The Truth About Back Pain
Like most doctors, I was taught two myths about back pain.
1. You can’t diagnose lower back pain; and
2. Back pain goes away quickly all by itself.
These myths have lead to back pain being ignored as an important problem because the prevailing attitude has been “You can’t diagnose it, and it will go away anyway, so why bother”. But this is not true. Eighty percent of people will suffer lower back pain at some time in their life. Although, a significant minority (20 per cent) recover fully, most (80 per cent) people still complain of pain at 12 months. Fifty-five per cent suffer low grade pain, 15 per cent moderate levels and 10 per cent are significantly disabled (Von Korff M, Saunders K. Spine 1996). Said differently, at some time in your life you are likely to suffer back pain that lasts for 12 months, or longer. The diagnosis of the cause of lower back pain is also now possible in most cases. “Non-specific lower back pain” is no longer “Non-specific”.
The five causes of lower back pain
Facet Joints - Sacroiliac Joints - Hips - Discs - Nerves
To help identify which one is the primary cause of pain, medical professionals use a range of standard questions such as what triggered the pain, where the pain is located, where does is radiate to, what makes it better or worse and we seek to identify any associated symptoms to try to pin down which of the five is the culprit. Unfortunately, many answers are not specific to one structure and if the patient is in a lot of pain, everything hurts. Below is a graphic of the referral patterns of sources of lower back pain - sacroiliac joint (yellow), facet joint (blue), hip (purple), disc (green) and nerve root pain (orange). As you can see they all overlap, making it difficult to identify pain simply based on where its felt.
In this situation you would think that a scan would help the doctor diagnose the site of the pain and help with finding appropriate treatment. In my next Insight column, I will deal with the issue of scans. You may be surprised at the results.