Ep. 20 Lower Back Pain
In this podcast episode, Dan and Juz explore an at-a-glance, step-by-step approach to managing patients with lower back pain. They begin with busting some significant yet persistent myths when it comes to patient recovery, and continue the conversation by identifying key patient concerns, focusing on red flags and understanding their ability to cope. For pain that is manageable and under three months in duration, they dive into the conservative treatment pathway. As pain becomes more long-lasting, they delve into appropriate medications, diagnostic considerations, and potential additional investigations and while emphasizing regular reviews. If red flags are present or the patient isn’t coping well, more urgent or specialized referrals are suggested. The episode concludes with insights on differentiating between leg and back pain, offering targeted treatments based on the pain's location, whether it be hips, nerves, facets, discs, or sacroiliac joints. Listen to be able to better understand and advocate for your presentation as a patient, and more efficiently identify and treat as a physician.
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Episode Summary
Introduction
The episode focuses on Dr. Dan Bates' back and leg pain algorithm, aiming to provide primary care doctors with a structured approach to diagnosing and managing back pain. The hosts, Dr. Dan Bates and Justine Feitelson, discuss the inadequacy of the diagnosis "non-specific lower back pain" and aim to clarify misconceptions about back pain resolution.
Back and Leg Pain Algorithm
The algorithm is designed for quick reference by primary care physicians to decide on conservative management or referral for back pain.
It incorporates guidelines from the Faculty of Pain Medicine and New South Wales guidelines.
Conservative vs. Interventional Management
The algorithm is divided into conservative management and interventional management.
Key factors in deciding management approach include patient coping ability, presence of red flags, duration of pain, and severity.
Coping and Red Flags
Coping is assessed through a structured inquiry into the patient's well-being.
Red flags include history of malignancy, unexpected weight loss, infection symptoms, significant trauma, neurological symptoms, and inflammatory arthropathies.
Myth Busting: Back Pain Resolution
Contrary to common belief, only 20% of back pain resolves in six weeks; many patients experience ongoing pain.
Historical studies have propagated the myth that 90% of back pain resolves quickly, but recent analyses show persistent low-intensity pain in a significant number of cases.
Diagnosis of Lower Back Pain
It's possible to diagnose lower back pain by identifying specific causes such as facet joints, sacroiliac joints, hip issues, disc problems, and nerve compression.
Diagnostic blocks can help pinpoint the source of pain more accurately than traditional methods.
Conservative Management Strategies
Emphasizes self-management through education on positional challenges, mindfulness, and understanding contributing factors.
Encourages staying active and pacing activities to manage flare-ups effectively.
Involves goal setting to maintain motivation and progress in managing pain.
Pharmacological Interventions
While paracetamol is often used as a placebo due to its safety profile, anti-inflammatories are commonly prescribed despite potential side effects.
Lidocaine patches are suggested for acute pain relief due to their minimal downside.