Red Flag Nyeri Punggung Bawah

Oleh :

Josephine Darmawan

Tanda bahaya atau red flag pada nyeri punggung bawah (low back pain) harus dikenali secara dini, karena mempengaruhi intervensi dan prognosis pasien. Misalnya membedakan nyeri punggung bawah karena kekakuan otot dengan keganasan atau fraktur.

Nyeri punggung bawah merupakan keluhan yang sering ditemukan pada fasilitas kesehatan tingkat primer dan sekitar 85- 90% keluhan pasien akan membaik dalam 6 minggu. Diagnosis nyeri punggung bawah non spesifik juga mengambil porsi paling besar dibandingkan akibat etiologi lainnya. Akan tetapi, sekitar 1 - 4% pasien dengan keluhan nyeri punggung bawah memiliki patologi yang serius yang dapat menyebabkan gangguan neurologis sampai mengancam jiwa. [1,2]

Mengenali tanda bahaya merupakan hal yang penting dan direkomendasikan oleh seluruh pedoman klinis yang ada. Akan tetapi, setiap panduan memiliki tanda bahaya yang berbeda-beda, dan tidak semuanya memiliki signifikansi yang baik.[3 – 8]

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low-back pain in primary care. Eur Spine J 2006;15(Suppl 2):S169–91
2. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009. Oct;60(10):3072-80.
3. Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G , Cotterell M, Hill D, Browne N, et al. Low Back Pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners.
4. Toward Optimized Practice (TOP) Low Back Pain Working Group. 2015 December. Evidence-informed primary care management of low back pain: Clinical practice guideline. Edmonton, AB: Toward Optimized Practice. Diakses dari: http://www.topalbertadoctors.org/cpgs/885801
5. German Medical Association (BÄK); National Association of Statutory Health Insurance Physicians (KBV); Association of Scientific Medical Societies (AWMF). National Disease Management Guideline ‘Low back pain’ – Short Version. Version 4. 2011 last amended: August 2013. Diakses dari: http://www.kreuzschmerz.versorgungsleitlinien.de
6. Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition)
7. Intermountain Healthcare. Primary Care Management of Low Back Pain 2014. Diakses dari: https://intermountainhealthcare.org/ext/Dcmnt?ncid=522579081.
8. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain. 2003.
9. Verhagen AP, Downie A, Maher CG, Koes BW. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain. 2017 Oct;158(10):1860-1868.
10. Henschke N, Maher CG, Ostelo RW, de Vet HC, Macaskill P, Irwig L. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD008686.
11. Williams CM, Henschke N, Maher CG, van Tulder MW, Koes BW, Macaskill P, et al. Red flags to screen for vertebral fracture in patients presenting with low‐back pain. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD008643.
12. Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013 Dec 11;347:f7095.
13. Premkumar A, Godfrey W, Gottschalk MB, Boden SD. Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. J Bone Joint Surg Am. 2018 Mar 7;100(5):368-374.
14. Negrini S, Giovannoni S, Minozzi S, Barneschi G, Bonaiuti D, Bussotti A, et al. Diagnostic therapeutic flow-charts for low back pain patients: the Italian clinical guidelines. Eura Medicophys. 2006 Jun;42(2):151-70.
15. Verhagen AP, Downie A, Popal N, Maher C, Koes BW. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016 Sep;25(9):2788-802.
16. Underwood M, Buchbinder R. Red flags for back pain. BMJ. 2013 Dec 12;347:f7432.
17. Cook CE, George SZ, Reiman MP. Red flag screening for low back pain: nothing to see here, move along: a narrative review. Br J Sports Med. 2018 Apr;52(8):493-496.