Pain in Primary Care

Low Back Pain: What Works? What Doesn't?

Charles P. Vega, MD


September 30, 2021

To focus on issues of pain management in primary care, this month I'm presenting a clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, whether you agree or disagree.

Henry is a 50-year-old man presenting with a complaint of left low back without sciatica for the past 7 weeks. He works in construction and is used to physical labor. He felt a "pull" in his left back when lifting a bag of concrete about 6 weeks ago. He took 5 days off work, which helped a little, and then returned to work. On the job, Henry has tried to limit physical activity that aggravates his condition, but he continues to have pain daily, which he rates as 7 out of 10. This pain interferes with his daily functioning, including lifting and carrying.

Henry has tried acetaminophen and naproxen at over-the-counter doses for the pain, with modest effects. He tried some old hydrocodone-acetaminophen from a previous prescription, but this drug made him nauseous. In contrast, a back brace at work has provided some relief.

His medical history includes obesity and hypertension. His only routine medication is amlodipine 5 mg daily.

On physical exam, there is no apparent distress. His range of motion is normal, and he has mild paraspinal tenderness to the left of the lumbar spine, without spasm. Power and sensation in the lower extremities are normal, as is a straight leg raise test.


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