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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

Back to skin conditions

Back pain resident survival guide

Introduction

Overview

Overview

Back pain is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine.

Causes

Causes

Life Threatening Causes

Common Causes

Management

Management

 
 
 
 
 
 
 
 
 
Back pain
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sciatica present?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute radiculopathy with urinary retention, saddle anesthesia and bilateral neurologic findings

AND/OR

Progressive motor weakness
 
 
 
 
 
 
 
 
 
 
 
 
Age less than 50 Y/O

AND

Simple back pain

AND

No systemic disease or cancer?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Proper spinal immobilization
Urgent CT or MRI to evaluate cauda equina syndrome
Urgent neurosurgical or neurologic consultation
 
Order plain film of vertebra
Order ESR and/or CRP if you suspicious of osteomyelitis
 
 
 
 
 
 
 
 
Consider musculoskeletal back pain
Provide back pain conservative treatment for 4-6 weeks
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Plain film and ESR/CRP both normal?
 
 
 
 
 
 
 
 
Patient improved?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Provide back pain conservative treatment for 4-6 weeks unless neurological deficit is progressive
 
Consider CT or MRI
High clinical suspicious in patient with cancer and new back pain
High clinical suspicious in febrile patient with IUD and back pain
Close follow up
 
 
 
 
 
 
 
 
 
Consider systemic causes
Order plain film of vertebra,
order ESR and/orCRP
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient improved?
 
 
 
 
 
 
 
 
 
 
 
 
 
Plain film and ESR/CRP both normal?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Reassure patient
Advise to stay active
Prescribe medication for pain if necessary
Discourage bed rest[1]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider CT or MRI
High clinical suspicious in patient with cancer and new back pain
High clinical suspicious in febrile patient with IUD and back pain
Close follow up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
References

References

  1. ↑ “An updated overview of clinical guidelines for t… [Eur Spine J. 2010] – PubMed – NCBI”. Retrieved 29 July 2013.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Hilda Mahmoudi M.D., M.P.H.[2]