Basics
- Second most common reason for visiting a physician in the US and the number one cause of disability in those less than 45 years-old
- There are many causes of back and neck pain that range from processes affecting the muscles, vertebrae, spinal cord, nerve roots, and other surrounding structures.
- Do to the wide variety of causes related to back pain making generalizations about the underlying cause is difficult unless performed by a neurologist or neurosurgeon on an individual case basis.
- Common causes include: Degenerative changes, trauma, sprains and strains, congenital abnormalities, tumors, autoimmune disorders, infection, inflammation, and referred pain from organ sites.
- Acute low back pain- pain of less than 3 months duration that is aggrevated with motion and relieved by rest: 85% have full recovery
Symptoms and Signs
- The character of the pain and the history of the patient direct the diagnostic work-up and provide an indicator as to the underlying cause.
- The specific symptoms of each type of back pain are covered in other sections.
- Some important findings that warrant further investigation include: Pain worse at rest or at night, prior history of cancer, chronic infections, prior trauma, incontinence, IV drug use, steroid use, rapid worsening of motor or sensory function, fever, weight loss, pain directly over the spine to hard pressure
Demographics
- Affects all age groups
- Varies depending on specific cause
Diagnosis
- X-ray, CT scan, MRI
- Laboratory blood test
- EMG and nerve conduction studies
Treatment
- Dependent on the underlying cause- Ranging from Reassurance to Surgery
- Back pain of less than 3 months duration without any other risk factors is treated with reassurance and pain relief in necessary (NSAIDS)
Prognosis
- Acute low back pain of less than 3 month duration- 85% fully recovery
- Otherwise, the prognosis is dependent on the underlying cause
Differential Diagnosis
