Back pain

Introduction
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By Richard S Polin MD

Back pain remains an evolving and controversial topic in modern medicine and a multidisciplinary field that involves specialists in neurology, neurosurgery, orthopedic surgery, rheumatology, physiatry, and occupational medicine. In this clinical article, Dr. Richard Polin of George Washington University discusses the multifactorial etiologies of back pain and addresses controversies in terms of diagnostic workup, conservative management, and the role of and indications for operative management, including disc replacement. In this annual update, the author includes emerging data on comparative efficacy of fusion, arthroplasty, and nonoperative care.

Key points

  • Lumbar pain is multifactorial and entails great societal costs.
  • Conservative care including anti-inflammatory therapy and physical therapy should be the first treatment unless trauma, infection, or tumor is suspected.
  • Surgical approaches to back pain are controversial unless overt instability is apparent.