Subtypes of Low Back Pain
December 30, 1997 2 minutes read
Subtypes of Low Back Pain
Many primary care providers use what has been termed the "black box" approach to back pain: Having excluded herniated disks requiring intervention and pertinent secondary pathology, all other back pain is treated conservatively and symptomatically. On the other hand, specialty groups often strive for much more specific diagnoses and direct therapies believed to be targeted to particular diagnoses (e.g., injection for trigger points). This study examined the subtypes of back pain seen in a group model HMO, population 54,000.
Subtypes of low back pain were delineated by a consensus group of representatives from the departments of family practice, internal medicine, orthopedics, neurosurgery, and physical therapy. Over a nine-month period, 32% of acute back pain cases in this HMO were categorized as acute low back strain, characterized as related to a history of recent significant injury, accompanied by diffuse tenderness in the low back, a normal neurologic examination, and normal sacroiliac exam. Radicular syndromes (presenting with leg pain in addition to back pain, limited straight leg raise, and motor or sensory nerve root signs) comprised 28% of patients. Posterior facet syndrome was defined as precipitated by twisting the spine or lifting in rotation, with recent onset of acute pain, tenderness 1-2 inches lateral to the spinous processes, worsening by extension or rotation, limited painful range of motion toward the involved side, and a normal neurological exam; 6% of cases fell into this category. Somewhat more common (10%) was sacroiliac syndrome, defined by tenderness over the sacrum or sacroiliac line, pain upon sacroiliac joint stress, and a normal neurologic examination. The remaining 10% of acute cases included trigger points, coccidynia, piriformis syndrome, and others, which the authors note have been reported substantially more prevalently in reports from specialty clinics. Whether such a classification system will benefit the clinician or patient in approaching this clinical problem remains to be determined.
Newton W, et al. J Fam Pract 1997; 45:331-335.
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