DIAGNOSIS AND CONSERVATIVE TREATMENT OF LOW BACK PAIN: REVIEW AND GUIDELINES OF THE CROATIAN VERTEBROLOGIC SOCIETY

Križobolja je vrlo česta, a troškovi skrbi za te bolesnike su visoki. Liječnici različitih specijalnosti donijeli su smjernice za dijagnostiku i konzervativno liječenje križobolje, čija primjena treba dovesti do skrbi utemeljenoj na dokazima i boljeg ishoda. U dijagnostičkom postupniku ključno je mjesto anamneze i kliničkog pregleda, a najvažnije je klasificirati bolesnike na one s nespecifičnom križoboljom, s križoboljama povezanima s radikulopatijom (radikularni sindrom) i križoboljom potencijalno povezanom sa suspektnom ili potvrđenom ozbiljnom patologijom. Kako križobolja nije samo fizički problem, u obzir treba uzeti i psihosocijalne čimbenike, odnosno rano identificirati bolesnike koji će razviti kroničnu križobolju, jer to determinira odabir liječenja. U ocjeni bolesnika s križoboljom treba nastojati koristiti validirane upitnike. U pristupu bolesniku s križoboljom korisno je primijeniti principe upravljanja sadržajem. Načelno, akutna i kronična križobolja liječe se različito. Uz edukaciju, u bolesnika s akutnom križoboljom najvažniji su savjeti (napose da ostane aktivnim), primjena lijekova (ponajprije za kontrolu boli), te eventualno spinalna manipulacija i kratkotrajna primjena ortoza. Glavni cilj liječenja bolesnika s kroničnom križoboljom je obnavljanje funkcije, pa i uz perzistiranje boli. Za kroničnu križobolju, uz edukaciju i primjenu lijekova, preporučuju se terapijske vježbe, fizikalna terapija, masaža, a u bolesnika s visokim stupnjem onesposobljenosti i intenzivni multidisciplinarni biopsihosocijalni pristup.Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient’s symptoms. In the diagnostic algorithm, patient’s history and clinical examination have the key role. Furthermore, most important is to classify patients into those with nonspecific back pain, LBP associated with radiculopathy (radicular syndrome) and LBP potentially associated with suspected or confirmed severe pathology. Not solely a physical problem, LBP should be considered through psychosocial factors too. In that case, early identification of patients who will develop chronic back pain will be helpful because it determines the choice of treatment. In order to make proper assessment of a patient with LBP (i.e. pain, function), we should use validated questionnaires. Useful approach to a patient with LBP is to apply the principles of content management. Generally, acute and chronic LBP cases are treated differently. Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective