Persistent Low Back Pain

• Published in: The New England journal of medicine Vol. 352; no. 18; pp. 1891 - 1898
• Main Author: Carragee, Eugene J
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 05.05.2005
• Subjects: Back pain; Biological and medical sciences; Diseases of the osteoarticular system; Diseases of the spine; Ergonomics; General aspects; Infections; Medical sciences; NMR; Nuclear magnetic resonance; Risk factors; Medicine; Pain; Lumbar spine; Low back pain; Diseases of the osteoarticular system; Rachialgia; Spine disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMcp042054

A 49-year-old maintenance worker with a history of depression and previous reports of minor back pain is seen during four months of continuing low back pain. He has remained out of work for fear of worsening the injury. Magnetic resonance imaging two weeks after the onset of pain showed only mild degenerative changes in the lumbar region without spinal stenosis or disk collapse or extrusion. How should this patient be evaluated and treated? A 49-year-old maintenance worker with a history of depression is seen during four months of continuing low back pain. Magnetic resonance imaging showed only mild degenerative changes in the lumbar region. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage A 49-year-old maintenance worker with a history of depression and previous reports of minor back pain is seen after four months of continuing low back pain. He has remained out of work for fear of worsening the injury. Magnetic resonance imaging (MRI) two weeks after the onset of pain showed only mild degenerative changes in the lumbar region without spinal stenosis or disk collapse or extrusion. How should this patient be evaluated and treated? The Clinical Problem Low back pain without sciatica, stenosis, or severe spinal deformity is common, with a reported point prevalence as high as 33 percent . . .