was no evidence that sitting or standing work is risk, while the evidence concerning. physical activity at work was assessed as inkonklusiv.5 For psychosocial working conditions are based on prospective studies found evidence to suggest that there is no positive association between "perception of work" or social support while the importance of components in work organization are insufficiently clarified. ( 6, 7). Other aetiology Earlier pain episodes. Smoking, obesity and extreme sports are reported to be risk factors with RR up to about 1.5 (8).

Individual vulnerability

No known Exposure The stark contrast between the sparse epidemiological evidence on the one hand and the right exact recognition criteria for low back pain on the other. It is thus largely industrial system needed exposure documentation to be accommodated. Information is collected in order to estimate the average daily lifting load ("tons / day"), number of years with this load, posture, lifting distances, row spacing, etc. Average daily exposures to vibration (time-weighted acceleration level) can be based on knowledge of estimated levels various vehicles is calculated by the HSE's vibration exposure Arbetslivsinstitutets calculator or calculator.

Clinical evaluation includes:

1. The need for further diagnostics on suspicion of specific disease: In 10-15% of patients with back pain in general practice can establish a specific diagnosis to explain the pain. The following indicative approach can be used for this purpose (9):
3. Psychosocial risk factors for prolonged course and social consequences (10): the patient's perception of low back pain has expressed serious and potentially crippled disease, expulsion of avoidance behavior in relation to the activities that the patient (erroneously) have been given the impression can be harmful, sadness and tendency to social isolation and expectation of passive treatments and rest rather than active own efforts is the way forward. There may be questions into what the patient perceives as the cause of pain, which studies, treatment and advice received in care, previous sick leave due. Pain, patient's assessment of its opportunities and barriers to return to work, including options for support from workplace and colleagues.

Diagnosis Codes

M54.4 Lumbago with sciatica M54.5 Lower Back Pain

Prognosis

90% of patients with low back pain experience significant improvement within 1-2 weeks. About 70% of sick leave with low back pain are back to work within a week and 90% within 2 months while less than 50% of sick leave over 6 months get a job (11). The following interventions are evaluated by having beneficial/probable beneficial effect on one or more of the parameters: pain, function, absenteeism, coping and pain behavior or depression symptoms of back pain: pain killers, antidepressants, multi-disciplinary interventions, back school, behavioral therapy, physical training and manipulations, while blockade / local steroid in the facet joints and traction considered ineffective / harmful. The effect of other treatments are considered unknown (12, 13).

Counseling

Reassure the patient it is usually good progress and to stay as active as possible. Tell regular and increased physical exercise. Where there is a workplace attachment focus on business-oriented effort remaining in the usual work if necessary. supported by modifications of symptomforværrende activities in work (10).

References

  1. van Tulder M, Koes B. Low back pain (chronic). Clin Evid. 2004; 1659-1684.
  2. van Tulder M, Koes B. Low back pain (acute). Clin Evid. 2004; from 1643 to 1658.
  3. Dudler J, Balague F. What is the rational diagnostic approach two spinal disorders? Best Pract Res Clin Rheumatol. 2002; 16: 43-57.
  4. Anderson G. The epidemiology of spinal disorders. In: Frymoyer J, ed. The adult spine: Principles and Practice. New York: Raven Press; 1997: 93-141.
  5. Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health. 1999; 25: 387-403.
  6. Hartvigsen J, Ling S, Leboeuf-Yde C, Bakketeig L. Psychosocial factors at work forhold low back pain and konsekvensene of low back pain; systematisk, critical review of prospective cohort studies. Occup Environ Med. 2004; 61: e2.
  7. Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine. 2000; 25: 2114-2125.
  8. Dempsey PG, BURDORF A, Webster BS. The influence of personal variables on work-related low-back disorders and implications for future research. J Occup Environ Med. 1997; 39: 748-759.
  9. Carter J, Birrell L. Occupational health guidelines for the management of low back pain at work - principal rekommendationer. Occupational health guidelines for the management of low back pain at work. Evidence review and recommendation. London: Faculty of Occupational Medicine; 2000: 5-21.
 10. Waddell G. The clinical course of low back pain. The back pain revolution. Edinburgh: Churchill Livingstone; 1998: 103-117.

Author: Lone Donbæk Jensen, Poul Frost, Aarhus, revised February 2007 Rapporteur: Kurt Rasmussen