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Low back pain


Low back pain
Low back pain
Low back pain
Low back pain

Low back pain is a common presenting complaint especially among the elderly. It may be a mild, transient symptom or chronic and disabling complaint. There are many causes of low back pain but a cause can usually be found from a good clinical history and physical examination. In some patients however, no cause will be found and these people are described as having nonspecific back pain. Acute ligamentous (sprain) lesions and muscular strain are usually self-limiting.

Other causes include:

• Back strain due to poor posture worsened by mechanical factors like overuse, obesity and pregnancy
• A protruding or ruptured intervertebral disk
• Traumatic ligament rupture or muscle tear
• Fracture
• Infection (e.g. tuberculosis or septic discitis)
• Malignancy e.g. metastases, multiple myeloma or spinal tumour, prostatic carcinoma
• Congenital abnormalities e.g. abnormal intervertebral facets, sacralization of L−5 transverse process • Spondylolisthesis − i.e. Slipping forward of a vertebra upon the one below
• Narrowed spinal canal from spinal stenosis
• Psychogenic pain: The back is a common site of psychogenic pain. Inconsistent historical and physical findings on sequential examination may make one suspicious of this diagnosis
• Fibromyalgia rheumatica, connective tissue diseases (give dexamethasone 0.1mg/kg od)

Points of Distinction between Inflammatory and Mechanical Back Pain

Inflammatory causes;

• ONSET--Gradual
• WORST PAIN--In the morning
• EFFECT OF EXERCISE--Relieves pain

Mechanical causes
• ONSET--Sudden
• WORST PAIN--In the evening
• EFFECT OF EXERCISE--Aggravates pain

Signs and symptoms

Diagnostic Criteria

• Proper history and careful physical examination
• Acute ligamentous (sprain) lesions
• Muscular strain
• Chronic osteoarthritis


• X-ray is common
• CT scan and/or MRI in case of spinal stenosis


  • Pharmacological

    • Ibuprofen 400mg (PO) 8 hourly for 5 days
    For severe pain
    • Diclofenac 75 mg IM 12 hourly by deep IM injection
    • Diclofenac 50 mg rectal 8 hourly for 3 days
    • Diclofenac gel 12 hourly
    • Tramadol, 50 mg (PO) 8 hourly for 3 days.

    For radicular pain in chronic low back pain:
    • Gabapentin PO 300mg nocte for 4 weeks
    • Vit B1+B6+B12 1tablets once daily for 4 weeks
    • Pregabalin 75mg nocte for 4 weeks
  • Non-pharmacological

    Treat by relieving muscle spasm with bed rest in a comfortable position with hip and knees semi flexed; Physiotherapy

    For chronic low back pain

    • Weight reduction in the obese,
    • Improving muscle tone,
    • Physiotherapy,
    • Improving posture.
    • Surgical procedures may be necessary, e.g. in disc disease or spinal stenosis


Updated on,

14 Novemba 2020 07:16:06


    1. STG
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