Background:Low back pain is an extremely common patient complaint. Most cases resolve quickly after the acute episode. However, a significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired.Objectives:The aim of this study is to describe the characteristics of chronic LBP, physical examination abnormalities, treatment strategies and the impact of LBP on the professional life of the patients.Methods:It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized investigation and clinical assessment.Results:The study included 80% of active military serving members and 20% of administrative officers. The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. Four patients were suffering from diabetes; two patients were suffering from high blood pressure. All the patients were suffering from chronic LBP lasting for an average of 66.4 months. LBP was associated with radicular pain in 78% of the cases. It was a unilateral radicular pain in 72% of the cases and bilateral in 28% of the cases. The main triggering factors were: carrying heavy loads in 98% of the cases, standing or sitting for long periods in 90% and 76% of the cases, tremors in 74% of the cases. Neuropathic pain was found in 26% of patients. Physical examination showed paravertebral muscle tenderness in 66% of the cases and slack abdominal muscles in 56% of the cases. Assessement of range of flexion of the lumbar spine showed: fingertip to floor test was 18 ±12.2 cm [054cm], schober test was +3.8±1.2cm [16cm]. The extension of lumbar spine was painful in 80% of the cases. A trigger point was found in 28% of the cases. Lasegue sign was positive in 18% of the cases. Leri’s test was positive in 8% of the cases. Required treatments during the last episode of LBP were: Paracetamol (62%), nonsteroidal antiinflammatory drugs (26%), tramadol (4%), myorelaxant (4%) and pregabalin (2%). Half of the patients needed functional rehabilitation. Forty percent of the patients reported improvement; 46% of them reported improvement then recurrence of the pain, 8% of them reported no improvement and 4% reported worsening of the symptoms. Thirty six percent of the patients needed an average of 21 days of leave and 35% of them needed exemption from work for LBP problems. One patient needed an outplacement from his original work and one patient needed an early retirement.Conclusion:Chronic low back pain can cause significant functional disability, and commonly becomes frustrating for both patients and physicians to cope with and treat. There is still no consensus on the best way to manage chronic low back pain, and clinical guidelines are scarce. A combination of pharmacological agents and non-pharmacological methods is the most appropriate therapeutic regimen.Disclosure of Interests:None declared
The Spine Physical Examination Using Telemedicine: Strategies and Best Practices
