BACK/BONE PAIN

Includes pain in the lumbar region of the spine or bone pain anywhere within the body.

Causes

Potential causes of back or bone pain:

  • Disc degeneration (often has a neuropathic element because of pressure on sciatic or other nerve)
  • Osteoporosis (if collapse of vertebrae or fracture)
  • Infection (e.g. TB, brucellosis, PID, retroperitoneal)
  • Metastatic cancers, renal disease
  • Strain
  • Congenital abnormalities
  • Spondylolisthesis

Clinical Features

Each situation will differ depending on the cause of the pain

  • If an infection is present: throbbing and constant pain
  • If sciatica, sciatic nerve roots will be involved

Investigations

  • Try to establish the cause and type of pain
  • X-ray: Spine and pelvis

Management of Back or Bone Pain

Analgesics

  • Analgesics (see section 13.1.2 above)
    • Give a Step 1 drug for 7 days or as long as required according to patient
    • NSAIDs are the Step 1 drug of choice in bone pain
    • May have to add a Step 2 or 3 drug, especially in metastatic disease

For acute back pain:

  • Rest the back on a firm but not hard surface

For neuropathic element:

  • Manage as for neuropathic pain above