Back Pain:

• causes: mechanical, inflammatory, infective (e.g. TB or osteomylitis), neurological, referred, or sinister (e.g. boney metastases)
• take full history + do musculoskeletal & neuro limb exam
• most pain resolves using the following treatments by 6 months: physio, analgesia +/- NSAIDs, lifestyle advice (inc. chair position & correct lifting techniques)
• if pain not settling or any sinister symptoms then investigate: bloods (inc. inflammatory markers & calcium), PSA (if prostatic cancer suspected), spinal X-ray (looking for boney mets or fractures) +/- spinal MRI
• cord compression: progressive neurological deficit = lower motor neurone signs at level of lesion + upper motor neurone signs below
• cauda equina syndrome (surgical emergency) = compression of cauda equina, causes (disc prolapse, tumour, fracture or abscess), symptoms (pain, muscle weakness, decreased sensation especially in the saddle, urinary/bowel disturbance & reduced anal tone when PR performed), needs urgent MRI +/- surgical decompression
• N.B. be suspicious of an aortic aneurysm