What is Back Pain?
Back pain is the commonest orthopaedic complaint.
Background
The vertebral column (or spine) consists of a number of separate bones or vertebrae interspaced by the inter-vertebral discs. These discs allow curvature and movement of the spine to occur, although they probably have limited shock-absorbing qualities.
The spine is a flexible column with many curves. Most movement of the vertebral column occurs in the cervical and lumbar spines (neck and low back); of these the lumbar spine carries the most weight or load.
The lumbar spine is a complicated structure consisting of bony vertebrae, the inter-vertebral discs, facet joints, ligaments, the spinal canal, spinal cord and nerve roots.
Pain may arise from any of these structures, but most commonly no structural abnormality can be identified to account for the person’s back pain.
The two commonest groups of back pain are:
Non-specific or Mechanical back pain, where the source of pain may originate in:
- The spinal joints
- The vertebrae
- The soft tissues surrounding the spinal column. Usually no pathology can be identified, and there is no structural abnormality of the back.
Specific Back Pain:
This is due to a definite and identifiable pathological cause and clear evidence exists to support the pathology.
Examples:
- The person may be on a waiting list for back surgery.
- Neurological signs such as muscle weakness/wasting and marked sensory changes may be present in the lower limbs.
Psychological and Social Factors
Psychological and social factors may be significant factors in the disability resulting from back pain. These may be managed by a multidisciplinary team as found in a Pain Management Clinic (See link below). Where a customer is attending such a clinic, Medical Services advice should be sought.
Principal differences between non-specific and specific back pain.
The table below details the main differences between non-specific and specific back pain.
| Mechanical/non-specific back pain | Specific back pain/nerve root entrapment |
|---|---|
|
Pain varies with activity |
Pain tends to be more constant Little variation with activity |
|
Diffuse distribution for leg pain |
Clear distribution of pain/other symptoms in region of leg supplied by a specific nerve root |
|
Back pain worse than leg pain |
Leg pain worse than back pain |
|
No neurological signs present |
Neurological signs may be present:
|
Click on the links for details of:
Amended December 2010
