Back pain

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

Causes:

·         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.

Investigations:

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

Management:

·         NSAIDs

·         Physiotherapy

·         Muscle relaxant

·         Proper posture

·         Antidepressant

·         Patient education

·         Surgery