Brian W. Nelson, M.D.

Most patients can achieve functional restoration

A rational approach to the
treatment of low back pain

ABSTRACT:

At the initial visit of a patient with low back pain, the physician must set a positive tone emphasizing that the problem is common in the human body and can be remedied. Initial treatment is I or 2 days of rest, a short course of analgesics, and stretches and other exercises. The 5% to 18% of patients who do not improve within 3 months (chronic-pain patients) or have a relapse frequently require an active functional rehabilitation program. Exercises are helpful only if they focus on the lumbar extensors. Patients may need encouragement at the beginning of the program to tolerate discomfort. Expensive imaging studies are reserved for patients who become disabled or show no improvement. Only when a lesion is identified in a patient who has seriously tried and failed conservative rehabilitation is surgery considered.

This article is the first in a special series on the diagnosis and management of back pain.

"A rational approach to the treatment of low back pain."
The Journal of Musculoskeletal Medicine 10(5): 67-82, May 1993. B. W. Nelson.