Practice tips

• Back pain that is related to posture, aggravated by movement and sitting, and relieved by lying down is due to vertebral dysfunction, especially a disc disruption.

• The pain from most disc lesions is generally relieved by rest.

• Plain X-rays are of limited use, especially in younger patients, and may appear normal in disc prolapse.

• Remember the possibility of depression as a cause of back pain; if suspected, consider a trial of antidepressants.

• If back pain persists, possibly worse during bed rest at night, consider malignant disease, depressive illness or other systemic diseases.

• Pain that is worse on standing and walking, but relieved by sitting, is probably caused by spondylolisthesis.

• If pain and stiffness is present on waking and lasts longer than 30 minutes upon activity, consider inflammation.

• Avoid using strong analgesics (especially opioids) in any chronic non-malignant pain state.

• Bilateral back pain is more typical of systemic diseases, while unilateral pain typifies mechanical causes.

• Back pain at rest and morning stiffness in a young person demand careful investigation: consider inflammation such as ankylosing spondylitis and Reiter's disease.

• A disc lesion of L5-S1 can involve both L5 and S1 roots. However, combined L5 and S1 root lesions should still be regarded with suspicion, e.g. consider malignancy.

• A large central disc protrusion can cause bladder symptoms, either incontinence or retention.

• Low back pain of very sudden onset with localised spasm and protective lateral deviation may indicate a facet joint syndrome.

• The T12-L1 and L1-L2 discs are the groin pain discs.

• Severe limitation of SLR (especially to less than 30°) indicates lumbar disc prolapse.

• A preventive program for dysfunctional back pain based on back care awareness and exercises is mandatory advice.

• Remember that most back problems resolve within a few weeks, so avoid overtreatment.

Dealing With Back Pain

Dealing With Back Pain

Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.

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