Makindo Medical Notes

💡 Back pain is one of the most common complaints in clinical practice. While most cases are mechanical and self-limiting, it is essential for clinicians to identify red flags that suggest serious pathology such as infection, malignancy, or neurological compromise.

📖 Clinical Approach to Back Pain

• History: Onset, duration, location, radiation, aggravating/relieving factors, associated symptoms (neurological, systemic, urinary, bowel).
• Red Flags 🚨:
  • Age <20 or >55 with new back pain
  • Night pain, progressive or non-mechanical pain
  • History of cancer, weight loss, immunosuppression
  • Fever, night sweats (infection)
  • Saddle anaesthesia, bladder/bowel dysfunction (cauda equina)
  • Unexplained neurological deficits
• Examination: Inspect posture, palpate for tenderness, assess range of motion. Neurological exam of lower limbs: power, sensation, reflexes. Special tests: straight leg raise (sciatica), Schober’s test (inflammatory causes).

📝 Causes of Back Pain

🔍 Investigations in Back Pain

• Baseline: FBC, ESR/CRP, urinalysis (exclude UTI or renal causes).
• Imaging:
  • X-ray for fracture, degenerative change.
  • MRI for soft tissue, discs, infection, malignancy.
  • CT if bony detail required or MRI contraindicated.
• Special tests: Bone scan (metastasis), EMG/nerve conduction (radiculopathy).

💊 Management Principles

• Conservative: Education, reassurance, maintain activity, physiotherapy, weight management.
• Pharmacological: NSAIDs first-line, consider weak opioids short-term, adjuvant neuropathic agents for radicular pain.
• Interventional: Steroid injections, nerve blocks, epidurals for radicular pain.
• Surgical: For cauda equina, instability, tumour, or severe refractory pain.
• Rehabilitation: Encourage exercise, posture training, CBT for chronic pain.

✅ Key Teaching Pearls

• Most back pain is benign and mechanical — reassure and keep active.
• Always screen for red flags — cancer, infection, cauda equina, fracture.
• MRI is the investigation of choice when serious pathology is suspected.
• Back pain is often recurrent — long-term management requires exercise, education, and self-care.