Lower back pain

Question 1

What are red lags for lower back pain?

Answer 1

• age < 20 years or > 50 years
• history of previous malignancy
• night pain
• history of trauma
• systemically unwell e.g. weight loss, fever

Question 2

What is the management of lower back pain?

Answer 2

Advice:

• try to encourage self-management
• stay physically active and exercise

Analgesia:
*NSAIDs first line (PPI cover)

Physiotherapy movements

Question 3

What are the features of a prolapse disc causing lower back pain?

Answer 3

• leg pain usually worse than back
• pain often worse when sitting
• Sensory changes

Question 4

When is a request for a MRI scan appropriate for lower back pain?

Answer 4

• non-specific back pain ‘only if the result is likely to change management’
• patients where malignancy, infection, fracture, cauda equina or ankylosing spondylitis is suspected