Back pain: diagnostic and therapeutic algorithms in outpatient practice

Abstract

Back pain is a common reason for seeking primary care from older and younger people. Early spinal imaging by a therapist is indicated to eliminate potentially dangerous causes of pain. Independent magnetic resonance imaging or computed tomography examination at the patient’s initiative in the absence of “red flags” back pain in most cases does not come close to identifying the obvious cause of pain syndrome, and it creates the preconditions for the formation of an exaggerated picture of the disease in the patient himself, driving him into the “trap” of chronic pain. Attention of the polyclinic doctor to the clinical symptoms detailed in the article, following the standard algorithms of diagnosis will allow timely suspicion of “red flags” back pain, avoid hyperdiagnosis of the cause, and minimize the risk of its chronization. The algorithm for treatment of acute and chronic episodes of pain should include informing the patient about the favorable outcome in the vast majority of cases, optimizing the physical activity of the patient, the use of complex drug therapy, the basis of which are nonsteroidal anti-inflammatory drugs (predominantly selective), muscle relaxants and other pathogenetically based medicines.

Keywords

• back pain
• diagnostic algorithm
• “red flags”
• visualization
• x-ray imaging
• magnetic resonance imaging
• computed tomography
• osteoarthritis of the spine
• axial spondylitis
• nonsteroidal anti-inflammatory drug
• nimesulide
• naiz