Back pain
Back pain is one of the major health problems in all developed countries and is most commonly treated in general practice. It is generally defined as pain, muscle spasm, or stiffness located below the costal margin and above the inferior gluteal folds, with or without leg pain, or sciatica. Pain and disability are the most essential signs and symptoms of non-specific low back pain. For decades, care has characterized a diagnostic and therapeutic approach with remarkable heterogeneity in general practice between countries and within countries among medical specialists and other members of the health profession.
This has been accomplished through conducting randomized clinical trials over the last two decades, writing systematic reviews, and developing clinical guidelines. There is now significantly better promise in the management of low back pain. This review summarises the state of science for diagnosing and managing back pain, neck pain, leg pain, headache, and leg pain.
Sources and selection criteria
We searched the Cochrane Library to identify systematic reviews relevant to the effectiveness of conservative, adjuvant, and surgical interventions. Other systematic reviews concerning the diagnosis and treatment of back pain were identified through Medline searches. We also requested additional references from our databases. We also searched and reviewed available clinical guidelines after
How is it diagnosed?
The diagnostic process is mainly oriented towards triaging patients with specific or non-specific low back pain. Specific low back pain is a symptom caused by a specific pathophysiological mechanism, such as herniation, infection, osteoporosis, rheumatoid arthritis, fracture, or tumor. A US-based report on patients with low back pain in primary care. About 90% of all patients with low back pain will have non-specific low back pain, which in itself is a diagnosis excluding a specific pathology.
Many healthcare providers use a multiple number of diagnoses. For instance, general practitioners often use lumbago, physiotherapists for hyperextension, chiropractic or manual therapy for facet joint disorders, and orthopedic surgeons use diagnostic labels for degenerative disc disorders. This can be used for most patients with nonspecific back pain.
Prevalence of incidence
The incidence of low back pain cannot be easily estimated. The incidence of first episodes of low back pain tends to be cumulative and peaks in early adulthood, with subsequent episodes usually recurring over time. Studies estimating incidence are more expensive than those estimating prevalence, which are cross-sectional studies. As a result, there is a large literature on the prevalence of low back pain. Remission
Duration
We performed a focused literature search and identified very few cohort studies that reported time-course estimates of low back pain. As for remission, only studies conducted within healthcare or clinical settings provided useful information. Again, the heterogeneity was substantial between studies. Some studies have documented prevalence in terms of the percentage of people who have pain at any given time, as described in the section on remission, above. Van den Hoogen reported the average duration of pain from index to extremity.
Recurrence
The natural history of low back pain has been reported to be very variable. And can range from a few days to several years. Recurrent episodes are the most common finding in people with activity-limiting back pain lasting more than a day. Recurrent back pain contributes disproportionately to the burden of non-specific back pain at work as people experience recurrence.
Prevalence
Comparison of pain prevalence across populations and over time is, however, challenging because of considerable methodological heterogeneity. Between studies and the lack of availability of actual population estimates. With these caveats in mind, however, there are far more publications on prevalence than on incidence, remission, or duration. Most of the methodological variation is related to case definition and recall period, age and sex distribution, and population representativeness.
Deaths
Deaths due to back pain. There are very few studies that have explored any possible association between mortality and back pain. Three studies were reviewed to establish the association. According to Zhu et al, it was noted that there was an overall increased risk of death and significantly higher risk of death due to heart disease among the population with back pain compared to those without back pain. Two studies found no correlation between back pain and mortality. There is more to be done in this field.
Causes
According to research, it can arise from any of a variety of anatomical structures, such as bones, intervertebral discs, joints, ligaments, muscles, nervous structures, and blood vessels. Only in a minority of cases is there a specific cause, including osteoporotic fracture, neoplasm, or infection. However, 85 to 95% of cases have no identifiable cause of low back pain.
How useful is imaging?
Nonspecific back pain does not appear to be associated with abnormalities on X-ray and magnetic resonance imaging. Abnormalities in people examined without any diagnosed pain overlap with pain statistics in the general population. According to Van Tulder and Roland, radiological abnormalities are already seen in 40 to 50% of degenerative and spondyloarthritis cases in pain-free populations. They opined that epidemiological data must be integrated with reporting any radiological examination. Indeed, most patients who have very mild pain always have some form of abnormality.
This has made most clinical guidelines exercise caution in their referrals of patients with imaging to the clinic due to nonspecific pain. They only imagine such patients when they are alert. Jarvik et al demonstrated that computed tomography and magnetic resonance imaging are approximately equivalent in the diagnosis of lumbar disc herniation and stenosis, two pathologies that are clearly distinguished from nonspecific pain by the presence of red flags. Magnetic resonance imaging may be more sensitive than other forms of imaging to identify infections and malignancies; however, these are relatively rare, like back pain, neck pain, headache, and foot and ankle pain.