Differential Diagnosis
- Single most likely diagnosis
- Musculoskeletal strain: The patient's symptoms of diffuse lower back pain after heavy lifting, alleviated by OTC pain patches and ibuprofen, and worsened by prolonged standing, sitting, or bending, are consistent with a musculoskeletal strain. The absence of red flag symptoms such as fever, chills, or neurological deficits further supports this diagnosis.
- Other Likely diagnoses
- Lumbar degenerative disc disease: The patient's age and history of heavy lifting may contribute to degenerative changes in the lumbar spine, which could cause chronic lower back pain.
- Lumbar facet joint pain: The patient's pain with flexion, extension, rotation, and lateral bending may indicate facet joint involvement, which is a common cause of lower back pain.
- Paraspinal muscle spasm: The patient's mild tenderness to the lumbosacral region and pain with movement may indicate paraspinal muscle spasm, which can occur in response to injury or strain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda equina syndrome: Although the patient denies neurological symptoms such as saddle anesthesia, urinary retention, or leg weakness, cauda equina syndrome is a medical emergency that requires prompt recognition and treatment.
- Spinal infection (e.g., osteomyelitis, discitis): The patient's mild pain and lack of systemic symptoms make this diagnosis less likely, but it is essential to consider spinal infection in patients with new-onset back pain, especially if they have risk factors such as diabetes or immunocompromised status.
- Spinal fracture: Although the patient denies previous trauma, a spinal fracture could occur with minimal trauma in patients with osteoporosis or other underlying conditions.
- Rare diagnoses
- Ankylosing spondylitis: This chronic inflammatory disease can cause lower back pain and stiffness, but it is relatively rare and typically presents with additional symptoms such as morning stiffness and improvement with exercise.
- Spinal tumor: Although rare, spinal tumors can cause back pain and neurological symptoms, and it is essential to consider this diagnosis in patients with unexplained or persistent back pain.