Behavioral Intention
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Back Pain Timothy H. Wideman and Michael J. L. Sullivan Department of Psychology, McGill University, Montreal, QC, Canada
Synonyms Backache; Dorsalgia; Lumbago
Definition Pain located between the base of the neck and the gluteal folds that can also be associated with radiating pain in the lower extremities.
Description Back pain is one of the most prevalent and costly conditions in the industrialized world. An estimated 80% of individuals will experience back pain at some point in their life. The vast majority of back pain episodes have an unknown etiology and are self-limiting. Approximately 80–90% of cases resolve within the first 6 weeks of onset. The relatively small percentage of individuals who develop chronic back pain (symptoms lasting longer than 3 months), however, account for the majority of the disability expenditures that are associated with this condition.
Criteria used to classify back pain are numerous and, in certain instances, divergent. For example, the classification of back pain has been based on the duration and location of symptoms, the underlying spinal pathology, the presence of spinal instability, and the quality of spinal movements. Current biopsychosocial models emphasize the importance of classifying back pain based on the presence of risk factors for severe illness or prolonged disability. A detailed history and physical exam are used to screen for the presence of Red Flags and Yellow Flags in individuals presenting with acute back pain (less than 6 weeks since the onset of symptoms). Red Flags are signs and symptoms that suggest the possibility of serious pathology, such as carcinoma, immunodeficiency, damage to the spinal cord or cauda equina, and inflammatory disorders. Red Flags are identified via the following signs and symptoms: a history of severe trauma, significant weight loss, neurological signs and symptoms, severe worsening of pain, and/or systemic illness. Emergency medical attention is required in the relatively rare incidence in which a patient with back pain presents with a Red Flag. In the absence of Red Flags, screening for Yellow Flags is indicated. Yellow Flags are psychosocial signs and symptoms that suggest an elevated risk for prolonged pain and disability. Yellow Flags include: depressed mood, belief that physical activity and pain are damaging, job dissatisfaction, and a history of back pain or work disability. The presence of Yellow Flags calls for
M.D. Gellman & J.R. Turner (eds.), Encyclopedia of Behavioral Medicine, DOI 10.1007/978-1-4419-1005-9, # Springer Science+Business Media New York 2013
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risk-factor-targeted interventions that aim to prevent long-term disability. In the absence of Red or Yellow Flags, clinical practice guidelines recommend minimal treatment for acute back pain. Recommendations emphasize the importance of reassuring patients that back pain is not commonly associated with serious pathology, that back pain typically resolves in the first 6 weeks following symptom onset, and that a prompt return to regular physical activities is i
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