Stat Consult: Chronic Low Back Pain

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The addition of daily exercise to education may prevent LBP in children.
The addition of daily exercise to education may prevent LBP in children.

Description

  • Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months

Incidence/prevalence 

  • 10.2% in United States in 2006
  • 13th most common diagnosis in family physician visits

Possible risk factors 

  • psychosocial factors (not mechanical factors) may be associated with LBP in children
  • overweight/obesity 
  • cigarette smoking

Factors not associated with increased risk

  • epidural anesthesia 
  • occupational factors (such as manual handling or patient-assisting, lifting, pushing, pulling)
  • insufficient evidence to support 
    • bending or twisting 
    • standing or walking

Associated conditions 

  • impaired health-related quality of life in children
  • trochanteric bursitis 
  • sleep disturbances

Causes 

  • cauda equina syndrome
  • specific mechanical causes
    • low back DJD  
    • herniated disk 
    • spinal stenosis
    • vertebral fracture
    • spondylolysis 
    • spondylolisthesis 
    • scoliosis
  • nonmechanical spinal conditions
    • cancer
    • infection (such as osteomyelitis, paraspinous abscess)
    • inflammatory arthritis ( such as ankylosing spondylitis)
    • Crohn disease or ulcerative colitis
    • Paget disease
    • Scheuermann disease (osteochondrosis)
  • visceral disease (nonspinal disease with referred pain) 
    • pelvic organ disease
    • renal disease
    • aortic aneurysm
    • shingles
    • gastrointestinal disease
  • in children, chronic LBP often does not have definitive diagnosis

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