Differentiating Inflammatory and Mechanical Back Pain: Difference between revisions
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Introduction | == Introduction == | ||
Back pain ( | Back pain (including neck, thoracic and lumbar pain) is a common presenting condition in physiotherapy practice. Neck and low back pain have been identified as the leading cause of global disability in 2015 in most countries.<ref>GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602. </ref> The lifetime prevalence of low back pain is reported to be 84 percent while the prevalence of chronic low back pain is around 23 percent. Moreover, between 11 and 12 percent of the population are considered disabled by low back pain.<ref>Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747. </ref> | ||
The lifetime prevalence of low back pain is reported to be 84 percent while the prevalence of chronic low back pain is around 23 percent. Moreover, between 11 and 12 percent of the population are considered disabled by low back pain. | |||
The vast majority of patients presenting with back pain will be classified as having non-specific mechanical back pain.<ref name=":0">Martey C. Differentiating Inflammatory and Mechanical Back Pain Course. Physioplus 2020. </ref> However, it is essential to be able to identify patients who fall outside of this category, including those with back pain of inflammatory origin.<ref name=":0" /> This page will highlight some key features that can help to differentiate between mechanical back pain and inflammatory conditions, as well as discussing other red flag features that should always be considered. | |||
== Red Flags == | |||
When assessing patients with back pain, it is necessary to first consider if there are any red flags present.<ref name=":0" /> Only around one percent of all musculoskeletal presentations in primary care will be due to serious pathology (such as spinal infection, cauda equina, fracture, malignancy and spondyloarthropathies)<ref name=":1">Finucane L. An Introduction to Red Flags in Serious Pathology. Physioplus 2020.</ref> However, as Finucane notes, these conditions should be considered as differential diagnoses when individuals present with back pain - particularly if the patient is not responding in an expected way or is starting to worsen.<ref name=":1" /> | |||
Red flags are defined as: “signs and symptoms that raise suspicion of serious spinal pathology."<ref>Finucane L, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020 Jul;50(7):350-372.</ref> They are identified during the subjective and objective assessment of a patient. | |||
Common red flags include:<ref name=":1" /> | |||
* Age over 50 years | |||
* Progressive symptoms | |||
* [[Thoracic Back Pain|Thoracic pain]] | |||
* Past history of [[Cancer Pain|cancer]] | |||
* Weight loss | |||
* [[Intraveneous Drug Abuse|Drug abuse]] | |||
* Night pain | |||
* Systemically unwell (fever) | |||
* Night sweats | |||
Other important points to consider include the presence or absence of trauma - could there be a fracture or a risk of osteoporotic fracture? - and could the pain be referred from visceral organs. An [https://physio-pedia.com/Abdominal_Aortic_Aneurysm abdominal aortic aneurysm] and the kidney can, for instance, both cause low back pain.<ref name=":0" /> | |||
For more information on Red Flags, please [https://www.physio-pedia.com/An_Introduction_to_Red_Flags_in_Serious_Pathology click here]. | |||
For information specifically on spinal malignancy, please [https://physio-pedia.com/Spinal_Malignancy click here]. | |||
It is important to note that signs and symptoms of various serious conditions may overlap with those that suggest inflammatory conditions.<ref name=":0" /> | |||
[[Category:Course page]] | |||
[[Category:Course Pages]] | |||
[[Category:Musculoskeletal/Orthopaedics]] | |||
[[Category:Rheumatology]] | |||
Revision as of 09:57, 11 November 2020
Introduction[edit | edit source]
Back pain (including neck, thoracic and lumbar pain) is a common presenting condition in physiotherapy practice. Neck and low back pain have been identified as the leading cause of global disability in 2015 in most countries.[1] The lifetime prevalence of low back pain is reported to be 84 percent while the prevalence of chronic low back pain is around 23 percent. Moreover, between 11 and 12 percent of the population are considered disabled by low back pain.[2]
The vast majority of patients presenting with back pain will be classified as having non-specific mechanical back pain.[3] However, it is essential to be able to identify patients who fall outside of this category, including those with back pain of inflammatory origin.[3] This page will highlight some key features that can help to differentiate between mechanical back pain and inflammatory conditions, as well as discussing other red flag features that should always be considered.
Red Flags[edit | edit source]
When assessing patients with back pain, it is necessary to first consider if there are any red flags present.[3] Only around one percent of all musculoskeletal presentations in primary care will be due to serious pathology (such as spinal infection, cauda equina, fracture, malignancy and spondyloarthropathies)[4] However, as Finucane notes, these conditions should be considered as differential diagnoses when individuals present with back pain - particularly if the patient is not responding in an expected way or is starting to worsen.[4]
Red flags are defined as: “signs and symptoms that raise suspicion of serious spinal pathology."[5] They are identified during the subjective and objective assessment of a patient.
Common red flags include:[4]
- Age over 50 years
- Progressive symptoms
- Thoracic pain
- Past history of cancer
- Weight loss
- Drug abuse
- Night pain
- Systemically unwell (fever)
- Night sweats
Other important points to consider include the presence or absence of trauma - could there be a fracture or a risk of osteoporotic fracture? - and could the pain be referred from visceral organs. An abdominal aortic aneurysm and the kidney can, for instance, both cause low back pain.[3]
For more information on Red Flags, please click here.
For information specifically on spinal malignancy, please click here.
It is important to note that signs and symptoms of various serious conditions may overlap with those that suggest inflammatory conditions.[3]
- ↑ GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602.
- ↑ Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747.
- ↑ 3.0 3.1 3.2 3.3 3.4 Martey C. Differentiating Inflammatory and Mechanical Back Pain Course. Physioplus 2020.
- ↑ 4.0 4.1 4.2 Finucane L. An Introduction to Red Flags in Serious Pathology. Physioplus 2020.
- ↑ Finucane L, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020 Jul;50(7):350-372.
