Differential diagnosis of back pain

Czech version

Authors: Hana Ciferská ¹; Jan Vachek ^2,3
Authors‘ workplace: Revmatologický ústav Praha a Revmatologická klinika 1. LF UK Praha ¹; Klinika nefrologie 1. LF UK a VFN v Praze ²; Interní oddělení a hemodialyzační středisko, Klatovská nemocnice, a. s. ³
Published in: Vnitř Lék 2022; 68(5): 332-341
Category: Review Articles
doi: https://doi.org/10.36290/vnl.2022.068

Overview

Back pain (BP) is among the most common reasons for seeking medical attention worldwide. The nature of BP depends on the causative stimulus and its anatomical location. Clinically, BP is manifested by pain, muscle tension, and stiffness. The development of BP is a very complex, multifactorial process in which not only somatic stimuli (anatomical structures), but also psychosocial effects are involved. Using a variety of criteria, BP can be divided into specific where the cause of pain is known, nonspecific wherein the cause remains unclear, or according to its duration (i.e., acute, subacute, and chronic back pain). Simple low back pain must be distinguished from inflammatory BP. Inflammatory BP is one of the symptoms of spondyloarthritides. It is typically a resting pain of insidious onset, peaking at night or in the morning associated with morning stiffness, improved with exercise, and responding to non-steroidal antirheumatic drugs. A red-flag system was developed for the early identification of at-risk patients with a potentially severe disease presenting with BP. Early diagnosis and identification of the cause of complaints often requires multidisciplinary cooperation. The treatment involves pharmacological agents (analgesic and muscle relaxation therapies) and nonpharmacological approaches (rehabilitation, surgical intervention, etc.).

Keywords:

back pain – axial spondyloarthritis – inflammatory back pain

Sources

1. Adamová B. Bolesti páteře. In: Hakl M a kol. Léčba bolesti. Mladá fronta, Praha, 2013: 170-182.

2. Hakl M. Léčba bolestí zad Čas. Lék. čes. 2018;157:62-66.

3. Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribe. Rheumatology (Oxford). 2020 Oct 1;59(Suppl4):iv25-iv37.

4. Conen AE, Schoenenberger RA. A pain in the back. Lancet. 2006 Jan 21;367(9506):240.

5. Danve A, Deodhar A. Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities. Clin Rheumatol 2019;38:625-34.

6. Sieper J, van der Heijde D, Landewe R et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of Spondylo Arthritis International Society (ASAS). Ann Rheum Dis 2009;68:784-8.

7. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009,15;147(1-3):17-9.

8. Imboden JB, Hellman DB, Stone JH et al Current diagnosis and treatment, Rheumatology, third edition. New York: McGraw‑Hill Medical; 2013.

9. Qaseem A, Wilt TJ, McLean RM et al. Clinical Guidelines Committee of the American College of Physicians Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017,4;166(7):514-530.

10. Verhagen AP, Downie A, Popal N et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25(9):2788-2802.

11. Vrba, I. Diferenciální diagnostika bolesti zad. Med Pro Praxi. 2008;5:208-212.

12. Scheinost M, Němejcová K, Pudlač A et al. Difuzní idiopatická skeletární hyperostóza. Vnitř Lék. 2014;60(5-6):442-447.

13. Vrba I. Komentáře ke článku Systém „červených praporků“ v diagnoistice a terapii bolestí zad. Bolest. 2004;7(Suppl 2/2004):27-31.

14. Rudwaleit M, van der Heijde D, Landewé R et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validization and final selection. Ann Rheum, DiS., 2009;68:777-783.

15. Ostrý S, Štětkářová I, Korsa J et al. Stanovisko České neurologické společnosti ČLS JEP k organizaci péče o pacienty s akutní bolestí zad v bederní úrovni u dospělých. Cesk Slov Ne urol N. 2020;83/116(6):659-666.

16. Sieper J, Rudwaleit M. Early referral recommendation for ankylosing spondylitis (including pre‑radiographic and radiographic forms) in primary care. Ann Rheum, DiS., 2005; 64:659-663.

17. Zeidler H, Amor B. The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. Ann Rheum, DiS., 2011;70:1-3.

18. Pavelka K a Výbor České revmatologické společnosti Doporučení České revmatologické společnosti pro farmakologickou léčbu axiálních spondyloartritid Část I. Strategie léčby a farmakoterapie Čes. Revmatol. 2021;29(1):5-19

19. Popescu A, Lee H. Neck Pain and Lower Back Pain. Med Clin North Am. 2020;104(2):279-292.

20. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015 Feb;90(2):284-99.

21. McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013, 1;87(3):177-82.

22. Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. Handb Clin Neurol. 2014;119:541-9.

23. Koes BW, van Tulder M, Lin CW et al. An updated overview of clinical guidelines for the 23 management of nonspecifi c low back pain in primary care. Eur Spine J 2010; 19(12):2075-2094.

24. BijlsmaJ WJ et al. EULAR Compendium on Rheumatic Diseases. BMJ Publishing Group Ltd. 2009;477-485.