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Research ArticleArticle

Evaluation and Treatment of Low Back Pain in Family Practice

Peter A. Rives and Alan B. Douglass
The Journal of the American Board of Family Practice November 2004, 17 (suppl 1) S23-S31; DOI: https://doi.org/10.3122/jabfm.17.suppl_1.S23
Peter A. Rives
MD
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Alan B. Douglass
MD
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  • Article
  • Figures & Data
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Algorithm for evaluation and management of low back pain.

  • Figure 2.
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    Figure 2.

    Sensory dermatomes of the lower extremities.

Tables

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    Table 1.

    Differential Diagnosis of Low Back Pain

    Uncomplicated low back pain
    Disc degeneration
    Uncomplicated sciatica
    Myofascial pain
    Fracture
    Spinal stenosis
    Spinal instability
    Facet arthropathy
    Infection
    Neoplasms
    Referred pain
        Ischemia
        Visceral organ pain
    Congenital deformity
    Neuropathic pain
        Peripheral
        Central
        Complex regional pain syndrome
        Fibromyalgia
    Psychogenic pain
        Litigation-associated pain
        Exaggeration reaction
        Somatization disorders
    Pseudoaddiction
    Drug diversion
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    Table 2.

    Important Historical Factors in Evaluation of Patients with Low Back Pain

    Mechanism of onset
    Location of symptoms
    Duration of pain
    Character of pain
    Neurologic
    Constitutional
    Behavioral
    Medical illness
    Prior surgery/back pain
    Lifestyle/trauma
    Legal/disability issues
    Pharmacologic
    Systems review
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    Table 3.

    Important Components of the Physical Examination in the Evaluation of Low Back Pain

    Inspection
        Muscle symmetry
        Skin
    Palpation
        Bone
        Spinous process
        Sacroiliac joint
        Hip and pelvis
        Muscles
        Trigger points
    Range of motion
        Axial load
        Extension with rotation
    Special tests
        Abdomen
        Rectal exam
        Pelvic exam
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    Table 4.

    Important Components of the Neurologic Examination in the Evaluation of Low Back Pain

    Sensory exam
        Touch
        Attention to dermatomes
    Motor exam
        Strength
        Gait (heel/toe)
        Muscle tone/bulk
        Posture/stance
    Deep tendon reflexes
        Special tests
        Dural signs
        Straight leg raise
        Crossed straight leg raise
        Waddell signs
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The Journal of the American Board of Family Practice: 17 (suppl 1)
The Journal of the American Board of Family Practice
Vol. 17, Issue suppl 1
1 Nov 2004
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Evaluation and Treatment of Low Back Pain in Family Practice
Peter A. Rives, Alan B. Douglass
The Journal of the American Board of Family Practice Nov 2004, 17 (suppl 1) S23-S31; DOI: 10.3122/jabfm.17.suppl_1.S23

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Evaluation and Treatment of Low Back Pain in Family Practice
Peter A. Rives, Alan B. Douglass
The Journal of the American Board of Family Practice Nov 2004, 17 (suppl 1) S23-S31; DOI: 10.3122/jabfm.17.suppl_1.S23
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  • Article
    • Abstract
    • Definitions
    • Prevalence and Natural History
    • Differential Diagnosis
    • Current Standards of Care
    • Evaluation of the Patient with a Diagnosis of Low Back Pain
    • Management of the Patient with Low Back Pain
    • Confounding Factors in the Evaluation and Management of Low Back Pain
    • Conclusions
    • Acknowledgments
    • Notes
    • References
  • Figures & Data
  • References
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