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Low back pain
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www.healthprezi.com
Low Back Pain
azharia@mums.ac.ir
dr.aminazhari@gmail.com
Introduction
60-80% of people will have low back pain sometime in their lives
Leading cause of disability between ages of 19-45
Second most common cause of missed work days
Epidemiology
Cost
Americans spend at least $90 billion each year
on back pain
Each year Americans lose 93 million days of work,
at a cost of $11 billion. They spend another $5
to $24 billion in direct medical expenses.
Cost
Chronic Back Pain
When symptoms persist for several months (over 3 months) chronic back pain results
Clinical Issues
Clinical Issues
Etiologies
Non Spinal Causes
- Ovarian disease (cyst, cancer…)
- Kidney disease
- Bladder infection
- Pelvic infections
- Fibromyalgia
- Pancreatitis
- Prostate disease
- Gall bladder disease
- Abdominal Aortic Aneurysm
Spine Related Causes
- Diskopathies
- Sprain or strain
- Rheumatoid Arthritis
- Fractures
- Infections
- Spinal tumor
- Spinal canal stenosis
- Spondylolisthesis
- Spinal cord injury
- Facet Joint Syndrome
- Kyphosis
- Lordosis
Red Flags
Red Flags
Cauda Equina
Syndrome
- Bladder/Bowel Dysfunction
- Anaesthesia or Paresthesia in
perineal region or buttoks
- Sexual Dysfunction
- Significant lower limb weakness
- Gait disturbance
Spinal Fracture
- Significant trauma
- Prolonged glucocorticoid use
- Age>50Y
Spinal Fracture
Infection Or Cancer
- History of cancer
- Unexplained weight loss
- Immunosupression
- Injection drug use
- Nocturnal pain
- Age>50Y
- Fever
Treatment
Principles
1- Primary therapy related to etiology
2- Attention to patient expectation
3- Patient education related to pain treatment
4- Cost effectiveness
5- Prevention of back pain exacerbation
6- Prevention of unnecessary surgery & suffering
(Failed- Back-Surgery-Syndrome)
Conservative
- Modification of daily activities
- Analgesics
- Physical therapy
- Back exercise
- Manual medicine
- Acupuncture
- Local injections (epidural, facet joints ...)
- Otehrs ( Kinesiotape, O3 ...)
Surgery
- Evidence of neurological deficit
- cauda equina syndrome
- Spinal instability
- Unacceptable spinal deformity
- Pain: Failed conservative treatment
Surgery
Prevention
- Exercise
- Attention to correct ways of lifting, sitting, sleeping,...
- Maintain body weight
- Wear low-heeled shoes
- Avoid smoking which increase osteoporosis
- Eat a nutritous diet (Ca,P, Vit D...) may help prevent osteoporosis
- Manage the stress in life