Three key questions when working out a persons back pain:
Are the symptoms the patient has reflecting a visceral disorder or a serious or potentially life-threatening disease?
From where is the patient's pain arising?
What has gone wrong with this person as a whole that would cause the pain to develop and persist?
The American College of Physicians currently recommends dividing the diagnosis into three categories:
Non specific LBP
LBP of radicular origin and spinal stenosis
LBP caused by pathology (eg malignancy) or other visceral source (e.g. renal)
Clarifying conditions arising from nociceptive pain:
Nociceptive pain:
- Clear proportionate mechanical/anatomical nature to the symtoms
- Pain in proportion to trauma/pathology
- Pain in area of injury/dysfunction with/without referral
- Resolving consistent with expected tissue healing time
- Usually intermittent and sharp with movement/mechanical provocation
- Pain in association with other symptoms of inflammation (e.g. swelling)
Discogenic pain:
- Centralisation phenomenon
Lumbar Radiculopathy:
Facet Joint Pain:
Lumbar spinal stenosis:
Lumbar discogenic pain:
SIJ Pain:
Piriformis syndrome:
Seronegative spondyloarthropathies:
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