title: A nonsurgical approach to low back pain.
abstract: Low back pain, a leading cause of disability in the United States, has a significant economic impact not only on lost productivity but also on healthcare expenditures. Approximately a fifth of patients will see multiple physicians in their quest for relief of low back pain. Primary care physicians therefore play a crucial role in the initial approach to these patients. A thorough history and physical examination directed toward the neurologic, orthopedic, and osteopathic evaluation are essential. This article reviews the diagnosis and assessment of pain levels and a triad system of therapy involving cortical, spinal, and peripheral levels. Options include antidepressants, neuroleptics, neurostimulants, and osteopathic manipulative treatment (OMT) (cortical level); opiates, tramadol hydrochloride, and transcutaneous electrical nerve stimulators (spinal level); and nonsteroidal anti-inflammatory drugs, epidural injections, spinal blocks, antispasmodics, physical therapy, muscle relaxants, exercise, and OMT (peripheral level), By choosing a modality directed at each level, the clinician may provide the patient with a pain management program that will maximize the chosen mode of therapy and restore function and mobility.
authors.affiliation: University Back Pain Center, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, Stratford, NJ, USA. jermynrt@umdnj.edu
authors.forename: R T
authors.initials: RT
authors.lastname: Jermyn
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000379:methods*; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal