Low Back Pain
Posted by dkwinter
Mechanical low back pain
Lumbar strain
Degenerative disease
  • Discs (spondylosis)
  • Facet joints
Herniated disc
Spinal stenosis
Congenital disease
  • Severe kyphosis
  • Severe scoliosis
  • Possible type II transitional vertebra*
Possible spondylolysis
Possible facet joint asymmetry
Non-mechanical spine disease
  • Multiple myeloma
  • Metastatic carcinoma
  • Lymphoma and leukemia
  • Spinal cord tumors
  • Retroperitoneal tumors
  • Osteomyelitis
  • Septic discitis
  • Paraspinous abscess
  • Epidural abscess
  • Bacterial endocarditis
Inflammatory arthritis (often HLA-B27 associated)
  • Ankylosing spondylitis
  • Psoriatic spondylitis
  • Reiter's syndrome
  • Inflammatory bowel disease
Scheuermann's disease (osteochondrosis)
Paget's disease
Visceral disease
Pelvic organs
  • Prostatitis
  • Endometriosis
  • Chronic pelvic inflammatory disease
Renal disease
  • Nephrolithiasis
  • Pyelonephritis
  • Perinephric abscess
Aortic aneurysm
Gastrointestinal disease
  • Pancreatitis
  • Cholecystitis
  • Penetrating ulcer
Fat herniation of lumbar space

Yellow flags:


Red flags:

  • Cauda equina symptoms
  • Pain worse at night or laying down (consider tumor or infection--any hx of recent cellulitis, UTI, fever?)
  • Significant trauma--Surgery consult
  • Weight loss, fever, history of cancer or HIV (consider infection or tumor)--MRI
  • IV drugs or steroid use
  • Widespread neurological signs (consider tumor or neurological disease)


Signs suggestive of underlying systemic disease:

  • History of cancer
  • Age over 50 years
  • Unexplained weight loss
  • Duration of pain greater than one month
  • Nighttime pain
  • Unresponsiveness to previous therapies
  • History of abdominal aortic aneurysm


Non-pharmacologic treatment options:

  • Exercise
  • Spinal manipulation
  • Massage and yoga
  • Acupuncture
  • Cold and heat


Pharmacologic options:

  • Ibuprofen 800mg TID
  • Tylenol 1g TID-QID
  • Tramadol
    • (Durela, Ralivia, Tridural): 100 mg once daily, may titrate up to max 300mg per day
    • Zytram® XL: 150 mg once daily, may titrate up to max 400 mg per day 
  • Tramacet


Dr. Mike Evans (http://www.evanshealthlab.com/)