Acute Lumbar Back Pain: Investigation, Differential Diagnosis, and Treatment

Background: Back pain has many causes.In Germany, about 70% of adults have at least one episode of back pain per year.Methods: This review is based on a selective literature search and on the German National Disease Management Guideline for Low Back Pain.Results: The physician taking the history from a patient with back pain should ask about the nature, onset, course, localization, and radiation of the pain and its dependence on physical activity and/or emotional stress.In the differential diagnosis, neurologic deficits and any "red flags" suggesting dangerous conditions such as spinal fracture, bacterial infection, and tumors must be ruled out.If no specific cause of the pain can be identified, no imaging studies are indicated on initial presentation.The treatment of acute, nonspecific low back pain focuses on pain relief and functional improvement.Adequate patient education and counseling are essential.Exercise therapy is no more effective than the continuation of normal daily activities.Restriction of activity, including bed rest, is of no benefit and merely prolongs recovery and the resumption of normal activity.Further diagnostic testing is indicated if there is any suspicion of a fracture, infection, or tumor.Conclusion: After dangerous conditions have been ruled out, low back pain can be pragmatically classified as either nonspecific or specific.More research is needed so that the diagnostic assessment and individualized treatment of acute lower back pain can be further refined.