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Monday, November 26, 2012

Back pain

Back pain is a human condition, with 60 – 80% of the world’s population experiencing pain at some time in their lives.


·         Spinal stenosis
·         Degenerative diseases
·         Disc compression and prolapse
·         Spondylolesthesis
·         Arachonoiditis

Classification and clinical assessment:

a.      Mechanical pain:

§  This accounts for more than 90% of back pain episodes, usually affecting patient aged 20 – 55 years. Mechanical pain is related to activity and relieved by rest.
§  Onset: Acute, associated with lifting or bending
§  Episodes: Recurrent
§  No clear cut nerve distribution
§  Systematically well
§  Prognosis is good (90 % recover in 6 weeks)

b.      Non – Mechanical Pain:

§  Causes: Malignancy, infection etc
§  Pain is constant and progressive
§  Systemic symptoms: fever, anorexia, weight loss, change in bowel habit, dyspepsia, per vaginam bleeding
§  Deformity with pain
§  Neurological signs: progressive
§  Multiple levels of spinal nerves distribution

c.       Inflammatory pain:

§  Onset: gradual (slow)
§  Pain is associated with morning stiffness and improves rather than worsens with activity.

d.      Spinal stenosis pain:

§  Symptoms of spinal stenosis occur due to limitation of space in the vertebral canal.

§  The most common presentation is Pseudoclaudication
§  Activity painful and relieves with rest
§  Causes: Paget disease, Simian posture

e.      Prolapsed disc Pain:

§  L4 – L5 more common
§  Age: 20 – 30 years
§  Onset: sudden
§  Radicular pain is common presentation

f.        Radicular Pain: (nerve root)

This has a severe, sharp, lancinating quality, radiates down the back of the leg beyond the knee and is aggravated by coughing, sneezing and straining at stool more than by back movement.


o   Plain X – rays
o   MRI
o   CT scan
o   Blood count, ESR and CRP
o   Serum calcium phosphate, alkaline phosphatase
o   Bone scan

o   EMG
o   NCS
o   Prostate specific antigen
o   HLA – B27


·         NSAIDs

·         Physiotherapy

·         Muscle relaxant
·         Proper posture
·         Antidepressant
·         Patient education

·         Surgery


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