Back Pain

Prevalence

• 60-80% of people will have LBP sometime in their lives.
• 30% are referred to Ortho; 3% admitted; 0.5% operated.
• 90% LBP resolves in 6w, 75% may experience symptoms & disability one year after initial consultation.
• The prevalence of LBP has changed little over the years, but the associated disability has increased four fold since the 1970s. 
• In the UK certified incapacity for LBP was 120 milion days in 1996/7. 
• Overall cost of LBP in 1993 was £6 billion. 14 million consultations in 1993.

Differential Diagnosis according to Age:

• Children
  1. congenital disorders
  2. developmental disorders
  3. infection
  4. primary tumours - eosinophilic granuloma, ewing's sarcoma, metastatic neuroblastoma, spinal cord tumours
• Young Adults
  1. disc disease
  2. spondylolisthesis
  3. fractures
  4. Scheuermann's disease
  5. Ankylosing spondylitis
• Older Adults
  1. spinal stenosis
  2. metastatic disease
  3. osteopaenic fractures
  4. infection

Types of Back Pain:

1. Discogenic back pain
   • pain from the innervated ligamentous layer of the annulous fibrosis when it is stretched with a bulging disc
   • it is midline & worse with lordotic postures, bending & lifting
2. Radicular back pain
   • pain extending to the buttock and/or leg
   • associated with disc herniation or spinal stenosis or intraspinal pathology
3. Referred back pain
   • Aortic Aneurysm
   • Visceral (ulcer, PID, endometriosis, gallbladder disease, pleural disease)
   • Infection
   • UTI, PID
   • Hip Arthritis
4. Iatrogenic back pain
   • dural adhesions 
   • post surgical instability
   • post operative discitis; arachnoiditis
5. Psychogenic back pain
   • must exclude organic pathology
   • Waddell's inappropriate signs often present