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Parcours de soins pour les lombalgies

Date de la dernière mise à jour : février 2024

Diagnosis for Non-specific Low Back Pain (NSLBP)

Clinical Cornerstone:

  • Diagnosis is primarily clinical, relying on patient history and clinical examination, and aims to exclude identifiable pathologies.

  • Definition: LBP not attributable to a discernible, specific pathology (e.g., infection, tumor, osteoporosis, lumbar disc herniation).

  • Prevalence: Approximately 90% of all LBP cases.

  • Risk Factors: Include low physical activity levels, smoking, obesity, and high physical stress at work.

  • Pain Location: Localized below the costal margin and above the inferior gluteal folds, with or without leg pain.

  • Duration: Pain can be acute (lasting less than 6 weeks), subacute (6 to 12 weeks), or chronic (more than 12 weeks).

  • Signs and Symptoms:

    • Pain can be sharp, dull, shooting, or aching.

    • Pain intensity can vary from mild to severe.

    • Pain may be aggravated by specific movements, postures, or activities and relieved by others.

    • There may be associated muscle stiffness or spasms.

    • Referred pain into the legs may or may not be present but does not commonly extend below the knee

  • Neurological Examination: Typically, there are no neurological deficits. If present, they are mild and do not follow a specific nerve root distribution.

  • Response to Conservative Management: Often responds to conservative treatments such as education, exercise, and manual therapy.

  • Psychosocial Factors: Consider psychosocial factors (yellow flags) that might influence pain perception and recovery (e.g., beliefs about pain, fear of movement, catastrophizing).

Conduct patient assessment

Red flags present

Red flags present

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Refer to appropriate emergency or healthcare provider

Non-specific LBP or LBP with radiculopathy:

  • Education

  • Self-care

  • Exercise

  • Manual therapy

  • Medicines

  • Psychological therapy

  • Social support

  • Mind-body interventions

  • Needling therapies, electrotherapies*

  • Mobility assistive devices

  • Multicomponent biopsychosocial care

  • Topical ceyenne pepper

Additionally for LBP with radiculopathy:

  • Medical/surgical consultations

Other specific LBP:

  • Refer to appropriate emergency or healthcare provider

Major symptom/sign change

Goals not achieved

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

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