Back pain might almost be described as a universal symptom for it occurs with every variety of ailments from kidney stones to disc prolapse, from heart failure to osteoarthritis. The severity of pain in the back is even harder to assess than pain else-where. (If it could, would it be measured in - hells and decihells?) There is no method of gauging the pain and reliance has to be placed on objective signs such as the manner in which it is recounted, the facial expression, and the extent of interference with the habitual mode of life.
Almost everyone has backache at some time or other and some have it more or less continually, but only a proportion of sufferers complains of it. Neither the intensity of pain be it of extreme degree, nor its duration, are in constant proportion to their objective effect and it is easy to form a wrong impression. The frequency with which symptoms in the back and a neurotic personality coincide is notorious, but the difficulty of cure by psychological methods is well known. Back pain is a psychosomatic problem, and whether the symptoms are slight or severe, whether the diagnosis is 'fibrositis'or sciatica, it is safe to say that sooner or later there will by psychological implications. But whatever the nature of pain, be it predominantly organic or psychogenic, it is equally serious to the patient and just as worthy of cure.
Pain in the back may be caused by disease or disorder in function of any structure in the back, that is to say, by the vertebrae and inter-vertebral discs, by the joints and ligaments, and by the muscles and nerves controlling them. The precise aetiology and pathology are often unknown, or are a matter for speculation, and it is difficult to reduce discussion to order. The classification adopted here is a clinical one and back pain is divided into four groups:
Acute back pain includes all cases of short duration, and chronic back pain those of longer duration whether or not there have been remissions.
A full history is essential; the story of the pain should commence with the first occasion when it was felt and continue through remissions and exacerbations to the current attack. Details of other illness and the obstetric history (in female subjects) may be relevant, and inquiry into the family history and environmental conditions help in assessing the patient's personality.
Physical examination requires particular care or an entirely false impression may be obtained. No reliable conclusion can be drawn from one or two isolated observations, and negative findings are as important as positive. The patient is examined standing, sitting, lying supine, lying on the side and lying prone. Basic investigations include blood and urine tests, x-rays of the spine, tomography and magnetic resonance imaging.
Vardaan Hospital is a New Delhi based multi-speciality hospital