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Low back pain
Low back pain is one of the commonest physical complaints and is a
major cause of lost work time. Most back pain is benign and the majority
recover within 3 months. Chronic back pain lasts longer than 3 months.
However, only 5 percent have a serious underlying cause.
i. Exclude spinal causes of back pain
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Neurological examination includes
motor, sensory and reflex exam of the lower limbs.
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If low back pain is accompanied by a deficit then request urgent imaging
(x-ray, CT or MRI) to the lumbosacral region.
- Abdominal aortic aneurysm
- Disc herniation / rupture
- Vertebral compression fracture
- Spinal tumors
- Spinal abscess
- Lumbosacral strain
ii. Exclude abdominal causes of back pain
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Abdominal examination
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- Peptic ulcer
- Pancreatitis
iii. Exclude rectal / pelvic causes of back pain
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PR, pelvic examination
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- Pregnancy
- Pelvic inflammatory disease
- Pelvic abscess
- Pelvic infection
- Endometriosis
- Pelvic tumors
- Prostatitis
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iv. Low back without abnormality on examination
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Request X-ray, CT, MRI to
the LSS and if necessary to the abdomen and pelvis
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Local bony disease:
- Disc herniation
- Osteoarthritis
- Compression fracture
- Ankylosing spondylitis
- Spondylolisthesis
- Hemangioma
- Osteosarcoma
- Neural tumors
- Osteoid osteoma
- Aneurysmal bone cyst
- Spinal TB
Generalized disease affecting the bone:
- Osteomalacia
- Osteoporosis
- Hyperparathyroidism
- Ochronosis
- Paget's disease
- Multiple myeloma
- Metastasis
Abdominal disease:
- Pancreatitis
- Retroperitoneal tumor
- Peptic ulcer
Others:
- Lumbosacral strain
- Herpes zoster
- Chronic pain syndrome
- Polymayalgia rheumatica
- Familial Mediterranean fever
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