From the Guidelines
To identify the reason for back pain, start by conducting a focused history and physical examination to help place patients into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause, as recommended by the American College of Physicians and the American Pain Society 1.
Key Considerations
- Note when the pain began, its location, intensity, and any activities that worsen or relieve it.
- Pay attention to associated symptoms like numbness, weakness, fever, or bowel/bladder changes.
- Consider recent injuries, repetitive movements, or changes in physical activity that might have triggered the pain.
- Common causes include muscle strain, poor posture, herniated discs, arthritis, osteoporosis, or kidney issues.
- If pain is severe, persists beyond a few weeks, radiates down the legs, is accompanied by fever, follows an injury, or causes bowel/bladder problems, consult a healthcare provider immediately.
Diagnostic Approach
- Clinicians should inquire about the location of pain, frequency of symptoms, and duration of pain, as well as any history of previous symptoms, treatment, and response to treatment.
- The possibility of low back pain due to problems outside the back, such as pancreatitis, nephrolithiasis, or aortic aneurysm, or systemic illnesses, such as endocarditis or viral syndromes, should be considered.
- All patients should be evaluated for the presence of rapidly progressive or severe neurologic deficits, including motor deficits at more than 1 level, fecal incontinence, and bladder dysfunction.
- Clinicians should also ask about risk factors for cancer and infection, as recommended by the American College of Physicians and the American Pain Society 1.
Recent Guidelines
- The most recent guidelines from the American College of Radiology (2021) emphasize the importance of a focused history and physical examination in evaluating low back pain 1.
- The guidelines also recommend considering the use of imaging tests, such as X-rays or MRIs, in patients with severe or progressive neurologic deficits, or in those with suspected serious underlying conditions, such as cancer or infection.
From the Research
Identifying the Reason for Back Pain
To identify the reason for back pain, it is essential to follow a step-by-step approach. The diagnostic work-up involves:
- A detailed patient history, taking into account the "red flags" 2
- A clinical examination
- Further stepwise diagnostics, including laboratory diagnostics and structured morphological imaging 2
Causes of Specific Back Pain
Specific back pain has a determinable cause that needs to be rapidly identified. Causes of specific back pain include:
- Fractures
- Infections
- Radiculopathy
- Tumors
- Axial spondylarthritis
- Extravertebral causes 2
Diagnosis and Treatment
The diagnosis, treatment, and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists 2. Evidence-based clinical guidelines, such as those developed by the North American Spine Society, provide recommendations for diagnosing and treating adult patients with nonspecific low back pain 3. These guidelines are based on the best available evidence and aid practitioners in making clinical decisions 3, 4.