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AHCPR Guideline #14 Low Back Pain 
Executive Summary  
Overview - Back Epidemiology  
 
Table of Contents - Mostly AHCPR Guide #14 "Finding and Recommendation" Statements  
1.  Initial Assessment Methods                                
     Medical History                                                       
      Physical Examination                                 
2.  Clinical Care and Treatment Methods 
      Care - Helping the Patient Cope  
       -Education 
          Individual Patient Education About Low Back Problems 
          Back School 
       Symptom Comfort Methods 
       - Medications Comfort Help: 
            Acetaminophen and NSAIDs 
            Muscle Relaxants 
            Opioid Analgesics 
            Oral Steroids 
            Colchicine 
            Antidepressant Medications 
       - Physical Methods Comfort Help: 
          Spinal Manipulation 
          Physical Agents and Modalities 
          Tens - ranscutaneous Electrical Nerve Stimulation 
          Shoe Insoles and Shoe Lifts 
          Lumbar Corsets and Back Belts 
          Traction 
          Biofeedback 
       - Invasive Comfort Help: 
          Trigger Point and Ligamentous Injections 
          Facet Joint Injections 
          Epidural Injections (Steroids, Lidocaine, Opioids) 
          Acupuncture 
     Low Risk Treatment of Reduce Activity Tolerance 
       - Activity Recommendations 
         Normal Activity ASAP 
         Modifications if Normal Activity Feared 
         Avoiding Bed Rest 
         Exercise to Treat Activity Intolerance 
3.  Special Studies and Diagnostic Considerations 
       - Tests for Evidence of Physiologic Compromise 
          Electrophysiologic Tests (EMG and SEP
          Bone Scan 
          Thermography 
      - Tests to Define Anatomic Lesions 
         Plain X-Rays 
         MRI, Myelography, and CT-Myelography 
          Expected Imaging findings without symptoms 
          MRI reading approach 
          Discography 
4. Higher Risk Treatment - Surgical Correction 
         Herniated Disc Surgery for Sciatica 
         Spinal Stenosis Surgery for Neuroclaudication 
         Spinal Fusion for Abnormal Motion, Discography, Intuitive 
         Total disk Replacement 
5. Non-Physical Influence (Disability Risk factors) 
6. Summary AHCPR Statements 
7. Primary Prevention - Lifting Fears, Trial results 
 
Authors Example "House Staff Handbook" 
I. Initial Patient Evaluation 
II. Initial Care 
III. Delayed Recovery Work up 
IV. Surgery 
V.  Disability Prevention after Procedures ( Late / Further Care
          Non-Physical Considerations 
          Conditioning is Treatment 
          Disabling Pain 
          Chronic Disability Treatment Caveats 
          Mortality of unemployment 
VI. Appendix (Handouts)  
VII. Glossary 
 
VIII. Non-Back links  including  
     Cervical Spine Exam, Neck Epi., & Elective Neck Surgery 
IX. Licensing Agreement 
 
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