Low Back Pain: A Short Quiz

Low back pain is one of the most frequent problems for which Americans seek medical care. According to one study, about 25% of adults in the US have experienced low back pain of at least 1 day's duration over the past 3 months.¹

The latest guideline on noninvasive treatments for low back pain from the American College of Physicians reviews the evidence for various therapies.² Which are effective-and which are unlikely to be helpful? Answers can be found in the following 5-question quiz.

1. Fill in the blanks: Acute back pain is defined as lasting less than ___ weeks, while chronic back pain lasts ____ weeks or more.

A. 1 weeks, 6 weeks

B. 2 weeks, 8 weeks

C. 3 weeks, 10 weeks

D. 4 weeks, 12 weeks

Please click below for answer, discussion, next question.

Answer: D. 4 weeks, 12 weeks

The American College of Physicians defines acute back pain as lasting less than 4 weeks, and chronic back pain as lasting 12 weeks or more. Subacute back pain is defined as lasting between 4 and 12 weeks.²

2. Which of the following is not included in first-line treatment for chronic low back pain, according to guidelines from the American College of Physicians?

A. Acupuncture

B. NSAIDs

C. Tai chi

D. Yoga

Please click below for answer, discussion, next question.

Answer: B. NSAIDs

According to recommendations from the American College of Physicians, first-line treatment for chronic low back pain includes nonpharmacologic management with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercises, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.² Most of these are supported by low-quality evidence. Only exercise and multidisciplinary rehabilitation are supported by moderate-quality evidence. Consider pharmacotherapy for patients who do not respond to nonpharmacologic treatment.

3. Opioids are considered second-line therapy for chronic back pain.

A. True

B. False

Please click below for answer, discussion, next question.

Answer: B. False

According to guidelines from the American College of Physicians, opioids should be considered only in patients with chronic low back pain who have failed first-line nonpharmacologic therapy, and a trial of pharmacologic therapy with first-line NSAIDs or second-line tramadol or duloxetine.² Opioids should be considered only after careful discussion of risks and benefits, and if the potential benefits outweigh the risks of addiction and dependence.

4. Acute low back pain generally resolves with which of the following:

A. Time

B. Rest

C. Heat

D. Both A and C

Please click below for answer, discussion, next question.

Answer: D. Both A and C

guidelines from the American College of Physicians recommend that clinicians inform all patients with acute low back pain that the condition usually improves with time.² Regardless of treatment, there is a high likelihood of improvement in the first month. Patients should also be advised to remain active as tolerated. Superficial heat and massage have been found to be effective in improving pain and function in patients with acute back pain.

5. Which of the following pharmacotherapies has the strongest evidence supporting its benefit in chronic low back pain?

A. NSAIDs

B. Muscle relaxants

C. Benzodiazepines

D. Corticosteroids

Please click below for answer and discussion.

Answer: A. NSAIDs

According to recommendations from the American College of Physicians, NSAIDs have moderate-quality evidence that suggests small to moderate improvement in chronic low back pain, compared with placebo.² Evidence was low-quality or insufficient for muscle relaxants, benzodiazepines, and corticosteroids.

References:

1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724-2727.

2. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514-530.