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- Lower back pain is the 2nd commonest reason for a person to seek medical advice
- 80-90% people have lower back pain at some time in their lifetime
- Backache accounts for 15% of sick time of work
Most patients who have back pain resolve within 4 weeks. This is due to the fact that the body has an amazing healing capacity. Some patients may proceed onto chronic back pain and a small proportion have a more serious underlying problem.
Many diagnostic labels have been applied to back pain, from a sprain, musculoskeletal, strain etc. These labels are usually inconsistent have have little bearing on the importance of the potential cause.
A widely accepted American classification is
| Clinical category | Description |
| Potentially serious spinal condition | Includes spinal tumour, infection, fracture or cauda equina syndrome |
| Sciatica | Pain along the course of the sciatic nerve, usually resulting from nerve root compromise |
| Nonspecific back symptoms | Symptoms occurring primarily in the back that suggest neither nerve root compromise nor a serious underlying condition |
Certain factors must be assessed in any patient with back pain to ensure a serious underlying cause has not been overlooked. The list of worrying problems tabulated below is known as RED FLAG symptoms. Not every patient who has one of the problems listed below has a serious underlying problem,however they should be investigated fully before being given a diagnosis of nonspecific back symptoms.
RED FLAGS for patients with lower back pain
| Condition | RED FLAGS |
| Possible cancer or infection | Age >50 or <.20 years History of Cancer Unexplained weight loss Immunosuppression UTI, IV drug abuse, fever/chills with back pain No improvement with rest Night pain |
| Possible spinal fracture | History of trauma Prolonged use of steroids Age > 70 |
| Cauda Equina Syndrome or severe neurological compromise | Acute urinary retention Urinary incontinence Faecal incontinence Saddle Anaesthesia (numb bum) Global or progressive weakness in legs |
