Guide to conservative, medical, and procedural therapies.
For patients without a specific diagnosis, treatment of low back pain begins with strategies to avoid re-injury and exacerbation. Most patients benefit from some form of medical therapy, guided by the three-step World Health Organization analgesic ladder. Opioid therapy is appropriate when needed for low back pain, especially in the acute period. Adjuvant medication (eg, an anticonvulsant or antidepressant) may help reduce or eliminate the need for opioid therapy. Side effects are common with opioid medications, although many resolve with time. Patient education in exercise, back protection, nutrition, and sexual concerns is an important component of treatment. Some patients may benefit from referral to a pain center for multidisciplinary management. Those with a structural or mechanical cause of pain may do well with surgery.
Cohen
R I
RI
Arnold Pain Management Center, Beth Israel-Deaconess Medical School, Boston, USA.
Chopra
P
P
Upshur
C
C
D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D010353:Patient Education as Topic
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic