Acute Lower Back Problems in Adults - Summary of Findings

Summary of Findings

Positive answers to key medical history questions, in addition to positive findings on physical examination and/or simple lab tests, are red flags that suggest the possibility of a serious underlying condition as the cause of acute low back problems.

For cancer or infection, red flags are: history of cancer, unexplained weight loss, immunosuppression, urinary infection, intravenous drug use, prolonged use of corticosteroids, back pain not improved with rest, and age of patient over 50.

For spinal fracture, red flags are: history of significant trauma (for example, a fall from a height, motor vehicle accident, or direct blow to the back for a young adult, or a minor fall or heavy lift in a potentially osteoporotic or elderly individual), prolonged use of steroids, and age over 70.

For cauda equina syndrome or severe neurologic compromise, red flags are: medical history or physical examination findings of acute onset of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, saddle anesthesia (about the anus, perineum, and genitals), and global or progressive motor weakness in the lower limbs.

There are indications in the literature that psychological or socioeconomic factors may affect a patient's report of symptoms and response to treatment.

Simple laboratory tests, including complete blood count (CBC) and erythrocyte sedimentation rate (ESR), are sufficiently inexpensive and efficacious for use as initial tests when there is suspicion of back–related tumor or infection.

3. Clinical Care Methods

In the absence of red flags, treatment is similar for most patients with activity intolerance due to an acute episode of low back symptoms. After assuring the patient that there is no hint of a dangerous problem and that a rapid recovery is expected, the goals are to provide accurate patient information about low back problems, to help provide comfort by means of symptom control methods, and to recommend activity modifications.

Patient Information
Patient Education About Low Back Symptoms

Panel findings and recommendations:

Patients with acute low back problems should be given accurate information about the following (Strength of Evidence = B):

• Expectations for both rapid recovery and recurrence of symptoms based on natural history of low back symptoms.
• Safe and effective methods of symptom control.
• Safe and reasonable activity modifications.
• Best means of limiting recurrent low back problems.
• The lack of need for special investigations unless red flags are present.
• Effectiveness and risks of commonly available diagnostic and further treatment measures to be considered should symptoms persist.

Patient education as defined here includes all forms of patient–oriented education about low back problems except for "back schools" (formally structured, classroom–style back education programs). Under this definition, patient education includes printed and audiovisual materials, information given by health care providers, and educational programs that are less formal than back schools.

Literature Reviewed.

Of 14 articles screened for this topic, 2 met the criteria for review. [67] <http://text.nlm.nih.gov>, [68] <http://text.nlm.nih.gov> Other articles contained information used by the panel, but did not meet article selection criteria. [69] <http://text.nlm.nih.gov>– [71] <http://text.nlm.nih.gov>
Neither of the studies meeting the criteria focused solely on patients with acute low back problems. Both evaluated patients with low back problems of unspecified duration. Interventions evaluated included giving patients booklets on back pain [68] <http://text.nlm.nih.gov> and holding a brief individual educational session during an emergency room visit or by phone after the visit. [67] <http://text.nlm.nih.gov>


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.