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Causes of Back pain

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Causes	Clinical Features	Investigations	Management
Mechanical Back Pain	Muscle Strain: Sudden onset of pain after lifting or twisting, localized pain, no radiation. Ligament Sprain: Similar to muscle strain, may have mild swelling and tenderness. Degenerative Disc Disease: Chronic pain, worse with sitting or bending, stiffness in the morning. Facet Joint Arthritis: Localized pain, worse with extension and rotation, often unilateral.	Physical Examination: Assess for range of motion, tenderness, and specific maneuvers to reproduce pain. X-rays: May show degenerative changes in bones or joints. MRI: Useful if symptoms persist to evaluate soft tissues and discs.	Rest and Activity Modification: Avoid activities that exacerbate the pain. Physical Therapy: Strengthening and stretching exercises. Analgesics: NSAIDs or acetaminophen for pain relief. Injections: Corticosteroid injections for facet joint pain or inflammation.
Radicular Pain (Sciatica)	Shooting pain that radiates down the leg, usually along the path of the sciatic nerve. Associated numbness, tingling, or weakness in the leg. Worsened by activities that increase intra-abdominal pressure (e.g., coughing, sneezing).	Physical Examination: Positive straight leg raise test, neurological examination for sensory or motor deficits. MRI: To evaluate for disc herniation or nerve root compression. Nerve Conduction Studies: May be used if diagnosis is unclear.	Physical Therapy: Exercises to relieve pressure on the sciatic nerve. Medications: NSAIDs, muscle relaxants, or gabapentin for neuropathic pain. Epidural Steroid Injections: To reduce inflammation around the nerve root. Surgery: Considered if there is significant weakness, severe pain, or failure to improve with conservative treatment.
Spinal Stenosis	Gradual onset of pain, numbness, and weakness in the legs, often bilateral. Worse with standing or walking (neurogenic claudication), relieved by sitting or bending forward. Older adults are more commonly affected.	MRI: To assess narrowing of the spinal canal and compression of the nerve roots. X-rays: To detect degenerative changes, such as osteophytes or spondylolisthesis. CT Myelogram: Can provide detailed images if MRI is contraindicated or inconclusive.	Physical Therapy: Focus on flexion-based exercises to open the spinal canal. Medications: NSAIDs and pain relievers for symptom control. Epidural Steroid Injections: For temporary relief of leg symptoms. Surgery: Decompression surgery (laminectomy) to relieve pressure on the nerves, particularly if there is significant functional impairment.
Infectious Causes (e.g., Discitis, Osteomyelitis)	Severe, constant back pain, often with fever and night sweats. Pain may not be relieved by rest and may worsen with movement. History of recent infection, IV drug use, or immunosuppression.	Blood Tests: Elevated white blood cell count (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). MRI: To detect infection in the vertebrae or intervertebral discs. Blood Cultures: To identify the causative organism. Biopsy: Needle biopsy of the affected area to obtain a sample for culture.	Antibiotic Therapy: Prolonged course, often IV antibiotics, tailored to the specific pathogen. Pain Management: NSAIDs and other analgesics. Surgery: May be necessary to drain abscesses or debride infected tissue. Immobilization: Using a brace to stabilize the spine during healing.
Neoplastic Causes (e.g., Spinal Tumours)	Persistent, progressive back pain, often worse at night. May be associated with weight loss, fatigue, and neurological deficits. History of cancer or risk factors for malignancy.	MRI: To detect and characterize spinal tumours. CT Scan: Useful for evaluating bone involvement. Biopsy: To confirm the diagnosis and determine the type of tumour. Bone Scintigraphy: To detect metastatic disease.	Radiation Therapy: For metastatic or primary malignant tumours. Surgical Resection: For removal of the tumour, often followed by stabilization of the spine. Pain Management: NSAIDs, opioids, and adjuvant pain medications. Chemotherapy: Depending on the type of cancer and its responsiveness to treatment.
Inflammatory Causes (e.g., Ankylosing Spondylitis)	Chronic back pain, often with morning stiffness that improves with activity. Pain and stiffness in the sacroiliac joints and lower back. Associated with systemic symptoms like fatigue and, in severe cases, reduced spinal mobility.	X-rays: May show sacroiliitis and syndesmophytes in advanced cases. MRI: More sensitive for detecting early inflammatory changes. Blood Tests: Elevated ESR and CRP; HLA-B27 testing may be positive.	NSAIDs: First-line treatment for pain and inflammation. Physical Therapy: To maintain mobility and posture. Biologics: TNF inhibitors for patients who do not respond to NSAIDs. Exercise: Regular exercise to maintain spinal flexibility.

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