LOW BACK PAIN – CLASSIFICATION, RISK AND LOCALIZATION


Back pain has many different causes and can result in chronic pain. Causes for back pain are among others osteoarthritis, osteoporosis, herniated discs or muscle strains. In many cases the real cause of back pain cannot be definitely diagnosed. The precise diagnosis of back pain is difficult since there are a variety of symptoms. Back pain can have both nociceptive and neuropathic features.

 

Back pain can be subdivided into acute, sub-acute and chronic back pain1

Both acute and chronic back pain can be further defined by the presence or absence of neurological symptoms and signs. In comparison to radicular back pain, non-radicular back pain is not associated with neurological symptoms or signs.

 

Risk of back pain2-4

Many factors can contribute to the risk of back pain. Physical behaviour, such as lack of exercise and sedentary lifestyle, and environmental factors affecting posture or exposing the back to strain may be important. Patient factors, such as age, height, poor physical condition, and also poor psychological condition, can contribute to the risk of developing back pain.

The causes of back pain are most often non-specific – leading to a functional disorder that may involve wear or damage, although often the exact aetiology of non-specific back pain is hard to determine. Specific, clearly identifiable causes of back pain, such as nerve root irritation or compression and inflammatory diseases, are less common.

 

Non specific back pain


Localization of back pain3

Back pain can have a number of different locations and often radiates beyond the back itself. Pain in the neck and shoulder region is commonplace. The lower back moves a lot more than the thoracic spine and also carries all the weight of the torso, making it the most frequently injured area of the spine. The most common pain location is the lumbar region, and lumbar pain is reported by over 70% of back pain sufferers.

 

Back pain often radiates to the arms and to the legs

The vast majority of patients have back pain that cannot be attributed to any specific cause. This is termed unspecific or non-radicular back pain. Non-radicular pain tends to be limited to one region of the back.

A minority of patients have back pain with a specific cause that can be discerned. Specific pain is often associated with radiculopathy or spinal stenosis, but can also be associated with another specific spinal cause.

 

References
1 Schmidt C et al. Modelling the prevalence and cost of back pain with neuropathic components in the general population. Eur J Pain. 2009; 13:1030-35.
2 Heliovaara M. Risk factors for low back pain and sciatica. Ann Med. 1989; 21:257-64.
3 Chou R et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147:478-91.
4 Vlaeyen JWS, Linton SJ. Pain 2000;85:317–32.
5 Krismer M et al. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol. 2007; 21(1):77 - 91.
6 van Tulder M et al. Low back pain. Best Pract Res Clin Rheumatol. 2002; 16:761-75.