"Acute low back pain with or without sciatica usually is self-limited and has no serious underlying pathology," writes Scott Kinkade, MD, MSPH, from the University of Texas Southwestern Medical School in Dallas. "For most patients, reassurance, pain medications, and advice to stay active are sufficient. A more thorough evaluation is required in selected patients with 'red flag' findings associated with an increased risk of cauda equina syndrome, cancer, infection, or fracture."
Specific findings necessitating greater concern, more thorough workup, and closer monitoring include age older than 50 years; fevers; chills; recent urinary tract or skin infection; penetrating wound near spine; significant trauma; unrelenting night pain or pain at rest; progressive motor or sensory deficit; saddle anesthesia; bilateral sciatica or leg weakness; difficulty urinating; fecal incontinence; unexplained weight loss; history of cancer or strong suspicion for current cancer; history of osteoporosis; immunosuppression; long-term use of oral steroids or intravenous drugs; substance abuse; and failure to improve after 6 weeks of conservative therapy.
Treatments with good underlying evidence of efficacy include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, heat therapy, physical therapy, and advice to stay active. Although spinal manipulative therapy may provide short-term benefits when compared with sham therapy, benefits are limited in comparison with standard treatments.
