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Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and

Treatment

Article  in  Current Pain and Headache Reports · March 2019

DOI: 10.1007/s11916-019-0757-1

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University of Massachusetts Medical School
eScholarship@UMMS
Senior Scholars Program School of Medicine

2019-03-27

Low Back Pain, a Comprehensive Review:

Pathophysiology, Diagnosis, and Treatment
(poster)
Ivan Urits
Harvard Medical School

Aaron Burshtein
Hofstra-Northwell Health System

Medha Sharma
Harvard Medical School

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Repository Citation
Urits, Ivan; Burshtein, Aaron; Sharma, Medha; Testa, Lauren; Gold, Peter A.; Orhurhu, Vwaire; Viswanath, Omar; Jones, Mark R.;
Sidransky, Moises A.; and Kaye, Alan D., "Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment
(poster)" (2019). University of Massachusetts Medical School. Senior Scholars Program. Paper 268.
https://escholarship.umassmed.edu/ssp/268

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Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis,
and Treatment (poster)
Authors
Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath,
Mark R. Jones, Moises A. Sidransky, and Alan D. Kaye

Keywords
low back pain, diagnosis, pathophysiology, treatment

Comments
Lauren Testa participated in this study as a medical student as part of the Senior Scholars research program at
the University of Massachusetts Medical School. Her work was presented on Senior Scholars Program Poster
Presentation Day at the University of Massachusetts Medical School, Worcester, MA, on May 1, 2019.

Rights and Permissions

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This poster is available at eScholarship@UMMS: https://escholarship.umassmed.edu/ssp/268

 Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment
Ivan Urits, MD1; Aaron Burshtein2; Medha Sharma1; Lauren Testa16; Peter A. Gold, MD2; Vwaire Orhurhu, MD MPH1; Omar Viswanath, MD3; Mark R. Jones, MD1; Moises A. Sidransky, MD4; Alan
D. Kaye, MD PhD5
1 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215.
2 Department of Orthopedic Surgery, Hofstra-Northwell Health System, Great Neck, NY 11021.
3 Valley Anesthesiology and Pain Consultants, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Omaha, NE
4 UT Health East Texas Physicians, Department of Anesthesiology, Tyler, TX, USA.
5 Louisiana State University Health Science Center, Department of Anesthesiology, New Orleans, LA, USA. 70112.
6 University of Massachusetts Medical School, Worcester, MA. 01604

Purpose of Review Diagnostic and Therapeutic Approach to the Patient with Low Back Pain Conclusions
Low back pain encompasses three distinct sources: axial Multidisciplinary approach to treatment:
Patient with low back pain
lumbosacral, radicular, and referred pain. Annually, the • Lower back pain management varies from person to
prevalence of low back pain in the general U.S. adult person, as not all patients respond to the same
population is 10-30%, and the lifetime prevalence Perform a history and treatment approach, and no single intervention is
among U.S. adults is as high as 65-80%. physical evaluating: generally completely effective for all patients.
Recent Findings: Patient history, physical exam, and • Duration • Consequently, limited trials of one or more
diagnostic testing are important components to accurate • Red Flags interventions guided by evidence and effectiveness
diagnosis and identification of patient pathophysiology. • Yellow Flags are utilized to manage the pain, while aiming to
Etiologies of low back pain include myofascial pain, facet decrease overall costs.
joint pain, sacroiliac joint pain, discogenic pain, spinal
stenosis, and failed back surgery. In chronic back pain Yes • Pertinent courses of care include pharmacological
Are there any serious Perform diagnostic studies
patients, a multidisciplinary, logical approach to treatments, psychological treatments, physical and
conditions suspected? to find cause
treatment is most effective and can include multimodal rehabilitation treatments, complementary and
medical, psychological, physical, and interventional alternative medicine approaches, and minimally
approaches. Discuss conservative invasive percutaneous approaches.
treatment options:
Summary: Low back pain is a difficult condition to
effectively treat and continues to affect millions of
• Pharmacologic References
• Non Pharmacologic • Atlas SJ, Deyo RA. Evaluating and managing acute
Americans every year. In the current investigation, we
present a comprehensive review of low back pain and low back pain in the primary care setting. J Gen
discuss associated pathophysiology, diagnosis, and Intern Med 2001;16:120–131.
Assess response to • Bogduk N. On the definitions and physiology of back
treatment.
treatment pain, referred pain, and radicular pain. Pain 2009;
147:17–19.
Overview of Low Back Pain • Chou R, Qaseem A, Snow V, Casey D, Cross JT,
Continue conservative Shekelle P, et al. Diagnosis and treatment of low back
Low back pain encompasses three distinct sources: axial Back pain resolved or Yes
treatment and follow up in pain: A joint clinical practice guideline from the
lumbosacral, radicular, and referred pain improved?
1 month American College of Physicians and the American
• Axial lumbosacral back pain refers to pain in the Pain Society. Ann Intern Med 2007;147:478.
lumbar, or L1-5 vertebral region, and sacral spine, or • Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et
S1 to sacrococcygeal junction region. Reassess symptoms and
risk factors and re- al. The global burden of low back pain: estimates
• Radicular leg pain travels into an extremity along a from the Global Burden of Disease 2010 study. Ann
evaluate diagnosis.
dermatomal distribution secondary to nerve or dorsal Rheum Dis;2014;73:968–74.
Consider imaging studies.
root ganglion irritation. • Samanta J, Kendall J, Samanta A. 10-minute
• Referred pain spreads to a region remote from its consultation: chronic low back pain. BMJ 2003;
source but along a non-dermatomal trajectory. 326:535.
Consider alternative
pharmacologic and non- Acknowledgements
Chronicity: acute (<6 weeks), subacute (6-12 weeks), pharmacologic Thank you to the University of Massachusetts Medical School
and chronic (>12 weeks) low back pain interventions Senior Scholars Program for the opportunity to research and
present my work.

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