Chronic Low Back Pain

Question 1

What constitutes chronic low back pain?

Answer 1

> 90 days (or 3 months)

Age 30-60

Symptoms are recurrent and episodic

Question 2

What are the s/s of chronic low back pain?

Answer 2

Hallmark: LBP radiating to 1 or both buttocks

• Mechanical pain
• Worse with movement- bending, lifting, stooping, twisting
• Stiffness
• Intermittent pain down back of leg
• Pain relief with lying down

Question 3

What is observed in physical exam of chronic low back pain?

Answer 3

• TTP lumbar and/or SI joint
• Side or forward list due to muscle spasm
• Normal motor and sensory exam
• Decreased ROM
• Positive SLR

Question 4

What imaging is used in chronic low back pain?

Answer 4

Plain films

• Look for degenerative changes
• Loss of joint space

MRI
- Evaluate for structural changes

Question 5

What is the treatment of chronic low back pain?

Answer 5

• Narcotic abuse is huge problem for this group
• Patient education is key
• Comprehensive pain management program

Question 6

What is included in comprehensive pain management program?

Answer 6

Psychological testing
Injections
Biofeedback
Cognitive/behavior conditioning programs
Spinal cord stimulation
Psychotherapy 
Detoxification programs