With back pain being the #2 most common symptom reported in a primary care setting, you are bound to run into it at some point. If you feel unsure of yourself when treating low back pain, here are my Top Do’s and Don’ts of Low Back Pain.
Please keep in mind this is not a comprehensive list, and you should still utilize your clinical judgment when treating your own patients!
Do Not | Do |
Send the patient directly to a surgeon in the absence of any focal neurologic deficit | Perform a thorough H&P and determine need for pain relief and send to a well trained physical therapist |
Tell patient what pathology they have without explanation | Explain pathology, and that although it can cause pain, it is not an “abnormal” finding (Read more about this topic here) |
Show fear | Patients feed on our emotion around diagnosis, if you are unsure of your clinical assessment and exam – send to a non-surgical spine specialist for further work up |
Skip the physical exam | I would rather you not image the patient and rely on a good H&P – so much so, I had to put this in twice!! |
Forget about other diagnoses | Having abnormal imaging on the lumbar spine or having “low back pain” is not an excuse to not treat their hip, HTN, cough, etc. |
Rely on opioids | There are better medicines to rely on for pain relief – start with your first line anti-inflammatories and maximum acetaminophen dose. Consider steroids, muscle relaxants and anti-neuropathic medications if OTC medications are ineffective *Only use opioids if the above are contraindicated |
Fail to address patient’s anxiety and depression | Back pain is scary -- especially when it is new to the patient. Many patients have a bad association with what back pain means (the friend's brother's uncle who had terrible back pain and 5+ surgeries because of it). YOU SET THE STAGE for how the patient will associate with a back pain diagnosis. It is as much mental as it is physical! |
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