Pathophysiology

  • Non-specific low back pain, MSK or mechanical back pain refers to pain from the bottom of the ribs to the lumbosacral spine 
  • Clinical features:
    • MSK back pain is typically exacerbated by movement and varies with posture.
    • There may be a history of precipitating injury or trauma.
    • Red flags should be excluded/

Management of non-specific LBP

  • Exclude underlying causes of LBP such as sciatica, myelopathy, spinal stenosis, ankylosing spondylitis, osteoarthritis + rule out emergencies such as cauda equina syndrome, vertebral fractures and spain malignancy/infection
  • Most cases should resove in 3-4 weeks without intervention
  • Analgesia:
    • 1st line: NSAID (ibuprofen) for the shortest effective time (if no contraindications)
    • If NSAID CI - alternative: Consider short term use of codeine with or without paracetamol 
    • NICE advise to NOT use paracetamol alone for LBP, benzodiazepines for muscle spasm or opioids for chronic LBP. 

References

NICE CKS. Back pain - low (without radiculopathy) [September 2023]. Available here.