Please forgive the slight inconvenience in creating a new account. Due to juvenile delinquents spamming garbage to the site, we had to install a "Captcha", which can differentiate a spam bot from a human. Once you open your account, confirm it by returning the email, and identifying yourself, we will give you edit privileges. Just request them by leaving a message at click here.

Low back

From English WikiChiro
Jump to: navigation, search
Low back pain
Lumbar region in human skeleton.png

The five vertebrae in the lumbar region of the back are the largest and strongest in the spinal column.
ICD-10 M54.4-M54.5
ICD-9 724.2
MedlinePlus 003108
eMedicine pmr/73
MeSH D017116

Low back pain ( or lumbago) is a common musculoskeletal disorders affecting 80% of people at some point in their life. It accounts for more sick leave and disability than any other medical condition.[1] It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.

The causes of lower back pain are varied. A traumatic event may result in either muscular pain or a vertebral fractures. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, degeneration of a facet joint a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor.

Low Back pain is certainly one of the most costly conditions afflicting our society today. Due to the enormity of the problem caused by low back pain and associated disability, effective strategies to lower the costs of treatment and disability/indemnity have become a top priority in the United States. Based upon the evidence, care rendered by chiropractic physicians, along with other conservative measures, should be promoted as first-line treatment, instead of the treatment of last resort.

To further highlight the issue, researchers in 2008 attempted to conduct a systematic review of low back pain cost of illness in the United States and internationally. The researched conducted a systematic review of the literature and found that many studies have attempted to determine the costs associated with the treatment of low back pain. While the studies examined use a variety of methodologies many indicate that the costs of care for this ailment is substantial. Researchers determined that additional studies which would provide an estimate of the cost of low back pain with its associated costs from a societal perspective would be helpful in determining how to allocate health care resources. [2]

In one of the most important papers to be released, researchers in 2007 sought to determine the benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical= nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). Researchers conducted MEDLINE searchers and the Cochrane Database of Systematic Reviews and graded the methodologies of the studies. Researchers concluded that there was good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation were moderately effective for chronic or subacute low back pain. [3]

Recurrent Nature of Back Pain

Quite often the healing time related to soft tissue injury is reported to be "self-limiting" with 90+% of patient recovering within 6-8 weeks. However, many researchers now feel that the original concepts of soft tissue healing were overly optimistic. In one study the researchers sought to determine the one year prognosis of patients with low back pain. In this study, 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the prognosis for the patients in the study. Recovery was slow for most patients and almost 1/3 of patients did not recover within one year. [4]

Classification

One method of classifying lower back pain is by the duration of symptoms: acute (less than 4 weeks), sub acute (4–12 weeks), chronic (greater than 12 weeks).

Causes

Most cases of lower back pain are due to benign musculoskeletal problems and are referred to by the medical people, as non specific low back pain. The rate of serious causes is less than 1%.[5] The full differential diagnosis includes many other less common conditions.

Diagnosis

As Chiropractors are considered Physicians in the majority of the States, and the Federal Government, and today, are well trained as such to diagnose your problems, a complete evaluation will be performed by your doctor.

Acute back pain is defined as pain less than 6 weeks duration, while chronic back pain is defined as pain that has been present for over three months. The intermediate time period is known as sub acute back pain.[6] Determination of the underlying cause is usually made through a combination of a medical history, physical examination, and, when necessary, diagnostic testing, such as an x-ray, CT scan, or MRI.

Imaging

NB: Chiropractic Physicians are trained to take or order, and interpret x-rays and other imaging methods, like MRI or CT-scans, as well as ordering and interpreting laboratory tests, to determine if your problem is a Medical, Surgical or Chiropractic problem. If they determine it is not a case suitable for Chiropractic care, then the Doctor of Chiropractic is required by law to send you to a specialist who can appropriately treat your condition.

X-rays and CT scans are not required in every lower back pain case, except where "red flags" are present.[7] If the pain is of a long duration X-rays may increase patient satisfaction.[8]

Red flags

  • Milder trauma if age is greater than 50 years
  • Unexplained weight loss
  • Unexplained fever
  • Intravenous drug use
  • Osteoporosis
  • Chronic corticosteroid use
  • Age greater than 70 years
  • Focal neurological deficit
  • Duration greater than 6 weeks[9]

Management

Medical (non chiropractic) approach

Due to the issues of standards of practice will generally start with a physical examination, similar to that which a Doctor of Chiropractic will perform; then you will probably be referred to an Orthopedic Surgeon, if medications don't relieve your pain in a short time. The Orthopedic surgeon will usually refer you to a Physical therapist for a course of treatment, usually around six weeks of traction, ultrasound, massage or electrical stimulation which when it fails to cure the problem, as it does not address the cause of the problem, is to prepare you for their next course of action; a recommendation of surgery.

Medications

Pain medications, such as NSAIDs or acetaminophen can help with the symptoms of lower back pain.[10][11] Muscle relaxants for acute[10] and chronic[11] pain have some benefit, however, there are concerns with side effects, and their routine use is discouraged. And, if you are receiving Chiropractic care, they are generally contraindicated, as they lengthen the treatment time.[12]

Chiropractic management

For the vast majority of patients, low back pain can be treated by Chiropractic methods. A systematic review of randomized controlled trials made a number of recommendations[13]:

Spinal manipulation vs Chiropractic adjustment

The vast majority of studies which have fairly included a Doctor of Chiropractic providing the manipulation, have shown that Chiropractic was vastly superior to any other means of treating low back pain. Significant 1990 and then 1995 studies published in the British Medical Journal, involving respectively 741 patients, and then in a follow-up "Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain." [14] [15]

As if it could not be predicted, most MEDICAL studies, involving manipulation, are performed without involving a Doctor of Chiropractic, and those reviews and guidelines have found that spinal manipulation (SM) therapy for low back pain of unknown cause is of no benefit beyond standard conservative management.[16][17] A 2007 U.S. guideline weakly recommended SM as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail,[18] well the Swedish guideline for low back pain in 2002 does not recommend considering SM therapy for acute low back pain in patients needing additional help, possibly because the guideline's recommendations were based on a higher evidence level.[16] A 2008 review found that SM is similar to other forms of conventional care.[19] A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain.[20] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[21] stated that SM or mobilization is no more or less effective than other standard interventions for back pain.[22] A 2008 systematic review found insufficient evidence to make any recommendations concerning medicine-assisted manipulation for chronic low back pain.[23]

A 2007 U.S. guideline weakly recommending MEDICAL SM as one alternative therapy for spinal low back pain in nonpregnant adults, was only a weak endorsement, and predictably only when drugs and PT (ordinary) treatments fail,[24] well the Swedish guideline for low back pain in 2002 does not recommend considering SM therapy for acute low back pain in patients needing additional help, possibly because the guideline's recommendations were based on a higher evidence level.[16] A 2008 review found that SM is similar to other forms of conventional care.[19] A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain.[20] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[25] stated that SM or mobilization is no more or less effective than other standard interventions for back pain.[26] A 2008 systematic review found insufficient evidence to make any recommendations concerning medicine-assisted manipulation for chronic low back pain.[27]

In another study 102 patients with acute back pain and/or leg pain of moderate to severe intensity and MRI evidence of disc protrusion were treated with spinal manipulation or simulated manipulation. The patients received a maximum of 30 manipulations or simulated manipulations over a 30 day period. 28% of the manipulation group became pain-free locally vs. only 6% in the sham group. 55% of the manipulation group experienced absence of radicular symptoms compared to 20% of the no manipulation group. The manipulation group also had a significant decrease in use and prescriptions for NSAIDs. [28]

Other management methods common to both professions

Activity

Staying physically active as opposed to bed rest leads to faster recovery.[10][29] Structured exercise in acute low back pain however lead to neither improvement or harm.[30]

Chronic back pain

Chiropractic should be the FIRST course of any treatment for back pain, once cancer, infection and fracture have been ruled out; but failing that,

The following measures are used by the medical profession, when drugs and surgery fail to bring results, and have been found to be occasionally effective for chronic non-specific back pain:

Surgery

Surgery may be indicated as a "last resort" when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurological symptoms such as leg weakness, bladder or bowel incontinence, which can be seen with severe central lumbar disc herniation causing cauda equina syndrome or spinal abscess.[citation needed] Spinal fusion has been shown not to improve outcomes in those with simple chronic low back pain.[37]

The most common types of low back surgery include microdiscectomy, discectomy, laminectomy, foraminotomy, or spinal fusion. Another less invasive surgical technique consists of an implantation of a spinal cord stimulator and typically is used for symptoms of chronic radiculopathy (sciatica). Lumbar artificial disc replacement is a newer surgical technique for treatment of degenerative disc disease, as are a variety of surgical procedures aimed at preserving motion in the spine.

A medical review in March 2009 found the following. Four randomised clinic trials showed the benefits of spinal surgery are limited when treating degenerative discs with spinal pain (no sciatica). Between 1990-2001 there was a 220% increase in spinal surgery despite there being no changes, clarifications or improvements in the indications for surgery or improved effectiveness of spinal surgery. The review also found that higher spinal surgery rates are sometimes associated with worse outcomes and the best surgical outcomes occurred where surgery rates where lower. It also found that use of surgical implants increased the risk of nerve injury, blood loss, overall complications, operating times and repeat surgery while only slightly improved solid bone fusion rates. There was no added improvement in pain levels or function.[38]

Other therapies that might have some benefit

  • Correcting leg length difference may help by inserting a heel lift or building up the shoe.[39] Though it is likely that having a gait evaluation, and proper orthoses (orthotics) fitted and then re-checking the leg length, (after a course of CMT), would be a preferable approach to a simple lift.

Additionally, these treatments have been more recently reviewed by the Cochrane Collaboration:

  • Heat application may feel good, though it is usually better to use ice massage. However, the scientific evidence for cold therapy is limited.[41]
  • Yoga has been found beneficial.[42][43]
  • The role of narcotics for chronic low back pain is uncertain.[44]
  • A 2008 review found antidepressants ineffective in the treatment of chronic back pain[45] even though some previous studies did find them helpful.[11]

Prognosis

Most patients with acute lower back pain recover completely over a few weeks regardless of treatments.[46][47]

Epidemiology

Over a life time 80% of people have lower back pain,[47] with 26% of United States adults reporting pain of at least one day in duration every three months.[48]

See also

References

  1. ↑ "Lower Back Pain Fact Sheet. nih.gov". http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Retrieved 2008-06-16. 
  2. ↑ Dagenais, S; Caro, J; Haldeman, S (2008 Jan-Feb). "A Systematic Review of Low Back Pain Cost of Illness Studies in the United States and Internationally". The Spine Journal 8 (1): 8-20. http://www.ncbi.nlm.nih.gov/pubmed?term=A%20Systematic%20Review%20of%20Low%20Back%20Pain%20Cost%20of%20Illness%20Studies%20in%20the%20United%20States%20and%20Internationally. Retrieved 6/07/2012. 
  3. ↑ Chou, R et al (2007 Oct 2). "Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med 147 (7): 492-504. http://www.ncbi.nlm.nih.gov/pubmed/17909210. Retrieved 3/09/2013. 
  4. ↑ Refshauge, KM (2008 July). "Prognosis in Patients With Recent Onset Low Back Pain in Australian Primary Care: Inception cohort study". British Medical Journal 337 (a171). http://www.ncbi.nlm.nih.gov/pubmed?term=Prognosis%20in%20Patients%20With%20Recent%20Onset%20Low%20Back%20Pain%20in%20Australian%20Primary%20Care%3A%20Inception%20cohort%20study. Retrieved 6/5/2012. 
  5. ↑ Henschke N, Maher CG, Refshauge KM, et al. (October 2009). "Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain". Arthritis Rheum. 60 (10): 3072–80. doi:10.1002/art.24853. PMID 19790051. 
  6. ↑ Bogduk M (2003). "Management of chronic low back pain". Medical Journal of Australia 180 (2): 79–83. PMID 14723591. http://www.mja.com.au/public/issues/180_02_190104/bog10461_fm.html. 
  7. ↑ "Imaging strategies for low-back pain: systematic review and meta-analysis : The Lancet". http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60172-0/fulltext. 
  8. ↑ "BestBets: Early radiography in acute lower back pain". http://www.bestbets.org/bets/bet.php?id=867. 
  9. ↑ "www.acr.org". http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonNeurologicImaging/LowBackPainDoc7.aspx. 
  10. ↑ 10.0 10.1 10.2 10.3 Koes B, van Tulder M (2006). "Low back pain (acute)". Clinical evidence (15): 1619–33. PMID 16973062. http://clinicalevidence.bmj.com/ceweb/conditions/msd/1102/1102.jsp. 
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 van Tulder M, Koes B (2006). "Low back pain (chronic)". Clinical evidence (15): 1634–53. PMID 16973063. http://clinicalevidence.bmj.com/ceweb/conditions/msd/1116/1116.jsp. 
  12. ↑ "BestBets: Muscle relaxants for acute low back pain". http://www.bestbets.org/bets/bet.php?id=878. 
  13. ↑ "Clinical Evidence: The international source of the best available evidence for effective health care". http://clinicalevidence.com/+ClinicalEvidence.com. 
  14. ↑ T W Meade, S Dyer, W Browne, J Townsend, A O Frank (1990). "Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment". British Medical Journal 300: 1431-1437. doi:10.1136/bmj.300.6737.1431. http://www.bmj.com/cgi/content/abstract/300/6737/1431. 
  15. ↑ T W Meade, S Dyer, W Browne, J Townsend, A O Frank (1995). "Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up". British Medical Journal 311: 349-351. http://www.bmj.com/cgi/content/abstract/311/7001/349. 
  16. ↑ 16.0 16.1 16.2 Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948. http://jmptonline.org/article/S0161-4754(06)00186-2/fulltext. 
  17. ↑ Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958. 
  18. ↑ Chou R, Qaseem A, Snow V et al. (October 2, 2007). "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society". Ann Intern Med 147 (7): 478–91. PMID 17909209. http://annals.org/cgi/content/full/147/7/478. 
  19. ↑ 19.0 19.1 Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469. 
  20. ↑ 20.0 20.1 Meeker W, Branson R, Bronfort G et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. http://ccgpp.org/lowbackliterature.pdf. Retrieved 2008-03-13. 
  21. ↑ Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958. 
  22. ↑ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. PMC 1420782. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22). 
  23. ↑ Dagenais S, Mayer J, Wooley JR, Haldeman S (2008). "Evidence-informed management of chronic low back pain with medicine-assisted manipulation". Spine J 8 (1): 142–9. doi:10.1016/j.spinee.2007.09.010. PMID 18164462. 
  24. ↑ Chou R, Qaseem A, Snow V et al. (October 2, 2007). "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society". Ann Intern Med 147 (7): 478–91. PMID 17909209. http://annals.org/cgi/content/full/147/7/478. 
  25. ↑ Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958. 
  26. ↑ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. PMC 1420782. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22). 
  27. ↑ Dagenais S, Mayer J, Wooley JR, Haldeman S (2008). "Evidence-informed management of chronic low back pain with medicine-assisted manipulation". Spine J 8 (1): 142–9. doi:10.1016/j.spinee.2007.09.010. PMID 18164462. 
  28. ↑ Finucci, S (2006 Mar-Apr). "Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations". Spine J 6 (2): 131-7. http://www.ncbi.nlm.nih.gov/pubmed?term=Chiropractic%20manipulation%20in%20the%20treatment%20of%20acute%20back%20pain%20and%20sciatica%20with%20disc%20protrusion%3A%20a%20randomized%20double-blind%20clinical%20trial%20of%20active%20and%20simulated%20spinal%20manipulations. Retrieved 6/22/2012. 
  29. ↑ Hagen KB, Hilde G, Jamtvedt G, Winnem M (2004). "Bed rest for acute low-back pain and sciatica". Cochrane Database Syst Rev (4): CD001254. doi:10.1002/14651858.CD001254.pub2. PMID 15495012. 
  30. ↑ 30.0 30.1 Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005). "Exercise therapy for treatment of non-specific low back pain". Cochrane Database Syst Rev (3): CD000335. doi:10.1002/14651858.CD000335.pub2. PMID 16034851. 
  31. ↑ Weiss HR, Scoliosis-related pain in adults: Treatment influences. Eur J Phys Med Rehabil 1993; 3(3):91-94.
  32. ↑ King SA (July 1, 2008). "Update on Treatment of Low Back Pain: Part 2". Psychiatric Times 25 (8). http://www.consultantlive.com/pain/article/10168/1167024. 
  33. ↑ Haake M, Müller HH, Schade-Brittinger C, et al. (2007). "German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups". Arch. Intern. Med. 167 (17): 1892–8. doi:10.1001/archinte.167.17.1892. PMID 17893311. 
  34. ↑ Paul Little et al.,Randomised controlled trial of Alexander technique (AT) lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain,British Medical Journal, August 19, 2008.
  35. ↑ "BestBets: Are back schools effective in the management of chronic simple low back pain?". http://www.bestbets.org/bets/bet.php?id=1029. 
  36. ↑ Chou R, Loeser JD, Owens DK, et al. (May 2009). "Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society". Spine 34 (10): 1066–77. doi:10.1097/BRS.0b013e3181a1390d. PMID 19363457. 
  37. ↑ "BestBets: Spinal fusion in chronic back pain". http://www.bestbets.org/bets/bet.php?id=909. 
  38. ↑ "Overtreating chronic back pain: time to back off? Deyo.A et.al, Journal of the American Board of Family Medicine, March 2009". http://www.jabfm.org/cgi/content/full/22/1/62. 
  39. ↑ Defrin R, Ben Benyamin S, Aldubi RD, Pick CG (2005). "Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain". Archives of physical medicine and rehabilitation 86 (11): 2075–80. doi:10.1016/j.apmr.2005.06.012. PMID 16271551. 
  40. ↑ Furlan AD, Brosseau L, Imamura M, Irvin E (2002). "Massage for low back pain". Cochrane database of systematic reviews (Online) (2): CD001929. doi:10.1002/14651858.CD001929. PMID 12076429. 
  41. ↑ French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ (2006). "Superficial heat or cold for low back pain". Cochrane database of systematic reviews (Online) (1): CD004750. doi:10.1002/14651858.CD004750.pub2. PMID 16437495. 
  42. ↑ Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA (2005). "Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial". Ann. Intern. Med. 143 (12): 849–56. PMID 16365466. 
  43. ↑ Williams KA, Petronis J, Smith D, et al. (2005). "Effect of Iyengar yoga therapy for chronic low back pain". Pain 115 (1-2): 107–17. doi:10.1016/j.pain.2005.02.016. PMID 15836974. 
  44. ↑ Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D (2007). "Opioids for chronic low-back pain". Cochrane database of systematic reviews (Online) (3): CD004959. doi:10.1002/14651858.CD004959.pub3. PMID 17636781. 
  45. ↑ Urquhart DM, Hoving JL, Assendelft WW, Roland M, van Tulder MW (2008). "Antidepressants for non-specific low back pain". Cochrane Database Syst Rev (1): CD001703. doi:10.1002/14651858.CD001703.pub3. PMID 18253994. 
  46. ↑ "BestBets: Prognosis in acute non-traumatic simple lower back pain". http://www.bestbets.org/bets/bet.php?id=860. 
  47. ↑ 47.0 47.1 Urquhart DM, Hoving JL, Assendelft WW, Roland M, van Tulder MW (2008). "Antidepressants for non-specific low back pain". Cochrane Database Syst Rev (1): CD001703. doi:10.1002/14651858.CD001703.pub3. PMID 18253994. 
  48. ↑ Deyo RA, Mirza SK, Martin BI (November 2006). "Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002". Spine 31 (23): 2724–7. doi:10.1097/01.brs.0000244618.06877.cd. PMID 17077742. 

External links

v • d • e
Chiropractic
Specialties in Chiropractic
Conditions and studies
Asthma · Allergy · Colic · Blood Pressure · Low back pain · Misc Conditions · Neck  · Safety · Sciatica
Chiropractic methods
Education
Accrediting Bodies
CCEI · CCE · CCEA · CFCREAB · ECCE
Licensing and Regulation
Ethics
National Organizations
ACA · BCA · CCA · ICA  · COCSA
WHO/UNESCO recognized World Agencies
WFC · FICS
Other Organizations
IAOCO · ISCA · WCA
Peer Reviewed Journals
Trade publications
Online resources
Chiropractors
Legal and Insurance issues
Historical concepts and critique/response
v • d • e
Dorsopathies / spinal disease (M40-M54, 720-724,737)
Deforming dorsopathies
Other
Spondylopathy
Back pain
Intervertebral disc disorder
joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc
v • d • e
Pain and nociception
Head and neck
Thorax
Abdominal
Limbs
Joints (arthralgia)
Musculoskeletal
Other/unspecified
Related concepts
Wikipedia-logo.png
 The basis of this article is contributed from Wikipedia. These articles are licensed under the GNU Free Documentation License It may have since been edited beyond all recognition. But we thank Wikipedia for allowing its use. Please discuss further on this Article's talk page.
he:מתנת

nl:Lumbago ja:腰痛 no:Lumbago pl:Lumbago pt:Lumbago ru:Люмбаго fi:Noidannuoli sv:Ryggskott tr:Lumbago zh:下背痛

Retrieved from "http://wikichiro.org/en/index.php?title=Low_back&oldid=13048"