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8in10 people get lower back pain at some stage
Non specific
19 out of 20 acute onset LBP is non specific

Nerve root pain (Sciatica)
less than 1 in 20 acute pain
9 of 10 are prolapsed disc

Cauda Equina
emergency - rare
lower back pain, weakness in one or both legs, numbness saddle, problems
bladder / bowel (usually urine retention)

Arthritis
OA - more common - older
RA - usually other joints affected
Ank Spond - younger, pain and stiffness

Rarely - other tumor / lesion / infection / bone disorder


Non-specific pain
? sprain (stretched muscle /ligament), minor disc, facet joint - very
hard to prove one or other as no test good
may have obvious cause, may not
may be mild or severe
usually in one place but may spread
relieved by lying, exacerbated by activity / coughing
usually resolves within a week but may recur, if continues for several
months - chronic

Red flag
gradual onset pain that is getting worse esp if constant and unrelieved
by rest
numbness / weakness
pain that is upper back / lower thoracic
steroids
stiffness - esp if relieved by activity - ank spond
bowel / bladder Sx - cauda equina
post Hx trauma esp RTA
over 50 / under 20 / aches at night / cancer elsewhere / HIV / drugs /
wt loss / night sweats - ca / infection

Usually no tests

Mx
Exersize - graded and within pain limits - get back to work asap,
continue to avoid ongoing problems
Pain control - PCM, NSAID, ?codeine, ??diazepam to muscle relax if very
severe
?hot baths
review 4-6 weeks if persistent

Chronic
more than 6/52, usually intermittent, variable mild and severe
Mx - same as acute then ...
Amitriptiline
Physio, massage, acupuncture
CBT
pain clinic ??? spinal fusion