Chapter 34 Low Back Pain
INTRODUCTION
Description: Pain located in the lower portion of the back (generally between the level of the iliac spines and the lower ribs) with radiation to the abdomen, pelvis, legs, or trunk. In women, gynecologic processes are often implicated (correctly or incorrectly) in this complaint. Low back pain is especially common during pregnancy.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Pain and discomfort between the level of the iliac spines and the lower ribs, generally sudden in onset after an injury or gradually over the subsequent 24 hours
• Radiation of pain to buttocks or posterior thighs (stopping at the knees); referred pain, not radicular; back pain greater than leg pain
• Pain aggravated by back motion, lifting, coughing, straining, bending, or twisting; relieved by rest
DIAGNOSTIC APPROACH
Differential Diagnosis
Associated Conditions: Chronic pain states (pelvic pain, headaches), radiculopathy, obesity, and psychosocial disease. Secondary gain often complicates both the diagnosis and treatment of low back pain. Warning signs of significant secondary gain include pending litigation or compensation, depression, hostility, and prolonged use of potent analgesics.
