Specific Causes of Back pain

Specific causes of back pain: some ideas from European Guidelines for the management of Chronic non specific back pain (2004)

There is  little relationship  between  low back pain symptoms, pathology  and radiological findings.

In 85% of people (Deyo 1988), pain has no relationship  to any time of physical abnormality.

*4% of people seen with low back pain in primary care have compression fractures

*1% have a neoplasm (Deyo et al 1992).

*5% develop at least one vertebral fracture in 4 years (Kado et al 2003).

Spondylarthropathies have been reported to occur at a rate of 0.8 to 1.9% of the general population (Saraux et al 1999).

Spinal infections are rare, and chronic spinal infections are particularly rare. Infectious diseases of the spine should be considered if the patient has fever, has had previous surgery, has a compromised immune system, or is a drug addict.

Spondylolysis and spondylolisthesis are often classified as non-specific low back pain because a considerable proportion of patients with such anatomic abnormalities are asymptomatic (Soler and Calderon 2000)

Back and leg pain after surgery represent a major problem addressed at specific conferences for failed back surgery.

Failure rates range from 5-50%. Based on a failure rate of 15%, it was estimated that 37500 new patients with failed back surgery syndrome would be generated annually in the US (Follet and Dirks 1993).

One of the causes that is consistently reported in the literature includes poor patient selection (Goupille 1996, Van Goethem et al 1997).

“This means that patients with non-specific back pain are operated on for radiologically diagnosed disc bulging, herniation or degeneration, which turn out not to be responsible for their pain.”

  • References
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    2. Balague F, Troussier B, Salminen JJ (1999) Non-specific low back pain in children and adolescents: risk factors. Eur Spine J, 8(6): 429-38.
    3. Barash HL, Galante JO, Lambert CN, Ray RD (1970) Spondylolisthesis and tight hamstrings. J Bone Joint Surg Am, 52(7): 1319-28.
    4. Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly. A systematic review of the literature. Spine, 24(17): 1813-9.
    5. Cassidy JD, Carroll LJ, Cote P (1998) The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine, 23(17): 1860-6; discussion 7.
    6. Deyo RA (1988) Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil, 69(12): 1044-53.
    7. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? Jama, 268(6): 760-5.
    8. Dickson RA, Stamper P, Sharp AM, Harker P (1980) School screening for scoliosis: cohort study of clinical course. Br Med J, 281(6235): 265-7.
    9. Ebbehoj NE, Hansen FR, Harreby MS, Lassen CF (2002) [Low back pain in children and adolescents. Prevalence, risk factors and prevention]. Ugeskr Laeger, 164(6): 755-8.
    10. Follet KA, Dirks BA (1993) Etiology and evaluation of the failed back surgery syndrome. Neurosurgery Quarterly, 3: 40-59.
    11. Goupille P (1996) Causes of failed back surgery syndrome. Rev Rhum Engl Ed, 63(4): 235-9.
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Is an MRI for you

Clients with bad backs clutch onto their MRI scans . Often they are of no value. There is little correlation with  disc degeneration and pain. Most people have  a bit of disc degeneration.

MRI’s are often ordered by doctors for patients as placebo’s

But for those who  want a bit more insight into  MRI magic, here is the best lay persons description I can find. Focus on slides  61-63.

As this slide show says, “ask specific questions”

Experiment with Bracing?

One of the biggest confusions in “back pain” is the role of  abdominal muscles.

For years hard working doctors and researchers have attempted to assess the role and value and ideal type of abdominal engagement and training methodology. At the same time fraudsters and  charlatans have always sought to promote  and mystify the actions of an obscure muscle

There are 3 things you can do with your abs if you are standing up in a neutral position ( we need to talk about this concept too!)

1) You  can suck them in
2) You can “tighten” them where they are
3) You can “bear out”

Ill discuss these ideas in painful depth else where.