Diagnosis and management of acute low back pain

Acute low back pain is commonly encountered in primary care practice but th e specific cause often cannot be identified. This ailment has a benign cour se in 90 percent of patients. Recurrences and functional limitations can be minimized with appropriate conservative management, including medications, physical therapy modalities, exercise and patient education. Radiographs a nd laboratory tests are generally unnecessary, except in the few patients i n whom a serious cause is suspected based on a comprehensive history and ph ysical examination. Serious causes that need to be considered include infec tion, malignancy, rheumatologic diseases and neurologic disorders. Patients with suspected cauda equina lesions should undergo immediate surgical inve stigation. Surgical evaluation is also indicated in patients with worsening neurologic deficits or intractable pain that is resistant to conservative treatment. The current recommendation is two or three days of bed rest for patients with acute radiculopathy. The treatment plan should be reassessed in patients who do not return to normal activity within four to six weeks.