The management of lower back pain

摘要

Lower back pain (LBP) is one of the most common musculoskeletal conditions, with an estimated 60-70% of the adult population experiencing a back problem at some point in their lives. It can have a significant social and occupational impact on a patient, and therefore is a major concern to both civilian and military populations. The impact of low back pain in the military setting, regardless of chronicity, can result in considerable restrictions on a patient's ability to perform his or her job. This may have important ramifications for deployability, medical category and, potentially, a patient's future career. This article will consider the diagnosis and classification of lower back pain (LBP) in the pre-shore, pre-hospital and hospital settings. It will detail management options including investigations, pain management and referral options; furthermore, the potential occupational implications of lower back pain will be detailed. Introduction Low back pain (LBP) is a common disorder, affecting around one-third of the UK adult population each year, around 20% of whom will consult their General Practitioner (GP) about it (1). Whilst the majority are managed in the primary care environment, around 5% of patients with LBP will present to hospital (3). Musculoskeletal disorders and injuries were the most common principal causes of medical discharge from the Royal Navy (RN) during the period from 2008/9 to 2012/13, accounting for 58% of all medical discharges. Overall, back pain accounted for 8% of all medical discharges, of which 82% were classed as LBP. It is also of note that musculoskeletal disorders, as the cause of medical discharge, rose over the period from 2009/10 to 2012/13 (2). LBP has a substantial occupational impact on a patient when working in a military environment, particularly in an operational theatre, or on a ship or aircraft with its associated hazards. In the RN, high operational tempo, mobilising around confined spaces, and dealing with external environmental factors, such as adverse sea states, are all additional difficulties in managing a military patient with LBP over and above those encountered in the civilian environment.