AOCOPM 2023 Midyear Educational Conference-259668

259668 - Article 18

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The document discusses disc annulus innervated low back pain (LBP) in the community with a focus on its prevalence, chronicity, and management. Acute low back pain is prevalent, affecting 60-90% of people at some point, with a 5% annual incidence, and is the second to fifth most common reason for visits to primary care specialists. Although most acute cases resolve within 6-12 weeks, chronic LBP remains a significant issue, contributing to disability, expense, and approximately 13 million annual physician visits in the U.S. Back pain is the leading cause of disability among Americans under 45.<br /><br />Veterans experience severe pain at a 40% higher rate than non-veterans, with 33% reporting LBP in a three-month period. Chronic LBP is described as a complex condition affected by physical, psychological, and lifestyle factors, with acute episodes serving as warnings of potential injury. The Veterans Affairs guidelines suggest detailed diagnostic evaluations and caution against unnecessary imaging and invasive tests for acute cases.<br /><br />Treatment recommendations for chronic LBP include cognitive behavioral therapy, mindfulness-based stress reduction, and clinician-directed exercises like Pilates, yoga, and tai chi. For pharmacological management, NSAIDs are recommended for both acute and chronic pain, while the use of benzodiazepines, systemic corticosteroids, and opioids is discouraged.<br /><br />The conference also emphasizes returning patients to active daily living, suggesting graded exercise programs and focusing on functionality when subjective complaints exceed findings. MRI findings often poorly correlate with patients’ symptoms, highlighting the importance of addressing the emotional aspects of pain and promoting an active lifestyle. Overall, the management strategy stresses comprehensive assessment, targeted conservative therapy, and judicious use of imaging and pharmacological methods.

Keywords

disc annulus innervated low back pain

chronic low back pain

prevalence

management

Veterans Affairs guidelines

cognitive behavioral therapy

NSAIDs

graded exercise programs

MRI findings

active lifestyle