jueves, 31 de diciembre de 2009

Low Back Pain, Adult (Guideline) [ICSI-NQMC-AHRQ]

Low Back Pain, Adult (Guideline)

abrir aquí: [pdf - 60 páginas - 2MB]

Scope and Target Population:
Adult patients age 18 and over in primary care who have symptoms of low back pain or sciatica. The focus is on acute and chronic management, including indications for medical, non-surgical or surgical referral. For workers' compensation patients, check with state guidelines where the patient resides and where the injury took place: http://www.workerscompensation.com/workers_comp_by_state.php.

Clinical Highlights and Recommendations:

Back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags" (Cauda Equina syndrome or other conditions) and psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.

Reduce unnecessary imaging unless “red flag” indicators exist.

A conservative approach should be first-line treatment. Emphasize patient education and conservative home self-care, which includes limited bed rest, early ambulation, postural advice, resumption of light-duty activities, use of ice and heat, anti-inflammatory and analgesic over-the-counter medications, and early return to work or activities.

Patients with acute low back pain should be advised to stay active and continue ordinary daily activity within the limits permitted by the pain. For chronic back pain, there is evidence that exercise therapy is effective.

Consult or refer to surgical spine specialist (neurosurgeon, orthopedic surgeon, or other) or non-surgical spine specialist (physical therapist, chiropractic provider, osteopathic or allopathic physician, or other) if conservative treatment fails.
Priority Aims

Improve the assessment and reassessment of adult patients with low back pain.

Reduce unnecessary imaging with adult patients with low back pain in the absence of “red flag” indicators or progressive symptoms.

Increase the use of recommended conservative approach as first-line treatment, such as activity, self-care and analgesics for adult patients with low back pain.

1 comentario:

  1. There was a time in my youth when I felt immortal.

    I was strong. Healthy. Full of life.

    Maybe like you, I felt like I could conquer the world.

    Every day I'd wake up, bursting with energy. Feeling unstoppable.

    I'd go out and exercise full out. Or put in a long day at work. Or go on a weekend adventure with friends to the mountains.

    And at the end of the day? I'd still feel REALLY good.

    Tired, but in a good, relaxing, "hit the sack" kinda way.

    Until one day, it happened.

    I was getting out of the car and for some reason, I twisted my back.

    It immediately seized up. Hunched over with hand on my hip, my muscles spasmed as if to protect it.

    The pain was sharp. Deep. Crippling.

    That was a day I'll never forget. That was the day I realized... I was human.

    Getting out of the car was something I'd done a thousand times before. Why did it happen THAT day, I wondered?

    I've replayed it a thousand times in my head, but I'll never know.

    What I do know is that day set off a chain reaction of events.

    Over the years, more unexpected bouts of pain. Days and even weeks off work.

    Make-you-feel-like-a-zombie pain pills.

    Physical therapy. Alternative therapy. Chiropractic.

    Days of "bed rest" watching Jerry Springer.

    Oh, I hated that term "bed rest." It's so not me.

    Ever since that fateful day, every so often out of the blue, I'll tweak my back again and relive that fateful day as well as the weeks afterward, nursing it back to health.

    Until recently.

    While I was experiencing my most recent painful bout, one of my business partners took pity and shared with me a wonderful natural method that not only relieves back pain in less than 20 minutes, but there's a strong likelihood you'll never have to deal with it again.

    Imagine that!

    I tried it and amazingly, it worked! Within just a few minutes, my back magically "unlocked." The relief was like a warm south Pacific wave, relaxing every muscle in my body.

    After wasting thousands of dollars on useless remedies, days and weeks off work, I was FINALLY FREE from pain.

    I'll be honest. As I've grown older, my experience with back pain has humbled me. When I look at it the right way, maybe it WAS a good thing, because I no longer take my health and body for granted.

    But the great thing is I'm back doing the things I love. Without giving second thought to whether my back will "go out." With this unique method, it's been months since I've experienced even the smallest inkling of pain...

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    All I can say I wish I'd know about this method sooner. But I thank my lucky stars I found it when I did.

    To your health,