Question

A 45-year-old manual labourer comes to seek help for his low back pain.
What are the causes of low back pain?

Hint:

When evaluating low back pain, always consider the patient's history, physical examination, and red flags that suggest serious underlying conditions.

Answer 1

Step 1: Mechanical Causes.
Mechanical causes of low back pain are the most common and include:
- Muscle strain or ligament sprain due to overuse or poor posture.
- Degenerative disc disease or spondylosis, which leads to wear and tear on the spine.
- Herniated discs or prolapsed intervertebral discs, which can compress nerves, leading to pain and dysfunction.

Step 2: Inflammatory Causes.
Inflammatory causes of back pain are often seen in conditions like:
- Ankylosing spondylitis, a type of inflammatory arthritis that primarily affects the spine.
- Rheumatoid arthritis, which can lead to inflammation of spinal joints.

Step 3: Infectious Causes.
Infections such as spinal osteomyelitis or discitis can cause significant pain, especially in patients with compromised immune systems.

Step 4: Neoplastic Causes.
Neoplastic causes include primary or secondary spinal tumors (e.g., metastatic disease from lung, breast, or prostate cancer). These can lead to chronic back pain, especially at night or with weight-bearing.

Step 5: Referred Pain from Abdominal or Pelvic Organs.
Conditions such as kidney stones, pancreatitis, or gynecological issues (e.g., pelvic inflammatory disease) can also cause referred pain in the lower back.

Step 6: Conclusion.
Low back pain can arise from multiple causes, ranging from mechanical to serious inflammatory, infectious, or neoplastic conditions. Proper diagnosis is crucial for effective management.