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Bel ağrılarına tanısal yaklaşım

Year 2023, Volume: 8 Issue: 2, 49 - 52, 21.03.2023

Hatice Resorlu

https://doi.org/10.22391/fppc.1037655

Abstract

Bel ağrısı birinci basamakta ağrı başvurularında önemli yer tutar. İlk başvuruların % 85’i nonspesifik bel ağrısıdır ve ek değerlendirmeye gerek kalmadan birkaç haftada iyileşir. Myofasiyal ağrı, lomber disk hernisi, spinal stenoz, faset eklem ve disk dejenerasyonu, sakroiliak eklem patolojileri sık görülen mekanik bel ağrısı nedenleridir. Non-mekanik bel ağrıları arasında vertebral korpus ve diskin enfeksiyonları, malign tümör/metastazlar ve inflamatuar hastalıklar yer alır. Bel ağrılı tüm hastalarda ciddi hastalıkları düşündüren kırmızı bayrak semptomları mutlaka değerlendirilmeli ve bu semptomların bulunduğu hastalarda tanı süreci hızlandırılmalıdır. Bel ağrısının kronikleşmesi ile ilgili sarı bayraklar olarak adlandırılan semptomlar psikososyal faktörleri içerir. Tanı sürecinde nonspesifik bel ağrılı hastalarda görüntüleme yöntemlerine gerek kalmadan, ağrının azaldığı gözlenir. Diğer bel ağrısı nedenlerini ayırmada, laboratuvar tetkiklerinden ve görüntüleme yöntemlerinden faydalanılabilir.

Keywords

Bel ağrısı birincil bakım kırmızı bayrak semptomlar pes planus düz tabanlık

References

  • 1. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976).1998;23(17):1860-6. https://doi.org/10.1097/00007632-199809010-00012
  • 2. Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T et al. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):155-65. https://doi.org/10.1016/j.berh.2009.11.002
  • 3. Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796-801. https://doi.org/10.1007/s00586-017-5432-9
  • 4. de Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo AS, Pereira CAB et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo). 2019;74:e789. https://doi.org/10.6061/clinics/2019/e789
  • 5. Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014;98(4):777-89. https://doi.org/10.1016/j.mcna.2014.03.005
  • 6. Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23. https://doi.org/10.1007/s11916-019-0757-1
  • 7. Knezevic NN, Candido KD, Vlaeyen JWS, Zundert JV, Cohen SP. Low back pain. Lancet, 2021;398:78–92. https://doi.org/10.1016/S0140-6736(21)00733-9
  • 8. Walsh JA, Magrey M. Clinical manifestations and diagnosis of axial spondyloarthritis. J Clin Rheumatol. 2021;27(8):e547-60. https://doi.org/10.1001/jama.1992.03490060092030
  • 9. Herndon CM, Zoberi KS, Gardner BJ. Common questions about chronic low back pain. Am Fam Physician. 2015;91(10):708-14. https://pubmed.ncbi.nlm.nih.gov/25978200/
  • 10. Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16(2):120-31. https://doi.org/10.1111/j.1525-1497.2001.91141.x
  • 11. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-70. https://doi.org/10.1056/NEJM200102013440508
  • 12. Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):1144-7. https://doi.org/10.1016/j.pain.2011.12.009
  • 13. Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P et al. Clinical efficacy assessment subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel*. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine. 2007;147(7):478-91. https://doi.org/10.7326/0003-4819-147-7-200710020-00006
  • 14. Chou R, Qaseem A, Owens DK, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181-9. https://doi.org/10.7326/0003-4819-154-3-201102010-00008
  • 15. Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB et al. ACR Appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069-78. https://doi.org/10.1016/j.jacr.2016.06.008
  • 16. Lee SH, Yun SJ, Jo HH, Kim DH, Song JG, Park YS. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation. Skeletal Radiol. 2018;47(4):491-504. https://doi.org/10.1007/s00256-017-2811-6

Diagnostic approach to low back pain

Year 2023, Volume: 8 Issue: 2, 49 - 52, 21.03.2023

Hatice Resorlu

https://doi.org/10.22391/fppc.1037655

Abstract

Low back pain is an important cause of pain referrals in the primary care setting. Overall, 85% of initial admissions are considered to be nonspecific low back pain that resolves in a few weeks without the need for additional evaluation. Myofascial pain, lumbar disc herniation, spinal stenosis, facet joint and disc degeneration, and sacroiliac joint pathologies are common causes of mechanical low back pain. Non-mechanical low back pain includes infections of the vertebral corpus and disc, malignant tumors and metastases, and inflammatory diseases. Red flag symptoms suggestive of serious diseases should be evaluated in all patients with low back pain, and the diagnosis process should be accelerated in patients with these symptoms. The so-called "yellow flags" associated with chronic low back pain include psychosocial factors. In the diagnosis process, pain relief is observed in patients with non-specific low back pain without the need for imaging methods. Laboratory tests and imaging methods can be used to distinguish other causes of low back pain.

Keywords

Low back pain primary care red flag symptoms pes planus flatfoot risk factors

References

  • 1. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976).1998;23(17):1860-6. https://doi.org/10.1097/00007632-199809010-00012
  • 2. Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T et al. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):155-65. https://doi.org/10.1016/j.berh.2009.11.002
  • 3. Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796-801. https://doi.org/10.1007/s00586-017-5432-9
  • 4. de Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo AS, Pereira CAB et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo). 2019;74:e789. https://doi.org/10.6061/clinics/2019/e789
  • 5. Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014;98(4):777-89. https://doi.org/10.1016/j.mcna.2014.03.005
  • 6. Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23. https://doi.org/10.1007/s11916-019-0757-1
  • 7. Knezevic NN, Candido KD, Vlaeyen JWS, Zundert JV, Cohen SP. Low back pain. Lancet, 2021;398:78–92. https://doi.org/10.1016/S0140-6736(21)00733-9
  • 8. Walsh JA, Magrey M. Clinical manifestations and diagnosis of axial spondyloarthritis. J Clin Rheumatol. 2021;27(8):e547-60. https://doi.org/10.1001/jama.1992.03490060092030
  • 9. Herndon CM, Zoberi KS, Gardner BJ. Common questions about chronic low back pain. Am Fam Physician. 2015;91(10):708-14. https://pubmed.ncbi.nlm.nih.gov/25978200/
  • 10. Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16(2):120-31. https://doi.org/10.1111/j.1525-1497.2001.91141.x
  • 11. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-70. https://doi.org/10.1056/NEJM200102013440508
  • 12. Vlaeyen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012;153(6):1144-7. https://doi.org/10.1016/j.pain.2011.12.009
  • 13. Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P et al. Clinical efficacy assessment subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel*. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of internal medicine. 2007;147(7):478-91. https://doi.org/10.7326/0003-4819-147-7-200710020-00006
  • 14. Chou R, Qaseem A, Owens DK, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181-9. https://doi.org/10.7326/0003-4819-154-3-201102010-00008
  • 15. Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB et al. ACR Appropriateness criteria low back pain. J Am Coll Radiol. 2016;13(9):1069-78. https://doi.org/10.1016/j.jacr.2016.06.008
  • 16. Lee SH, Yun SJ, Jo HH, Kim DH, Song JG, Park YS. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation. Skeletal Radiol. 2018;47(4):491-504. https://doi.org/10.1007/s00256-017-2811-6
There are 16 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Review Article
Authors

Hatice Resorlu 0000-0001-9889-1064

Publication Date March 21, 2023
Submission Date December 16, 2021
Acceptance Date March 7, 2023
Published in Issue Year 2023 Volume: 8 Issue: 2

Cite

APA Resorlu, H. (2023). Diagnostic approach to low back pain. Family Practice and Palliative Care, 8(2), 49-52. https://doi.org/10.22391/fppc.1037655
AMA Resorlu H. Diagnostic approach to low back pain. Fam Pract Palliat Care. March 2023;8(2):49-52. doi:10.22391/fppc.1037655
Chicago Resorlu, Hatice. “Diagnostic Approach to Low Back Pain”. Family Practice and Palliative Care 8, no. 2 (March 2023): 49-52. https://doi.org/10.22391/fppc.1037655.
EndNote Resorlu H (March 1, 2023) Diagnostic approach to low back pain. Family Practice and Palliative Care 8 2 49–52.
IEEE H. Resorlu, “Diagnostic approach to low back pain”, Fam Pract Palliat Care, vol. 8, no. 2, pp. 49–52, 2023, doi: 10.22391/fppc.1037655.
ISNAD Resorlu, Hatice. “Diagnostic Approach to Low Back Pain”. Family Practice and Palliative Care 8/2 (March2023), 49-52. https://doi.org/10.22391/fppc.1037655.
JAMA Resorlu H. Diagnostic approach to low back pain. Fam Pract Palliat Care. 2023;8:49–52.
MLA Resorlu, Hatice. “Diagnostic Approach to Low Back Pain”. Family Practice and Palliative Care, vol. 8, no. 2, 2023, pp. 49-52, doi:10.22391/fppc.1037655.
Vancouver Resorlu H. Diagnostic approach to low back pain. Fam Pract Palliat Care. 2023;8(2):49-52.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505