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Performing a Structured Physical Examination in a Patient with Low Back Pain

neuroscienceCME Multimedia Snack

Premiere Date: Tuesday, October 30, 2012

This activity offers CE credit for:

1. Physicians (CME)
2. Pharmacists (ACPE)
3. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

Credit Expiration Date:
Wednesday, November 1, 2017
Note: Credit Is No Longer Available

Faculty

Steven P. Stanos, DO (Moderator) Executive Medical Director, Rehabilitation and Performance Medicine Swedish Pain Services Swedish Health System Seattle, WA

Phyllis A. Grauer, RPh, PharmD, CGP, CPE  Clinical Consultant HospiScript Services, LLC Clinical Assistant Professor The Ohio State University College of Pharmacy Columbus, OH

Statement of Need

How robust are your examination skills in assessing back pain? American College of Physicians and American Pain Society guidelines recommend, “Clinicians should conduct a … physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause.” Guidelines recommend advanced imaging “only if patients are potential candidates for surgery or epidural steroid injection.”(1) To support a differential diagnosis of back pain without imaging, clinicians who encounter this common complaint(2)must be able to perform a physical examination.

Continuing training on physical exam techniques is uncommon but necessary. This neuroscienceCME Snack features a physician demonstrating hands-on assessment for radiculopathy, myofascial trigger points, and intervertebral and sacroiliac joint abnormalities in patients with low back pain. This neuroscienceCME Snack details motor strength, sensory, dural tension, and joint testing—with grading and signs to watch for. Participate, and improve your differential diagnosis so that your patients may receive appropriate relief and care.

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1. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491. PMID: 17909209.
2. Bratton RL. Assessment and management of acute low back pain. Am Fam Physician. 1999;60(8):2299-2308. PMID: 10593321.

Activity Goal

To teach participants how to perform a structured physical examination for radiculopathy, myofascial trigger points, and intervertebral and sacroiliac joint abnormalities in their patients who present with low back pain, allowing for accurate differential diagnosis and management of the pain.

Learning Objectives

At the end of this CE activity, participants should be able to:

• Consistently conduct a structured physical examination in patients presenting with low back pain to identify the anatomical and/or physiological bases for the pain.

Financial Support

This activity is supported by an educational grant from Endo Pharmaceuticals and Pfizer Inc.

Target Audience

Physicians and health care professionals who are interested in pain management or the physical examination to assess back pain.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Outfitters designates this enduring material for a maximum of .5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
Universal Activity Number: 0376-0000-12-022-H01-P (recorded programs)
Activity Type: knowledge-based

Post-tests, credit request forms, and activity evaluations must be completed online at www.neuroscienceCME.com/TST526 (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CME/CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CME/CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Stanos has disclosed that he receives grants from Pfizer Inc. He serves as a consultant to, or is on the advisory boards of, Covidien; Eli Lilly and Company; Endo Pharmaceuticals; King Pharmaceuticals, Inc.; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; and Purdue Pharma L.P. He is on the speakers bureaus of Eli Lilly and Company; Endo Pharmaceuticals; Forest Laboratories, Inc.; King Pharmaceuticals, Inc.; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; and Pfizer Inc.

Dr. Grauer has no disclosures to report.

Tony Graham, MD (Content/Peer Reviewer) has no disclosures to report.

Sandra Haas Binford, MAEd (planning committee) has no disclosures to report.

Joy Barnett Leffler, MLA, NASW, CSE (planning committee) has no disclosures to report.

Unlabeled Use Disclosure

Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

CME Outfitters, LLC, the faculty, Endo Pharmaceuticals, and Pfizer Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).