CHRONIC BACK PAIN IS CAUSE OF 14% OF LONG TERM DISABILITY IN THE UK
BACK PAIN TYPES AND RISK FACTORS
Low back pain is a common symptom.It is often traumatic and work related ,although lifting apparatus and other mechanical devices are used to avoid it .Episodes are generally short lived and self limiting ,and patients attend a physiotherapist or osteopath more often than a doctor.Chronic back pain is the cause of 14% of long term disability in the UK .
EXAMINATION
VISCERAL CAUSES OF LOW BACK PAIN
Low back pain is a common symptom.It is often traumatic and work related ,although lifting apparatus and other mechanical devices are used to avoid it .Episodes are generally short lived and self limiting ,and patients attend a physiotherapist or osteopath more often than a doctor.Chronic back pain is the cause of 14% of long term disability in the UK .
FIVE TYPES OF LOW BACK PAIN
1. LOCAL PAIN
Caused by activation of pain -sensitive nerve endings near affected part of the spine (e.g tears ,stretching ).
2. PAIN REFFERED TO THE BACK
Abdominal or pelvic origin ,back pain unafected by spine movement.
3. PAIN OF SPINE ORIGIN
Restricted to the back or reffered to lower limbs.Disease of upper lumbar spine refer pain to upper lumbar region,groin ,or anterior thighs.Disease of lower lumbar spine refer pain to buttocks or posterior thighs.
4. RADICULAR PAIN
Radiates from spne to leg in specific nerve root territory.Coughing,sneezing ,lifting heavy objects or straining may eicit pain.
5. PAIN ASSOCIATED WITH MUSCLE SPASM
Diverse causes ,accompanied by taut paraspinal muscles.
RISK FACTORS FOR POSSIBLE SERIOUS CAUSES OF ACUTE LOW BACK PAIN
HISTORY
Pain worse at rest or at night _______ Age >50 years.
Prior history of cancer _______ Intravenous drug use.
History of chronic infection ( especially pulmonary ,urinary tract or skin) _____Rapidly progressive neurologic deficit
History of trauma
EXAMINATION
Unexplained fever.
Unexplained weight loss.
Straight leg raising sign.
Percussion tenderness ___ low spine or costovertebral angle.
Abdominal, rectal or pelvic mass.
Rapidly progressive focal neurologic deficit ( e.g sensory loss ,leg weakness ,asymmetric or absent leg reflexes ,abnormal bladder function )
LABORATORY STUDIES
Routine laboratory studies and lumbar spine X-rays ___rarely needed for acute low back pain but indicated when risk factors for serious underlying disease are present MRI ans CT -myelography are tests of choice for anatomic definition of spine disease .Electromyography ( EMG) and nerve conduction studies useful for functional assessment of peripheral nervous system.
VISCERAL CAUSES OF LOW BACK PAIN
Stomach ( posterior wall ) __ Gall bladder ___Gall stones.
Pancreatic__tumor ,cyst ,pancreatitis.
Retroperitoneal __hemmorrhage ,tumor ,pyelonephritis.
Vascular __ abdominal aortic aneurysm ,renal artery and vein thrombosis.
Colon __ colitis ,diverticulitis ,neoplasm.
uterosacral ligaments __ endometriosis ,carcinoma.
Uterine malposition.
Menstrual pain.
Neoplastic infiltration of nerves.
Radiation neurosis of tumor/nerves.
Prostate ___ carcinoma ,prostatitis.
Kidney __ renal stones, inflammatory disease , neoplasm ,infection.
