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Medical Review - Articles by Medical Review Staff

September 3, 2004

Acute Low Back Pain – update August 24, 2004

By Howell Johnson, M.D., Associate Medical Director

Acute low back pain (duration of less than three months) with or without radiculopathy is one of the most common health problems. Uncomplicated acute low back pain is a benign, self-limited condition that does not warrant imaging studies. The vast majority of these patients are back to their usual activities in 30 days.

Plain film x-rays prior to certain treatment such as epidural injections or manual manipulations may be indicated.

Indications of a more complicated status are often termed “red flags.” Imaging studies are considered medically necessary for acute low back pain when any of the following red flags are present:

  1. Recent significant trauma or milder trauma age greater than 50.
  2. Unexplained weight loss.
  3. Unexplained fever.
  4. Immunosuppression
  5. History of cancer.
  6. Intravenous illicit drug use.
  7. Prolonged use of corticosteroids, osteoporosis.
  8. Age greater than 70.

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  1. Expert panel on neurologic Imaging. American College of Radiology ACR appropriateness criteria. http://www.acr.org
  2. Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research. Clin Pract Guide Quick Ref Guide Clin 1994; (14)iii-iv:1-25.
  3. Deyo, R.A., Weinstein, J.N. Low Back Pain. N. Engl J Med 2001; 344:363-370.
  4. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain

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