A research team from St. Louis designs a classification system to diagnose and treat nonspecific back pain.
At some point in their lives, four out of five people experience back pain. Yet the vast majority of them will never know exactly what caused their back pain.
Your back pain may be very specific -- you can literally put your finger on it -- but usually a physical exam does not reveal any identifiable cause such as a herniated disk or a neurological problem. X-rays and magnetic resonance scans are notoriously unhelpful.
Most often doctors end up diagnosing low back pain as mechanical or "nonspecific,” which means pain in the lower back due to an unknown cause. Although guidelines exist to help doctors decide how to manage nonspecific low back pain, the evidence about which treatments are effective has been conflicting.
Most often, nonspecific back pain is caused by muscle strain that responds to a few days of rest and pain medications, followed by a gradual return to normal activities. You may also need medications to reduce muscle spasms and perhaps physical therapy to improve strength and flexibility in your spine, abdomen, and legs. In most cases the back pain will eventually go away by itself. So does it matter at all what your doctor prescribes?
Yes, indeed it does, according to a recent study. A team based in Salt Lake City has spent years creating a classification system to rationalize the diagnosis of low back pain, based on factors such as duration and location of the back pain and range of motion. Recently, they proceeded to test whether their criteria really offered a solid rationale for treatment choice.
Their latest study involved 123 patients referred for physical therapy because of nonspecific low back pain that had persisted for less than 90 days. Based on the symptom classifications, 50 people received one of three treatments: spinal manipulation, repeated range-of-motion exercises to flex or extend their backs, or exercises designed to strengthen and stabilize their trunks. The remaining 73 people had one of these treatments chosen at random. Everyone got treatments twice a week for four weeks.
At the end of the four weeks and then a year later, the research team examined the study subjects again. Those who got a treatment chosen at random had about 20% more remaining disability than people whose treatments corresponded to the classification of their symptoms, the researchers reported in the journal Spine. Because failure to recover quickly from nonspecific low back pain carries a greater risk of permanent disability, choosing the best back pain treatment immediately may have long-term benefits.
So what to do if your own back goes out? You or your doctor can look up the classification system; it is described in two separate places on the Internet for free (Annals of Internal Medicine 2004;141:920–928 and BMC Musculoskeletal Disorders 2006; Feb 10;7:11).
