ACUTE LOW BACK PAIN

Back pain is the most common complaint/symptom related to clinician visits in most of the world. someone in his/her lifetime can get back pain which is estimated to be up to 85%.  the majority of the cause of lower back pain due to musculoskeletal problems but the following symptom suggest red signs show red flags or systemic causes which need medical attention.

1. history of cancer which includes a present, previous, and current history of cancer and cancer treatment 
2. a back pain associated with constitutional symptoms like fever and unexplained weight loss
3. a back pain that occurs during the night pain and causes sleeping difficulty
4. a pain that has a duration of more than one month
5. a pain that has no response to the previous treatment
6. a pain which has associated with neurologic signs and symptoms like body weakness, a progressive neurologic deficit like rectal incontinence/ unable to control feces, and urinary incontinence

if the patient has the above-related condition with back pain, they should have to be evaluated as he/has a red flag and needs further work up

The initial workup consists of a plain x-ray film of the back ( to look for lytic lesion or compression fracture) and ESR( a marker of inflammation). if both the x-ray and ESR findings are abnormal they should have checked with an MRI study to evaluate for the possible study causes of abnormality like disc disease, cancer, and spinal infection.  the most common malignancies that metastasized to vertebral bone are lung cancer, breast cancer, and prostate cancer are at the top of the list

 

note that: routine use of MRI in the place of initial plane x-ray film is not advisable

non-steroidal anti-inflammatory drugs are the initial treatment for the patient who presents with back pain in the patient without any signs of red flags and systemic illness. if the patient fails to show any improvement after 2 to 6 weeks of treatment, to needs further investigation that can be up to MRI study, but in a patient that have sign and symptoms of red flags warrant further investigation rather than  conservative treatment

Generally, back pain is a common problem in adult medicine and it is important to identify  signs and symptoms that suggest  serious etiology: these include pain that is constant/dull, unrelieved by rest, present at night time, and exacerbate with movement or palpation, along with fever, constitutional symptoms, and the presence of neurologic symptoms need urgent medical attention and further investigation

so referral to either neurosurgeon or orthopedics is needed if the patient has this red signs flags