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Diagnosis and treatment of low back pain

Year 2022, Volume: 2 Issue: 2, 36 - 42, 25.12.2022

Şehriban Güngürür , Tunay Sarpel

Abstract

Low back pain is the most common cause of pains in the musculoskeletal system. Low back pain can occur in the form of idiopathic, mechanical, non-mechanical and visceral pain. A carefully taken accurate history and physical examination greatly affect the decision-making mechanism. It is important to evaluate risk factors and conduct further examinations for diagnosis in order to determine the source of pain and give treatment for the main cause. Red flags are examined for findings suggestive of pathologies. In this study, the general approach for diagnosis of low back pain, which leads to economic burden and loss of labor force in almost all countries of the world, is examined.

Keywords

: Low back pain mechanical low back pain lumbar spine disc herniation treatment

References

  • 1) Hoy D, Bain C, Williams G et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028-2037.
  • 2) Polat M, Karaoğlan B. Bel Ağrısına Yaklaşım: Tanıdan Tedaviye. Klinik Tıp Aile Hekimliği. 2017;9(6):13-16.
  • 3) Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-491.
  • 4) Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-781.
  • 5) van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the Cochrane Colaboration Back Review Group. Spine 2003;28(12):1290-9.
  • 6) Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, Crosby P. Muscle Control and Non-specific Chronic Low Back Pain. Neuromodulation. 2018 Jan;21(1):1-9.
  • 7) Tüzün S. Tüzün F, Eryavuz M, Akarırmak Ü (Editörler). Hareket sistemi hastalıkları’nda bel bacak ağrıları. İstanbul: Nobel Tıp Kitabevi, 1997: p. 245- 60.
  • 8) Snook SH. Work-related low back pain: secondary intervention. Journal of Electromyography and Kinesiology, 2004. 14(1): p. 153-160.
  • 9) Oxtoby K. Why doctors don’t take sick leave. BMJ, 2015 Dec. 351:h6719.
  • 10) Arslan M, Cömert A, Açar Hİ, Özdemir M, Elhan A, Tekdemir İ, Tubbs RS, Attar A, Uğur HÇ. Lumbosacral intrathecal nerve roots: an anatomical study. Acta Neurochir (Wien). 2011 Jul;153(7):1435-42.
  • 11) Dolan P, Adams MA, Hutton WC: Commonly adopted postures and their effect on the lumbar spine. Spine (Phila Pa 1976) 13(2):197-201, 1988.
  • 12) Barr KP, Harrast MA. Bel ağrısı. In: Braddom RL, ed (Sarıdoğan M, çeviri editörü). Fiziksel Tıp ve Rehabilitasyon. 3. Baskı, Ankara: Güneş Tıp Kitabevleri; 2010. p.883-927.
  • 13) Oğuz H. Bel ağrıları. Oğuz H, editör. Romatizmal Ağrılar. 1. Baskı. Konya: Atlas Tıp Kitabevi; 1992. p.147-228.
  • 14) Adams M, Deyl Z: Degenerated annulus fibrosus of the intervertebral disc contains collagen type III. Ann Rheum Dis 43:258-263, 1984.
  • 15) Murray C, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Boston: Harvard University Press; 1996.
  • 16) Lopez A, Mathers C, Ezzati M, et al. Global burden of disease and risk factors. New York, NY: Oxford University Press; 2006.
  • 17) Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropractic and Osteopathy 2005 Jul 26;13:13.
  • 18) Hoy D, Toole MJ, Morgan D, et al. Low back pain in rural Tibet. Lancet 2003;361(9353):225–6.
  • 19) Roland MO. The natural history of back pain. The Practitioner 1983 Jul;227(1381):1119–22.
  • 20) Gilgil E, Kaçar C, Bütün B, Tuncer T, Urhan S, Yildirim Ç et al. Prevalence of low back pain in a developing urban setting. Spine, 2005. 30(9): p. 1093- 1098.
  • 21) Berker E. Bel Ağrısında Epidemiyoloji. Bel Ağrısı Tanı ve Tedavi. Eds: Özcan E, Ketenci A. Nobel Kitapevi, İstanbul, s, 2002: p. 51-56.
  • 22) Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014 Jul;98(4):777-89.
  • 23) Linton SJ. A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976). 2000 May 1;25(9):1148-56.
  • 24) van Tulder M, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol. 2002 Dec;16(5):761-75.
  • 25) Arasıl T. Fiziksel Tıp ve Rehabilitasyon Randall L Braddom, Güneş Kitabevi, 2005. p. 557-580.
  • 26) Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine (Phila Pa 1976). 2003 Jun 1;28(11):1195-202.
  • 27) Feldman DE, Rossignol M, Shrier I, Abenhaim L. Smoking. A risk factor for development of low back pain in adolescents. Spine (Phila Pa 1976). 1999 Dec 1;24(23):2492-6.
  • 28) Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-50.
  • 29) Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009 Oct;60(10):3072-80.
  • 30) Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009 Oct 6;339:b3829.
  • 31) Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001 Feb 1;344(5):363-70.
  • 32) Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009 Jun 15;79(12):1067-74.
  • 33) van Wijk RM, Geurts JW, Lousberg R, Wynne HJ, Hammink E, Knape JT, Groen GJ. Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain. Pain Med. 2008 Mar;9(2):212-21.
  • 34) Jensen S. Back pain-clinical assessment. Aust Fam Physician. 2004 Jun;33(6):393-5, 397-401.
  • 35) ) Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018 Oct 1;98(7):421-428.
  • 36) Şenköylü A. Bel ağrısında kırmızı bayraklar. Türk Fiz Tıp Rehab Derg 2011;57 (Kasım):0–0.
  • 37) Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992 Aug 12;268(6):760-5.
  • 38) Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992 May;65(773):361-9.
  • 39) Bogduk N. Degenerative joint disease of the spine. Radiol Clin North Am. 2012 Jul;50(4):613-28.
  • 40) Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007 Oct;37(2):69-80. doi: 10.1016/j.semarthrit.2007.01.007. Epub 2007 Mar 26.
  • 41) Oğuz H. Bel Ağrılarında Klinik Değerlendirme. Turkiye Klinikleri Journal of Physical Medicine Rehabilitation Special Topics, 2011, 4.1: 12-16
  • 42) van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431.
  • 43) Greenhalgh S, Selfe J. A qualitative investigation of Red Flags for serious spinal pathology. Physiotherapy. 2009 Sep;95(3):224-7.
  • 44) Beyazova M ve Kutsal Gökçe Y. Fiziksel tıp ve rehabilitasyon-1. 2016: Güneş Tıp Kitabevleri. 2053-66.
  • 45) Leone A, Costantini AM, Guglielmi G, Tancioni V, Moschini M. Degenerative disease of the lumbosacral spine: disk herniation and stenosis. Rays 2000;25(1):35-48.
  • 46) Chou R. Pharmacological management of low back pain. Drugs. 2010 Mar 5;70(4):387-402.
  • 47) Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
  • 48) Zhang W, Jones A, Doherty M. Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Ann Rheum Dis. 2004 Aug;63(8):901-7.
  • 49) Mens JM. The use of medication in low back pain. Best Pract Res Clin Rheumatol. 2005 Aug;19(4):609-21.
  • 50) Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7(5):R1046-51.
  • 51) Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res. 1988 Mar-Apr;16(2):83-91.
  • 52) Metscher B, Kübler U, Jahnel-Kracht H. Dexketoprofen-Trometamol und Tramadol bei akuter Lumbago [Dexketoprofen-trometamol and tramadol in acute lumbago]. Fortschr Med Orig. 2001 Jan 11;118(4):147-51.
  • 53) Grabiner MD, Koh TJ, el Ghazawi A. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine (Phila Pa 1976). 1992 Oct;17(10):1219-23.

Bel ağrılarında tanı ve tedavi

Year 2022, Volume: 2 Issue: 2, 36 - 42, 25.12.2022

Şehriban Güngürür , Tunay Sarpel

Abstract

Bel ağrısı, kas iskelet sistemindeki ağrıların en sık sebebidir. Bel ağrıları, idiopatik, mekanik, mekanik olmayan ve visseral ağrılar şeklinde karşımıza çıkabilmektedir. Dikkatle alınmış doğru bir öykü ve fizik muayene karar verme mekanizmasını oldukça etkiler. Risk faktörlerini değerlendirmek ve tanı için ileri incelemelerde bulunmak ağrının kaynağını saptamak ve ana sebebe yönelik tedavi vermek için önemlidir. Patolojileri düşündüren bulgular için kırmızı bayraklar incelenmektedir. Bu çalışmada neredeyse tüm dünya ülkelerinde ekonomik yük ve iş gücü kaybına yol açan bel ağrılarına tanı amaçlı genel yaklaşım incelenmelidir.

Keywords

: Bel ağrısı mekanik bel ağrısı lomber omurga disk hernisi tedavi

References

  • 1) Hoy D, Bain C, Williams G et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028-2037.
  • 2) Polat M, Karaoğlan B. Bel Ağrısına Yaklaşım: Tanıdan Tedaviye. Klinik Tıp Aile Hekimliği. 2017;9(6):13-16.
  • 3) Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-491.
  • 4) Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-781.
  • 5) van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the Cochrane Colaboration Back Review Group. Spine 2003;28(12):1290-9.
  • 6) Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, Crosby P. Muscle Control and Non-specific Chronic Low Back Pain. Neuromodulation. 2018 Jan;21(1):1-9.
  • 7) Tüzün S. Tüzün F, Eryavuz M, Akarırmak Ü (Editörler). Hareket sistemi hastalıkları’nda bel bacak ağrıları. İstanbul: Nobel Tıp Kitabevi, 1997: p. 245- 60.
  • 8) Snook SH. Work-related low back pain: secondary intervention. Journal of Electromyography and Kinesiology, 2004. 14(1): p. 153-160.
  • 9) Oxtoby K. Why doctors don’t take sick leave. BMJ, 2015 Dec. 351:h6719.
  • 10) Arslan M, Cömert A, Açar Hİ, Özdemir M, Elhan A, Tekdemir İ, Tubbs RS, Attar A, Uğur HÇ. Lumbosacral intrathecal nerve roots: an anatomical study. Acta Neurochir (Wien). 2011 Jul;153(7):1435-42.
  • 11) Dolan P, Adams MA, Hutton WC: Commonly adopted postures and their effect on the lumbar spine. Spine (Phila Pa 1976) 13(2):197-201, 1988.
  • 12) Barr KP, Harrast MA. Bel ağrısı. In: Braddom RL, ed (Sarıdoğan M, çeviri editörü). Fiziksel Tıp ve Rehabilitasyon. 3. Baskı, Ankara: Güneş Tıp Kitabevleri; 2010. p.883-927.
  • 13) Oğuz H. Bel ağrıları. Oğuz H, editör. Romatizmal Ağrılar. 1. Baskı. Konya: Atlas Tıp Kitabevi; 1992. p.147-228.
  • 14) Adams M, Deyl Z: Degenerated annulus fibrosus of the intervertebral disc contains collagen type III. Ann Rheum Dis 43:258-263, 1984.
  • 15) Murray C, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Boston: Harvard University Press; 1996.
  • 16) Lopez A, Mathers C, Ezzati M, et al. Global burden of disease and risk factors. New York, NY: Oxford University Press; 2006.
  • 17) Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropractic and Osteopathy 2005 Jul 26;13:13.
  • 18) Hoy D, Toole MJ, Morgan D, et al. Low back pain in rural Tibet. Lancet 2003;361(9353):225–6.
  • 19) Roland MO. The natural history of back pain. The Practitioner 1983 Jul;227(1381):1119–22.
  • 20) Gilgil E, Kaçar C, Bütün B, Tuncer T, Urhan S, Yildirim Ç et al. Prevalence of low back pain in a developing urban setting. Spine, 2005. 30(9): p. 1093- 1098.
  • 21) Berker E. Bel Ağrısında Epidemiyoloji. Bel Ağrısı Tanı ve Tedavi. Eds: Özcan E, Ketenci A. Nobel Kitapevi, İstanbul, s, 2002: p. 51-56.
  • 22) Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014 Jul;98(4):777-89.
  • 23) Linton SJ. A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976). 2000 May 1;25(9):1148-56.
  • 24) van Tulder M, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol. 2002 Dec;16(5):761-75.
  • 25) Arasıl T. Fiziksel Tıp ve Rehabilitasyon Randall L Braddom, Güneş Kitabevi, 2005. p. 557-580.
  • 26) Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine (Phila Pa 1976). 2003 Jun 1;28(11):1195-202.
  • 27) Feldman DE, Rossignol M, Shrier I, Abenhaim L. Smoking. A risk factor for development of low back pain in adolescents. Spine (Phila Pa 1976). 1999 Dec 1;24(23):2492-6.
  • 28) Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-50.
  • 29) Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009 Oct;60(10):3072-80.
  • 30) Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009 Oct 6;339:b3829.
  • 31) Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001 Feb 1;344(5):363-70.
  • 32) Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009 Jun 15;79(12):1067-74.
  • 33) van Wijk RM, Geurts JW, Lousberg R, Wynne HJ, Hammink E, Knape JT, Groen GJ. Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain. Pain Med. 2008 Mar;9(2):212-21.
  • 34) Jensen S. Back pain-clinical assessment. Aust Fam Physician. 2004 Jun;33(6):393-5, 397-401.
  • 35) ) Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018 Oct 1;98(7):421-428.
  • 36) Şenköylü A. Bel ağrısında kırmızı bayraklar. Türk Fiz Tıp Rehab Derg 2011;57 (Kasım):0–0.
  • 37) Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992 Aug 12;268(6):760-5.
  • 38) Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992 May;65(773):361-9.
  • 39) Bogduk N. Degenerative joint disease of the spine. Radiol Clin North Am. 2012 Jul;50(4):613-28.
  • 40) Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007 Oct;37(2):69-80. doi: 10.1016/j.semarthrit.2007.01.007. Epub 2007 Mar 26.
  • 41) Oğuz H. Bel Ağrılarında Klinik Değerlendirme. Turkiye Klinikleri Journal of Physical Medicine Rehabilitation Special Topics, 2011, 4.1: 12-16
  • 42) van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431.
  • 43) Greenhalgh S, Selfe J. A qualitative investigation of Red Flags for serious spinal pathology. Physiotherapy. 2009 Sep;95(3):224-7.
  • 44) Beyazova M ve Kutsal Gökçe Y. Fiziksel tıp ve rehabilitasyon-1. 2016: Güneş Tıp Kitabevleri. 2053-66.
  • 45) Leone A, Costantini AM, Guglielmi G, Tancioni V, Moschini M. Degenerative disease of the lumbosacral spine: disk herniation and stenosis. Rays 2000;25(1):35-48.
  • 46) Chou R. Pharmacological management of low back pain. Drugs. 2010 Mar 5;70(4):387-402.
  • 47) Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
  • 48) Zhang W, Jones A, Doherty M. Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Ann Rheum Dis. 2004 Aug;63(8):901-7.
  • 49) Mens JM. The use of medication in low back pain. Best Pract Res Clin Rheumatol. 2005 Aug;19(4):609-21.
  • 50) Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7(5):R1046-51.
  • 51) Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res. 1988 Mar-Apr;16(2):83-91.
  • 52) Metscher B, Kübler U, Jahnel-Kracht H. Dexketoprofen-Trometamol und Tramadol bei akuter Lumbago [Dexketoprofen-trometamol and tramadol in acute lumbago]. Fortschr Med Orig. 2001 Jan 11;118(4):147-51.
  • 53) Grabiner MD, Koh TJ, el Ghazawi A. Decoupling of bilateral paraspinal excitation in subjects with low back pain. Spine (Phila Pa 1976). 1992 Oct;17(10):1219-23.
There are 53 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Review
Authors

Şehriban Güngürür 0000-0003-0605-9129

Tunay Sarpel 0000-0002-6519-9757

Publication Date December 25, 2022
Published in Issue Year 2022 Volume: 2 Issue: 2

Cite

AMA Güngürür Ş, Sarpel T. Bel ağrılarında tanı ve tedavi. Çukurova Tıp Öğrenci Derg. December 2022;2(2):36-42.