Low back pain: an approach to diagnosis and management

Low back pain is a common condition, responsible for significant morbidity and major occupational and economic impact on society. While most cases of low back pain spontaneously resolve, the clinician must be alert to clinical indicators or "red flags" that suggest the presence of systemic illness or imminent neurologic compromise. In the absence of such findings, diagnostic imaging generally does not contribute to management, and may be safely delayed for a trial of conservative therapy. Continued activity is associated with a favorable outcome. Nonsteroidal anti-inflammatories, acetaminophen, muscle relaxants, and tricyclic antidepressants can provide meaningful pain relief, while several nonpharmacologic measures may also contribute to symptomatic and functional improvement.