Mechanical low back pain Lumbar strain Degenerative disease Discs (spondylosis) Facet joints Spondylolisthesis Herniated disc Spinal stenosis Osteoporosis Fractures Congenital disease Severe kyphosis Severe scoliosis Possible type II transitional vertebra* Possible spondylolysis Possible facet joint asymmetry

Non-mechanical spine disease Neoplasia Multiple myeloma Metastatic carcinoma Lymphoma and leukemia Spinal cord tumors Retroperitoneal tumors Infection 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/)

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.