Back Pain

Basics

Description

  • Low back pain (LBP):
    • Between lower rib cage and gluteal folds, often with radiation into thighs
  • Sciatica:
    • Distribution of the lower lumbar spinal roots
    • May be accompanied by neurosensory and motor deficits
  • Pain classification:
    • Acute: <6 wk
    • Subacute: 6–12 wk
    • Chronic: >12 wk

Etiology

  • Nonspecific musculoligamentous pain (strain of muscles, ligaments, or fascia)
  • Herniated intervertebral disc (herniation of the nucleus pulposus)
  • Degenerative changes (degenerative discs or joints, including osteoarthritis)
  • Spinal stenosis (narrowing of the spinal canal or foramina)
  • Anatomic abnormalities (spondylolisthesis, scoliosis, or congenital abnormalities)
  • Fractures (traumatic fractures or those from osteoporosis, often minimally symptomatic or poorly recalled)
  • Neoplasm (eg, primary or metastatic cancers)
  • Infections (eg, osteomyelitis, discitis, epidural abscess, or tuberculosis)
  • Vascular (eg, aortic aneurysm, vascular claudication)
  • Renal (eg, nephrolithiasis, pyelonephritis)
  • Gastrointestinal (eg, pancreatitis, peptic ulcers, diverticulitis)
  • Pelvic organ pathology (eg, endometriosis, pelvic inflammatory disease, ovarian cysts)

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