Low back pain

      The primary care physician plays an important role in the initial evaluation and treatment of acute low back pain (ALBP). In the present managed care environment, it is doubtful that this role will decrease. According to one study, the primary care physician is the initial evaluator for ALBP approximately 65% of the time and frequently is the sole provider of care [
      • Praemer A
      • Furner S
      • Rice D
      Musculoskeletal conditions in the United States.
      ]. Given the limited time the primary care physician often has to evaluate a patient with ALBP in the present medical system, it is imperative that the physician have an appreciation for the salient points in the history, the essentials of the physical/neurologic examination, the diagnostic testing options, and the effectiveness of the various available treatments.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Primary Care: Clinics in Office Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Praemer A
        • Furner S
        • Rice D
        Musculoskeletal conditions in the United States.
        American Academy of Orthopedic Surgeons, Rosemont, IL1992 (23–33)
        • Hart L
        • Deyo R
        • Churkin D
        Physician office visits for low back pain.
        Spine. 1995; 20: 11-19
        • Levin K.H
        • Covington E.C
        • Devereaux M.W
        • et al.
        Neck and low back pain.
        Continuum (NY). 2001; 7: 1-205
        • Deyo R.A
        • Tsui-Wu Y.-J
        Descriptive epidemiology of low back pain and its related medical care in the United States.
        Spine. 1987; 12: 264-268
        • Anderson G
        The epidemiology of spinal disorders.
        in: Frymoyer J.W The adult spine: principles and practice. Raven Press, New York1991: 107-146
        • Frymoyer J
        • Cats-Baril W
        An overview of the incidence and costs of low back pain.
        Orthop Clin North Am. 1991; 22: 263-271
        • Deyo R.A
        • Cherkin D
        • Conrad D
        • Volinn E
        Cost, controversy, crisis: low back pain and the health of the public.
        Annu Rev Public Health. 1992; 12: 141-155
        • Devereaux M.W
        Approach to neck and low back disorders.
        in: Evans R.W Saunders Manual of Neurologic Practice. Elsevier, Philadelphia2003: 745-751
        • Groen G
        • Baljet B
        • Drukker J
        Nerves and nerve plexuses of the human vertebral column.
        Am J Anat. 1990; 188: 282-296
        • Korkala O
        • Gronblad M
        • Liesi P
        • Karaharju E
        Immunohistochemical demonstration of nociceptors in the ligamentous structures of the lumbar spine.
        Spine. 1985; 10: 156-157
        • McCarthy P.W
        Innervation of lumbar intervertebral disks—a review.
        J Peripheral Nerv Syst. 1998; 3: 233-242
        • Johnson E
        The myth of skeletal muscle spasm.
        Am J Phys Med Rehabil. 1989; 6: 1
        • Dulaney E
        Radiculopathy and cauda equina syndrome.
        in: Evans R.W Saunders manual of neurologic practice. Elsevier, Philadelphia2003: 757-763
        • Boden S.D
        • Davis D.O
        • Dina T.S
        • et al.
        Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation.
        J Bone Joint Surg Am. 1990; 72: 403-408
        • Jensen M
        • Brant-Zawadzki M
        • Obuchowski N
        • et al.
        Magnetic resonance imaging of the lumbar spine in people without back pain.
        N Engl J Med. 1994; 331: 69-73
      1. Riggs BL, Melton IJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:S505–11.

        • Ledlie J.T
        • Renfro M
        Balloon kyloplasty: one year outcomes in vertebral body height restoration, chronic pain, and activity levels.
        J Neurosurg (Spine 1). 2003; 98: 36-42
        • Matsunoga S
        • Sako T
        • Morizono Y
        • et al.
        Natural history degenerative spondylolisthesis: pathogenesis and natural course of the slippage.
        Spine. 1990; 15: 1204-1210
        • Surez-Almazor M.E
        • Belseck E
        • Russell A.S
        • Mackel J.V
        Use of lumbar radiographs for the early diagnosis of low back pain: proposed guidelines would increase utilization.
        JAMA. 1997; 277: 1782-1786
        • Deyo R.A
        • Weinstein J.A
        Low back pain.
        N Engl J Med. 2001; 344: 363-370
        • Malmivarra A
        • Hakkinen U
        • Aro T
        • et al.
        The treatment of acute low back pain: bed rest, exercises, or ordinary activity?.
        N Engl J Med. 1995; 332: 351-355
        • Fager C.A
        Observations on spontaneous recovery from intervertebral disc herniation.
        Surg Neurol. 1994; 42: 282-286
        • Bigos S
        • Bowyer O
        • Braen G
        • et al.
        Acute low back problems in adults. Clinical Practice Guideline No. 14.
        (AHCPR Publication No. 95–0642) Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville, MD1994
        • Deyo R.A
        • Diehl A.K
        • Rosenthal M
        How many days of acute bed rest for acute low back pain? A randomized clinical trial.
        N Engl J Med. 1986; 315: 1064-1070
        • Cherkin D.C
        • Deyo R.A
        • Battie M
        • et al.
        A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.
        N Engl J Med. 1998; 339: 1021-1029
        • Beurskens A.J
        • de Vet H.C
        • Koke A.J
        • et al.
        Efficacy of traction for non specific low back pain: 12-week and 6-month results of a randomized clinical trial.
        Spine. 1997; 22: 2756-2762
        • van Tulder M.W
        • Waddell G
        Conservative treatment of acute and subacute low back pain.
        in: Nachemson A.L Jonsson E Neck and back pain the scientific evidence of causes, diagnosis and treatment. Lippincott Williams & Wilkins, Philadelphia2000: 241-269
        • Carette S
        • Leclaire R
        • Marcoux S
        • et al.
        Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.
        N Engl J Med. 1997; 336: 1634-1640
        • Deyo R.A
        • Walsh N.E
        • Martin D.C
        • et al.
        A controlled trial of transcutaneous electrical nerve stimulators (TENS) and exercise for chronic low back pain.
        N Engl J Med. 1990; 322: 1627-1634
        • Rabinstein A.A
        • Shulman L.M
        Acupuncture in clinical neurology.
        Neurologist. 2003; 9: 137-148
        • Shekelle P.G
        • Adams A.H
        • Chassin M.R
        • et al.
        Spinal manipulation for low-back pain.
        Ann Intern Med. 1992; 117970: 590-598
        • Cherkin D.C
        • Deyo R.A
        • Battie M
        • et al.
        A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.
        N Engl J Med. 1998; 339: 1021-1029
        • Assendelft W.J
        • Morton S.C
        • Yu Ei
        • et al.
        Spinal manipulative therapy for low back pain.
        Ann Intern Med. 2003; 138: 871-881