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Diagnosis and Treatment of Low-Back Pain Because of Paraspinous Muscle Spasm: A Physician Roundtable


  • Disclosures: The authors make the following disclosures of financial relationships during the past 3 years with companies whose products may be related to the topic of this article: Dr McCarberg has served on the speakers bureaus for PriCara, Forest, Endo, and NeurogesX. Dr Ruoff has served on the advisory boards and speakers bureaus for Takeda, Endo, and Cephalon. Dr Tenzer-Iglesias has served on the advisory boards for UCB and Forest. Dr Weil has served as a speaker for King, Cephalon, and Ferring.

  • Support: Support for the publication of this supplement was provided by Cephalon, Inc.

  • Disclaimer: Information contained in this supplement represents the opinions of the authors and is not endorsed by, nor does it necessarily reflect the views of Cephalon, Inc.

  • In order to facilitate the review of this supplement to Pain Medicine and to maintain the integrity of the editorial peer review process, reviewers of this supplement were chosen independently by the Supplement Editor. No compensation was paid to these reviewers for their review.

Bill H. McCarberg, MD, Kaiser Permanente, 732 North Broadway, Escondido, CA 92025, USA. Tel: 760-839-7008; Fax: 760-839-7053; E-mail:


Background.  Despite the availability of evidence-based guidelines to diagnose and treat acute low-back pain, practical application is nonuniform and physician uncertainty regarding best practices is widespread.

Objective.  The objective of this study was to further optimal treatment choices for screening, diagnosing, and treating acute low-back pain caused by paraspinous muscle spasm.

Methods.  Four experts in pain medicine (three family physicians and one physiatrist) participated in a roundtable conference call on October 18, 2010, to examine current common practices and guidelines for diagnosing and treating acute low-back pain and to offer commentary and examples from their clinical experience.

Results.  Participants discussed the preferred choices and timing of diagnostic and imaging tests, nonpharmacologic therapies, nonopioid and opioid medication use, biopsychosocial evaluation, complementary therapies, and other issues related to treatment of acute low-back pain. Principal clinical recommendations to emerge included thorough physical exam and medical history, early patient mobilization, conservative use of imaging tests, early administration of muscle relaxants combined with nonsteroidal anti-inflammatory medications to reduce pain and spasm, and a strong emphasis on patient education and physician–patient communication.

Conclusions.  Early, active management of acute low-back symptoms during the initial onset may lead to better patient outcomes, reducing related pain and disability and, possibly, preventing progression to chronicity.