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
- congenital disorders
- developmental disorders
- infection
- primary tumours - eosinophilic granuloma, ewing's sarcoma, metastatic neuroblastoma, spinal cord tumours
- Young Adults
- disc disease
- spondylolisthesis
- fractures
- Scheuermann's disease
- Ankylosing spondylitis
- Older Adults
- spinal stenosis
- metastatic disease
- osteopaenic fractures
- infection
Types of Back Pain:
- 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
- Radicular back pain
- pain extending to the buttock and/or leg
- associated with disc herniation or spinal stenosis or intraspinal pathology
- Referred back pain
- Aortic Aneurysm
- Visceral (ulcer, PID, endometriosis, gallbladder disease, pleural disease)
- Infection
- UTI, PID
- Hip Arthritis
- Iatrogenic back pain
- dural adhesions
- post surgical instability
- post operative discitis; arachnoiditis
- Psychogenic back pain
- must exclude organic pathology
- Waddell's inappropriate signs often present
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