Via practica 1/2013

Back pain

Back pain has many possible causes, including all diseases, injuries and other impairments that invoke nociceptive mechanisms in the region. However, the pain does not always correlate with pre presence of particular condition. More than 85% patients have back pain that cannot reliable be attributed to a specific disease or spinal abnormality due to weak correlation between clinical signs and neuroimaging findings (x-ray, computerized tomography, magnetic resonance imaging). The most frequent sources of back pain include non-specific musculoligamenotous impairment of thoracic and lumbar spine and back muscle itself, degenerative intervertebral discs (Internal Disc Disruption, Degenerative Disc Disease and Segmental Disc Instability) and facet joints, intervertebral disc herniation and stenosis of lumbar spinal canal. The priority in the diagnostic examination procedure is to make sure that pain is of musculoskeletal origin and to rule out emergent and urgent medical pathology (myocardial infarction, dissecting aortic aneurysm, ectopic pregnancy, acute pancreatitis, active duodenal ulcers, pyelonephritis, visceral trauma, other). The next step is to exclude the presence of serious spinal pathology (spinal cancer, spinal infections including spinal epidural abscesses, inflammatory disorders, fractures, syndrome of cauda equina). Once a serious diagnosis is ruled out, attention can be focused on appropriate back care and rehabilitation.

Keywords: acute back pain, chronic back pain, non-specific low back pain, degenerative spine disease, diagnosis, treatment