Specific physical causes and non-specific
back pain
Acute and subacute back pain
A minority of cases of back pain result from physical causes.
Trauma to the back caused by a motor vehicle crash or a fall
among young people and lesser traumas, osteoporosis with
fractures, or prolonged corticosteroid use among older people
are antecedents to back pain of known origin in most
instances. Relatively less common vertebral infections and
tumours or their metastases account for most of the remainder.
Specific causes account for less than 20% of cases of
back pain: the probability that a particular case of back pain
has a specific cause is only 0.2% (2). So-called “red flags” —
symptoms and signs that point to a specific cause — are well
delineated in Low back pain initiative (1).
Non-specific back pain is thus a major problem for
diagnosis and treatment. Studies in the United Kingdom
identified back pain as the most common cause of disability
in young adults (5): the survey implicated back pain in more
than 100 million work days lost per year. A survey in Sweden
suggested that low back pain increased the number of work
days lost from 7 million in 1980 to four times that (28 million)
by 1987 (6); however, social compensation systems
might account for some of this increase. Jayson’s group
found that 35–37% of workers experienced back pain in the
month before their survey, with a peak in the incidence seen
among those aged 49–59 years (7).
People with low back pain often turn to medical consultations
and drug therapies, but they also use a variety of
alternative approaches (Box 1) (1). Regardless of the treatment,
most cases of acute back pain improve. At the time,
people in such cases may credit the improvement to the
interventions ⎯some of which clearly are more popular and
even seemingly more effective than others (e.g. chiropractic
and other manipulative treatments in which the laying on of
hands and the person-to-person interaction during the treatment
may account for some of the salutary results
Specific physical causes and non-specificback painAcute and subacute back painA minority of cases of back pain result from physical causes.Trauma to the back caused by a motor vehicle crash or a fallamong young people and lesser traumas, osteoporosis withfractures, or prolonged corticosteroid use among older peopleare antecedents to back pain of known origin in mostinstances. Relatively less common vertebral infections andtumours or their metastases account for most of the remainder.Specific causes account for less than 20% of cases ofback pain: the probability that a particular case of back painhas a specific cause is only 0.2% (2). So-called “red flags” —symptoms and signs that point to a specific cause — are welldelineated in Low back pain initiative (1).Non-specific back pain is thus a major problem fordiagnosis and treatment. Studies in the United Kingdomidentified back pain as the most common cause of disabilityin young adults (5): the survey implicated back pain in morethan 100 million work days lost per year. A survey in Swedensuggested that low back pain increased the number of workdays lost from 7 million in 1980 to four times that (28 million)by 1987 (6); however, social compensation systemsmight account for some of this increase. Jayson’s groupfound that 35–37% of workers experienced back pain in themonth before their survey, with a peak in the incidence seenamong those aged 49–59 years (7).People with low back pain often turn to medical consultationsand drug therapies, but they also use a variety ofalternative approaches (Box 1) (1). Regardless of the treatment,most cases of acute back pain improve. At the time,people in such cases may credit the improvement to theinterventions ⎯some of which clearly are more popular andeven seemingly more effective than others (e.g. chiropracticand other manipulative treatments in which the laying on ofhands and the person-to-person interaction during the treatmentmay account for some of the salutary results
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