Managing a patient with low back pain in general practice

Low back pain is a common reason for consultation in general practice. It often leads to functional disability and is sometimes associated with psychosocial difficulties. Its origin is multifactorial and the biopsychosocial model explains how socio-demographic, biomechanical, medical, occupational and psychosocial factors have an important role in its evolution. While the prognosis for low back pain is generally favorable, the likelihood of improvement is considerably reduced when low back pain persists for more than 6 weeks. The medical evaluation has two main objectives: first to confirm the diagnosis of common low back pain and second to identify potential obstacles to favorable evolution (clinical, biomechanical and psychosocial factors). The diagnosis of common low back pain usually does not require further investigation in the acute phase. Diagnostic tests are recommended in the absence of clinical improvement after several weeks, in the case of major repercussions and / or when invasive treatment is considered. A large part of the care consists in reassuring the patient and informing him that spontaneous improvement is likely but may be long. Drug resources are poor and evidence of their effectiveness is scarce. Brief education emphasizing the importance of staying active is essential, bed rest is to be avoided. An early return to work should be sought and may require contact with the occupational physician. Active physiotherapy is recommended after a few weeks of evolution, as soon as reduction of the initial pain allows it. Patients with an unfavorable evolution (persistence of symptoms over time) should benefit from regular clinical reassessment, including the exploration of psychosocial factors, and possibly radiological examinations, in order to diagnose a (rare) specific pathology, to adapt care and to accompany the patient over time.