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

Neurological examination includes motor, sensory and reflex exam of the lower limbs.

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

Abdominal examination

  • Peptic ulcer
  • Pancreatitis

iii. Exclude rectal / pelvic causes of back pain

PR, pelvic examination

  • Pregnancy
  • Pelvic inflammatory disease
  • Pelvic abscess
  • Pelvic infection
  • Endometriosis
  • Pelvic tumors
  • Prostatitis

iv. Low back without abnormality on examination

Request X-ray, CT, MRI to the LSS and if necessary to the abdomen and pelvis

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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