Chronic low back pain: diagnosis and management issues
Chronic low back pain represents a public health challenge, with significant social and economic consequences. Prof. Marchesi emphasizes the importance of rigorous differential diagnosis, clinical evaluation, and targeted imaging. Surgery remains the exception, reserved for carefully selected cases.
Doctors
Topics
Treatments
Advice
- Prof. Dante Marchesi
- Chronic low back pain
- Risks of chronicity
- Importance of differential diagnosis
- Rare indications for surgery
- Patient Overall Assessment
- Conservative treatment
- Medical imaging
- Surgery in extreme cases
- act early
- avoid chronicity
- assess overall
- favor non-surgical approach
Chronic low back pain: think about differential diagnosis
Chronic low back pain covers a variety of realities: disc degeneration, facet osteoarthritis, spondylolisthesis, deformities, bone pathologies, and even non-spinal causes. The challenge is to identify the pain generator to avoid therapeutic dead ends.
The assessment combines history taking, clinical examination, and targeted imaging. MRI, which is more informative than CT for soft tissues and discs, is used when it impacts the decision.
Act early to prevent chronicity
Physical and drug treatment should be offered without delay, starting within the first few weeks. The goal is to control pain, maintain activity, and prevent the condition from becoming chronic, which accounts for the majority of costs and disability.
Patient information, reassurance and gradual reactivation are central at this stage.
Low back pain is a symptom, not a diagnosis.
Measured place of surgery
Surgery is not the systematic answer. It is intended for carefully selected situations, in cases of clear clinical and radiological correlation and failure of structured conservative treatments.
The decision is part of a care pathway that anticipates rehabilitation and functional monitoring.
Global approach and associated factors
Referred pain (hip, pelvis) and non-organic factors must be considered. A comprehensive assessment allows for warning signs to be recognized and for prompt action to be taken if necessary.
The therapeutic program remains personalized, reassessable and function-oriented.
It is very important to prevent lower back pain from becoming chronic.
Rehabilitation and return to activities
Rehabilitation combines strengthening, mobility, and education on protective gestures. Ergonomic adaptations and work resumption planning reduce the risk of relapse.
Concrete and measurable objectives mark progress in order to anchor the benefits over time.
Message to the patient
The best prognosis is achieved through early, active, and individualized management. This involves aligning assessment, treatment, and expectations to restore satisfactory function.
Regular clinical monitoring secures the course and prevents the onset of chronic pain.
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