BACK PAIN

A common presentation in primary care. Most cases are simple mechanical pain, caused by a strain or degenerative disease of the lumbar spine, and can be managed in primary care, with or without physiotherapy.

Assessment requires a detailed clinical history, with specific questions to elicit ‘red flag’ symptoms that warrant urgent referral to secondary care. NICE guidance defines persistent non-specific low-back pain as: ‘tension, soreness and/or stiffness in the lower back region lasting more than 6 weeks but less than 12 months and with no specific identifiable cause’. Joints, intervertebral discs and connective tissues can all contribute to symptoms. Clinical assessment should identify people with signs and symptoms suggestive of cauda equina syndrome (a medical emergency), spinal malignancy, infection, fracture (eg, in osteoporosis), ankylosing spondylitis or another inflammatory disorder. The diagnosis should be kept under review at all times.