Therapeutic and organizational approaches to the patients with acute back pain management in outpatient practice (according experience of Croatia and Slovenia)

2021 ◽  
Vol 2021 (2) ◽  
pp. 28-32
Author(s):  
L.S. Babinets ◽  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Chronic Back Pain ◽  
Family Doctor ◽  
Low Back ◽  
Permanent Disability ◽  
Acute Low Back Pain ◽  
Number Of Patients ◽  
Acute Back Pain

Acute low back pain is one of the most common health problems in family medicine. This pain is experienced at least once in the life of 60-80% of people. The aim is to analyze the European (Croatian and Slovenian) experience of medical and organizational approach to the management of a patient with acute back pain in the practice of a primary care physician. Main part. Treatment of low back pain should be comprehensive and not only pharmacological. An appropriate combination with other treatments is required. The patient should be well aware of the nature of his illness. In more patients, a course of treatment and a short hospital stay (up to two weeks) is prescribed by a family doctor. The main purpose of drug treatment is pain relief. Treatment begins with paracetamol, which effectively relieves low back pain, while side effects are very rare. If the effect is weak, use nonsteroidal anti-inflammatory drugs (not recommended for patients with gastric or duodenal ulcers). A small number of patients with acute low back pain develop chronic back pain, which is established as a diagnosis after clinical symptoms persist for six months. It is important to immediately diagnose patients who may initially develop chronic low back pain, which requires referral for additional diagnostic examination, physical therapy, and assessment for temporary or permanent disability. Conclusion: Acute low back pain is a disease in which more than 50% of patients recover within 14 days. 10% of them have chronic pain. Such patients put a serious burden on the family doctor and the health insurance system. These 10% of patients spend almost 90% of the resources allocated to the treatment of low back pain. Diagnosis of acute low back pain should be thorough, which will appoint an effective and rational scheme of management of such a patient in order to correct the clinical condition, pain relief and prevention of chronic acute back pain

scholarly journals Diagnostic Approaches to a Patient with the Problem of Acute Low Back Pain at the Family Doctor’s Practice (According the Experience of Croatia and Slovenia)

2021 ◽  
pp. 24-27
Author(s):  
Liliia Babynets ◽  
Iryna Halabitska
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Family Doctor ◽  
Diagnostic Process ◽  
Low Back ◽  
Permanent Disability ◽  
Acute Low Back Pain ◽  
Number Of Patients ◽  
The Family

Acute low back pain is one of the most common health problems in family medicine. This pain is experienced at least once in the life of 60–80 % of people. The aim is to study the European (Croatian and Slovenian) experience of the diagnostic approach to the management of a patient with the problem of acute low back pain in the practice of a family doctor. Acute low back pain is the reason for frequent visits to the family doctor. Most patients are diagnosed with uncomplicated low back pain, which does not require additional diagnostic tests, and a course of treatment and a short hospital stay (up to two weeks) is prescribed by a family doctor. Back pain is not a definitive diagnosis. This may be a reason to visit or as a working syndrome diagnosis. To determine the cause of pain, it is necessary to determine the source of pain in order to select the appropriate treatment for the patient. To identify the cause it is necessary to collect history and conduct clinical examinations for the following factors: uncomplicated low back pain, radicular back pain, severe pathology of the lumbosacral region, pain from related structures, psychosocial factors (somatization, exacerbation). A small number of patients with acute low back pain develop chronic low back pain, which is established as a diagnosis after clinical symptoms persist for six months. It is important to immediately diagnose patients who may initially develop chronic low back pain, which requires referral for additional diagnostic examination, physical therapy, and to assess for temporary or permanent disability. Carrying out the diagnostic process according to the above algorithm allows to determine the causative factor of acute low back pain, which will prescribe an effective and rational scheme of such a patient to correct the clinical condition, relieve pain and prevent chronic low back pain.

scholarly journals Watchful Waiting as a Strategy to Reduce Low-Value Spinal Imaging: Study Protocol for a Randomized Trial

2021 ◽  
Author(s):  
Joshua Fenton ◽  
Anthony Jerant ◽  
Peter Franks ◽  
Melissa Gosdin ◽  
Ilona Fridman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Watchful Waiting ◽  
Standardized Patient ◽  
Low Back ◽  
Patient Trust ◽  
Post Intervention ◽  
Acute Low Back Pain ◽  
Spinal Imaging ◽  
Acute Back Pain

Abstract Background: Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests. Methods: We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a cluster randomized clinical trial. We will recruit 8-10 primary care and urgent care clinics (~55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3 to 6 month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are: use of targeted communication techniques during a follow-up visit with an SP; clinician self-reported use of watchful waiting with actual low back pain patients; post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain); and patient trust and satisfaction with physicians. Discussion: This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests. Trial registration: NCT 04255199, ClinicalTrials.gov (January 20, 2020)

Onset of analgesic effect and plasma levels of controlled-release tramadol (Tramadol Contramid once-a-day) 200-mg tablets in patients with acute low back pain

2018 ◽  
Vol 4 (5) ◽  
pp. 285 ◽  
Author(s):  
Adrian Sarbu, MD ◽  
Florin Radulescu, MD ◽  
Sybil Robertson, BScN ◽  
Sylvie Bouchard, MD, PhD
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Controlled Release ◽  
Pain Relief ◽  
Plasma Levels ◽  
Immediate Release ◽  
Pharmacokinetic Profile ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Therapeutic Threshold

Background and Aims: Tramadol hydrochloride, a centrally acting, synthetic analgesic, has been available in Europe since 1977 in a variety of formulations and in the United States since 1995. Its clinical efficacy was established in a variety of painful conditions (cancer pain, neuropathic pain, and osteoarthritis). Nonetheless, little published data exist regarding the relationship between analgesic onset and minimum therapeutic plasma levels. Tramadol Contramid* once-a-day (OAD) demonstrates a pharmacokinetic profile with a sharp initial absorption slope similar to the pharmacokinetic profile of the immediate- release tramadol, suggesting that both the immediaterelease and the once-daily (Contramid) formulation may produce a similar onset of analgesia.Methods: This multicentre, open-label, single-dose study examined the pharmacokinetics/pharmacodynamics of Tramadol Contramid OAD in patients with acute low back pain. Patients who signed informed consent were screened and washed-out of prior analgesics. Patients received one dose of Tramadol Contramid OAD 200 mg. The patients indicated the time of onset of pain relief (stopwatch method). Ratings of pain intensity and pain relief and pharmacokinetic samples were taken prior to dosing, at the onset of pain relief, and 3 and 6 hours postdose. No rescue medication was permitted until the end of the study (6-hour postdose). Adverse events were monitored throughout the study.Results: Forty of the 47 patients enrolled completed the study. Onset of perceptible pain relief was achieved within 1 hour for the majority of patients and at plasma levels, suggesting a therapeutic threshold between 50 and 100 ng/mL. Two patients did not experience any pain relief.Conclusions: The results of this exploratory study suggest that similar to immediate-release tramadol, onset of analgesia for this controlled-release formulation of tramadol (Tramadol Contramid OAD) occurs within 1 hour at a mean therapeutic threshold concentration of 56 ± 38 ng/mL.

Transcutaneous electric nerve stimulation (TENS) for acute low back pain: systematic review

2019 ◽  
Vol 19 (2) ◽  
pp. 225-233 ◽  
Author(s):  
Justine Binny ◽  
Ngar Lok Joshua Wong ◽  
Shirali Garga ◽  
Chung-Wei Christine Lin ◽  
Chris G. Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Nerve Stimulation ◽  
Low Back ◽  
Transcutaneous Electric Nerve Stimulation ◽  
Acute Low Back Pain ◽  
Electric Nerve Stimulation ◽  
Quality Evidence

Abstract Background and aims There has been no comprehensive evaluation of the efficacy of transcutaneous electric nerve stimulation (TENS) for acute low back pain (LBP). The aim of this systematic review was to investigate the efficacy and safety of TENS for acute LBP. Methods We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL and PsycINFO (inception to May 2018) for randomised placebo controlled trials. The primary outcome measure was pain relief in the immediate term (within 2-weeks of administration) assessed using the 100 mm visual analogue scale. A mean difference of at least 10 points on the 100-point pain scale was considered clinically significant. Methodological quality of the eligible studies was assessed using the PEDro scale and overall quality assessment rating was assessed using GRADE. Results Three placebo controlled studies (n = 192) were included. One low quality trial (n = 63) provides low quality evidence that ~30 min treatment with TENS in an emergency-care setting provides clinically worthwhile pain relief for moderate to severe acute LBP in the immediate term compared with sham TENS [Mean Difference (MD) – 28.0 (95% CI – 32.7, −23.3)]. Two other studies which administered a course of TENS over 4–5 weeks, in more usual settings provide inconclusive evidence; MD −2.75 (95% CI −11.63, 6.13). There was limited data on adverse events or long term follow-up. Conclusions The current evidence is insufficient to support or dismiss the use of TENS for acute LBP. Implications There is insufficient evidence to guide the use of TENS for acute LBP. There is low quality evidence of moderate improvements in pain with a short course of TENS (~30 min) during emergency transport of patients to the hospital. Future research should evaluate whether TENS has an opioid sparing role in the management of acute LBP.

Rückenschmerzen: Wann muss man einweisen?

2019 ◽  
Vol 144 (10) ◽  
pp. 665-669 ◽  
Author(s):  
Markus Bleckwenn ◽  
Elisabeth Märker-Hermann
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Impression ◽  
Outpatient Basis ◽  
Low Back ◽  
Red Flags ◽  
Acute Low Back Pain ◽  
Disease Outcomes ◽  
Acute Back Pain ◽  
High Treatment

AbstractIn the case of acute back pain, the indication for inpatient diagnosis and therapy is rarely given. The indication is provided if a potentially dangerous disease situation is suspected and if the pain is immobilizing or cannot be controlled on an outpatient basis. The high treatment numbers in German hospitals indicate that there is overuse in the treatment of back pain. Back pain, especially acute low back pain, is a frequent consultative activity of general practitioners. Serious diseases of the spine occur in only about 1 % of cases in GP practices. Identifying potentially dangerous disease outcomes requires a detailed history and thorough physical examination of the unclothed patient. “Red flags”, together with the overall clinical impression of the patient, provide decisive warnings for urgently needed back pain. Common non-specific low back pain can be treated on an outpatient basis by prescribing painkillers and instructions for exercise by GPs.

scholarly journals Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Joshua J. Fenton ◽  
Anthony Jerant ◽  
Peter Franks ◽  
Melissa Gosdin ◽  
Ilona Fridman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Watchful Waiting ◽  
Standardized Patient ◽  
Low Back ◽  
Patient Trust ◽  
Post Intervention ◽  
Acute Low Back Pain ◽  
Spinal Imaging ◽  
Acute Back Pain

Abstract Background Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests. Methods We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a randomized clinical trial. We will recruit 8–10 primary care and urgent care clinics (~ 55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3- to 6-month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are use of targeted communication techniques during a follow-up visit with an SP, clinician self-reported use of watchful waiting with actual low back pain patients, post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain), and patient trust and satisfaction with physicians. Discussion This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests. Trial registration ClinicalTrials.govNCT 04255199. Registered on January 20, 2020

scholarly journals A derékfájás: mikor és mit tegyünk?

2015 ◽  
Vol 156 (33) ◽  
pp. 1315-1320 ◽  
Author(s):  
S. Tamás Illés
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Behavioral Therapy ◽  
Day Treatment ◽  
Therapeutic Process ◽  
International Standards ◽  
Low Back ◽  
Permanent Disability ◽  
Acute Low Back Pain ◽  
Active Mobilization

The low back pain has become one of the greatest public health problems worldwide. The author based on the current international standards summarizes the knowledge necessary for every day treatment of low back pain. In acute low back pain the author underlines the necessity of the rapid, accurate diagnosis and separation for specific and non-specific low back pain. In specific acute low back pain the treatment should focus on to eliminate the root causes. In non-specific cases pain killing treatment and early active mobilization is the choice for the therapeutic process. Beside analgesia, the primary goal of the treatment is to prevent becoming chronic the symptomatology. Objectives of the management of chronic low back pain are effective pain reduction, continuous maintainance of physical activity, prevention of permanent disability, and restoration of working ability. Analgesics, non steroid anti-inflammatory drugs, and muscle relaxants reduce pain, while multidisciplinary management programs, personalized and guided physiotherapy, cognitive behavioral therapy, as well as short training programs will help to restore function. Surgical treatment is only indicated in degenerative cases and only after the failure of conservative therapy. Orv. Hetil., 2015, 156(33), 1315–1320.

scholarly journals Prediction and trend of tactile acuity, pain and disability in acute LBP: a six-month prospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rita Morf ◽  
Fabian Pfeiffer ◽  
Sabina Hotz-Boendermaker ◽  
André Meichtry ◽  
Hannu Luomajoki
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Mixed Models ◽  
Chronic Back Pain ◽  
Early Stage ◽  
Linear Mixed Models ◽  
Low Back ◽  
Tactile Acuity ◽  
Acute Low Back Pain ◽  
Lower Back

Abstract Background Chronic back pain is known to be associated with altered tactile acuity. Tactile acuity is measured using the Two-Point Discrimination (TPD) test in both clinical and research settings. In subjects with chronic low back pain, the TPD threshold (TPDT) is increased and is associated with persistent pain. It remains unknown, however, whether TPDT is also altered in cases of clinical acute pain, or whether it could be used as a predictor of future pain and disability at an early stage of LBP. The main objective of this study was to investigate the predictive value of baseline TPDT for pain and disability at 3 and 6 months after the onset of acute LBP. The TPDT in acute low back pain (LBP) and the development of TPDT over 6 months has also been assessed. Methods LBP participants (n = 124) with acute LBP (< 4 weeks) were included. Subjects were examined within 4 weeks of pain onset and followed-up after 3 and 6 months of pain onset. Horizontal and vertical TPDTs of the lower back were collected. Linear mixed models were subsequently used to evaluate the association of TPDT with pain and disability over time. Results The vertical TPDT showed a mean (SD) of 4.9 cm (1.6) and the horizontal TPDT a mean (SD) of 6.0 cm (1.5) at baseline. The vertical TPDT altered from baseline up to 6 months from 4.9 to 4.6 cm and the horizontal TPDT from 6.0 to 5.4 cm. The association between the TPDT and the Oswestry Disability Index (ODI) after 6 months was moderate. Linear mixed models revealed no association between TPDT, pain and disability over the progression of LBP. Conclusion TPDTs appear to be raised in subjects with acute LBP. However, our study revealed no predictive capability of the TPDT for disability and pain. No comparisons are possible in the absence of similar studies, indicating the need for further research is in this area.

scholarly journals Watchful Waiting as a Strategy to Reduce Low-Value Spinal Imaging: Study Protocol for a Randomized Trial

2021 ◽  
Author(s):  
Joshua Fenton ◽  
Anthony Jerant ◽  
Peter Franks ◽  
Melissa Gosdin ◽  
Ilona Fridman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Watchful Waiting ◽  
Standardized Patient ◽  
Low Back ◽  
Patient Trust ◽  
Post Intervention ◽  
Acute Low Back Pain ◽  
Spinal Imaging ◽  
Acute Back Pain

Abstract • Background: Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests. • Methods: We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a cluster randomized clinical trial. We will recruit 8-10 primary care and urgent care clinics (~55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3 to 6 month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are: use of targeted communication techniques during a follow-up visit with an SP; clinician self-reported use of watchful waiting with actual low back pain patients; post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain); and patient trust and satisfaction with physicians. • Discussion: This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests. • Trial registration: NCT 04255199, ClinicalTrials.gov (January 20, 2020)

Management of acute low back pain: the practices and perspectives of primary care clinicians in Australia

2020 ◽  
Vol 26 (3) ◽  
pp. 256
Author(s):  
Malene Ahern ◽  
Catherine M. Dean ◽  
Blake F. Dear ◽  
Simon M. Willcock ◽  
Julia M. Hush
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Guidelines ◽  
Internet Survey ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Acute Back Pain ◽  
Primary Care Clinicians ◽  
Primary Care Practitioners

Low back pain (LBP) is the highest cause of years lived with a disability in Australia and the most frequent musculoskeletal condition for which patients seek primary care. The aims of this study were to: (1) evaluate the current practices and perspectives of Australian GPs and physiotherapists managing acute back pain; and (2) explore alignment of care with clinical guidelines. This was a prospective cross-sectional Internet survey conducted from March 2018 to May 2018 of experienced Australian GPs and physiotherapists. Descriptive statistics were used to analyse all quantitative outcomes. Two hundred primary care practitioners (72% physiotherapists and 28% GPs) from all States and Territories of Australia completed the survey. Most primary care practitioners were familiar with clinical guidelines for acute back pain management and reported delivery of many of the core components of guideline-based care, including education, advice about favourable prognosis, encouraging activity and self-management and discouraging prolonged bed rest. Deviations from guideline-based care were common, including provision of analgesic medication, passive therapies and using radiological imaging. Australian primary care clinicians in this sample were aware of back pain guidelines and typically implement care that is consistent with guideline-based recommendations. Divergences from these guidelines may indicate that primary care practitioners are delivering evidence-based and person-centred care that integrates clinicians’ judgement with patients’ preferences and guideline-based evidence.

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