It is important to consider malignant disease, especially in an older person. It is also essential to consider infection such as acute osteomyelitis and tuberculosis, which is often encountered in recent immigrants, especially those from Asia. These conditions are considered in more detail under thoracic back pain. For pain or anaesthesia of sudden onset, especially when accompanied by neurological changes in the legs, consider cauda equina compression due to a massive disc prolapse and also retroperitoneal haemorrhage. It is important to ask patients if they are taking anticoagulants.
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