Acute Lower Back Problems in Adults - Summary

Executive Summary

Acute low back problems, the subject of this Clinical Practice Guideline, are experienced by almost everyone at some time in their adult lives. Back problems rank high among the reasons for physician office visits and are costly in terms of medical treatment, time lost from work, and nonmonetary costs such as diminished ability to perform or enjoy usual activities. For persons under age 45, low back problems are the most frequent cause of disability.

The Agency for Health Care Policy and Research (AHCPR) convened a 23–member, multidisciplinary, private–sector panel to develop a guideline for the evaluation and treatment of acute low back problems in adults. The panel included physicians, nurses, chiropractors, experts in spine research, physical therapists, a psychologist, an occupational therapist, and a consumer representative. The panel defined back problems as activity intolerance due to back–related symptoms and acute as limitations of less than 3 months' duration. Back symptoms include pain, primarily in the back, as well as back–related leg pain (sciatica). The panel agreed that the guideline should provide primary care clinicians with information on the detection of serious spinal pathology (such as tumor or infection, spinal fracture or cauda equina syndrome) as well as nonspinal pathology that could be causing limitations due to low back symptoms, but that treatment of these conditions is outside the scope of the guideline.

Furthermore, the panel agreed that the assessment and treatment of patients younger than 18 years or those with chronic low back problems (back–related limitations lasting longer than 3 months) may be quite different than for adults with acute problems. For this reason, the panel decided that back problems in children as well as chronic low back problems are also outside the scope of the guideline.

The panel's overall intent was to change the paradigm of focusing care exclusively on the pain of low back problems to one of helping patients improve their activity tolerance. Findings and recommendation statements are based on an exhaustive and systematic review and analysis of the scientific literature as well as information gathered from the clinical experience of the expert panel, public testimony, peer review, and pretesting in outpatient settings. This guideline is divided into an introduction and three chapters to correlate with the clinical approach:

• (1) Initial Assessment Methods
• (2) Clinical Care Methods
• (3) Special Studies and Diagnostic Considerations.

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public Health
Service, U.S. Department of Health and Human Services. December 1994.