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What is the back pain due to?
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A Problem in the back
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A problem elsewhere
(eg. abdomen,
G-U, systemic)
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DIAGNOSE AND MANAGE APPROPRIATLY
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Is there a spinal cord or cauda equina lesion?
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EMERGENCY REFERRAL TO A SPINAL SURGEON
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Sphincter
disturbance
Gait disturbance
Saddle anaesthesia |
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Back pain diagnostic triage
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Possible serious spinal pathology
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Nerve root problem
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Simple backache
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RED FLAGS
Presentation age < 20 or >55
Non-mechanical pain
Thoracic pain
PH-carcinoma, steroids, HIV
Unwell, weight loss
Widespread neurology
Structural deformity
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Unilateral leg pain > LBP
Radiates to foot or toes
Numbness & anaesthesia in same distribution
SLR reproduces leg pain
Localised neurology
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|
Presentation age 20-55 years
Lumbosacral, buttocks & thighs
"Mechanical" pain
Patient well
|
PRIMARY CARE MANAGEMENT
(see Figure 5) |
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Is there severe or progressive motor weakness?
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PRIMARY CARE MANAGEMENT
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Is it settling?
|
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CONTINUED PRIMARY
CARE MANAGEMENT
|
|
|
|
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URGENT
SPECIALIST
REFERRAL
|
SPECIALIST
REFERAL
|
RETURN TO
WORK
|
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