The prevalence of back pain is remarkably consistent in all parts of the world and in all cultures. Roughly 20 percent of people across the globe have back pain at any given time, 40 percent have had back pain in the past year and 80 percent of people will have back pain during their lifetime. The prevalence of disability from back pain, however, is much more variable and depends on cultural influences, for example, disability due to back pain is largely a phenomenon of Westernized societies.
Signs and symptoms of back pain can be organized into these four categories:
1. Non-specific back pain
2. Possible serious pathology
3. Back pain with neurologic deficit
4. Non-spinal back pain
Non-Specific Back Pain
The most common form of back pain is “non-specific,” or general pain in the low back. It is typically positional in that patients feel better lying down and worse with activity. It is also helpful to tell your doctor whether the pain is made worse while sitting or while standing.
Possible Serious Pathology
If a patient has back pain along with any of the following symptoms, they should be treated more seriously by a medical professional:
1. Back pain with a history of cancer, weight loss, infection, fever or trauma
2. New onset of low-back pain in patients younger than 16 years old or older than 50
3. Back pain with osteoporosis or prolonged steroid use
Back Pain With Neurologic Deficit
Back pain may be related to a deficit in the brain or spinal cord if it is accompanied by leg weakness, sensory loss, a decrease in reflexes or bowel/bladder dysfunction.
Non-Spinal Back Pain
Back pain may not be related to dysfunction of the spine, rather it could be caused by a dysfunction of an organ in the abdominal or pelvic regions. In this case, symptoms include continuous pain in the same location, regardless of what position the patient is in (sitting, standing or lying down).
In addition to symptoms, it is useful to characterize back pain by looking at the impairments the back pain is causing. Rather than what the patient complains of, emphasis is on what the patient is able to do or not do. Considerations include:
1. Loss of back range of motion
2. Loss of back strength
3. Loss of back endurance
4. Loss of balance
5. Loss of leg strength
6. Gait (walking) impairment
Finally, it is useful to characterize any disability associated with the back pain. These assessments include:
1. How long can the patient walk?
2. How long can the patient sit?
3. How much can the patient lift?
4. How well does the patient sleep?
5. Can the patient wash and dress himself?
6. Does the pain affect the patient’s social life?
7. Can the patient work?