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Parcours de soins pour les lombalgies

Date de la dernière mise à jour : février 2024

Diagnosis

Clinical Cornerstone:

  • Diagnosing LBP requires a patient-centered approach that integrates physical, psychological, and social aspects of pain. A comprehensive diagnostic strategy integrates clinical findings with patient narratives and risk factor evaluations for a complete understanding of the patient's condition.

  • LBP is broadly categorized as either non-specific, where pain or symptomology is not attributed to a distinct pathology like disease or tissue damage, or specific, where it is linked to an underlying condition (e.g., cancer, fracture) or referred from other organs. Lumbar disc herniation causing LBP with radiculopathy, is a common specific cause. Further diagnostic testing is usually required to confirm a specific diagnosis of LBP.

Differential Diagnosis for Low Back Pain

1. Non-specific Low Back Pain

  • Lumbar or lumbo-sacral strain/sprain

  • Degenerative changes/osteoarthritis (e.g., degenerative disc disease, facet arthropathy)

2. Specific Low Back Pain

a) Low Back Pain with Radiculopathy:

  • Herniated nucleus pulposus (disc protrusion or herniation causing nerve root compression)

  • Spinal stenosis (narrowing of the spinal canal leading to nerve compression)

  • Piriformis syndrome

b) Fracture:

  • Vertebral fracture, including compression fracture from osteoporosis

c) Inflammatory and Infectious Causes:

  • Ankylosing spondylitis

  • Osteomyelitis (bone infection)

  • Discitis (intervertebral disc infection)

  • Epidural abscess

d) Neoplastic Causes:

  • Primary spinal tumors

  • Metastatic spinal tumors

 

e) Referred Pain:

  • Hip pathology (e.g., hip osteoarthritis, labral tears)

  • Visceral abdominal conditions (e.g., aortic aneurysm, endometriosis, tubal pregnancy, kidney stones, pancreatitis)

  • Pelvic conditions (e.g., prostatitis, pelvic inflammatory disease)

 

f) Neurological Causes:

  • Peripheral neuropathy (e.g., diabetic neuropathy)

  • Cauda equina syndrome

 

g) Other Causes:

  • Trauma or minor trauma leading to injuries

  • Pregnancy-related back pain

  • Fibromyalgia

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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