HPE Chronic pain – part one | Page 7

Nevertheless, serious causes (‘red flags’) have to be excluded. TABLE 1 Differential diagnosis of low back pain Spinal disorders Spinal disorders Lumbar strain or sprain Neoplasia Pelvic organs (for example, prostatitis, endometriosis, pelvic inflammatory disease) Degenerative disease Infection Spondylosis Inflammatory arthritis Vascular disease (for example, abdominal aortic aneurysm, aorto-iliac disease) Spondylolisthesis Paget’s disease Gastrointestinal disease (for example, pancreatitis, cholecystitis) Intervertebral disc herniation Osteochondrosis Spinal stenosis Fracture Congenital disease (kyphosis, scoliosis) Internal disc disruption Adapted from reference 22 Visceral disorders Renal disease Symptomatology and differential diagnosis The differential diagnosis of low back pain is broad and includes both mechanical and nonmechanical causes. Among the mechanical causes, lumbar strains/sprain, degenerative disease of the discs/facet joints, spondylosis/spondylolisthesis, disc herniation/ disruption, fractures and congenital diseases must be considered. Non-mechanical conditions include spinal disorders (for example, malignancies, infection, inflammatory arthritis) and visceral disorders (including prostatitis, endometriosis and pelvic inflammatory disease, as well as kidney, vascular, and gastrointestinal disease) (Table 1). 10 Currently the diagnosis is primarily based on anamnesis and clinical judgment. A thorough clinical assessment of the low back pain constitutes an important step to reassure patients and manage the condition, and a complete medical history may help speed up the diagnosis. This assessment should be accompanied by a thorough physical examination, which might include sensory tests (for example, response to pressure, cold/heat sensation, and vibration) and a psychosocial evaluation. Keep in mind that there is usually only a weak agreement between the results of the physical examination and the subjective reporting of the severity of pain and disability. However, this approach is not too time-consuming and can ensure that serious ‘red flags’ (that is, symptoms that could indicate potentially serious conditions, warranting immediate intervention, such as fever, urinary or faecal incontinence, bilateral lower extremity weakness or numbness, or progressive neurologic deficits) are not being missed. 2 Although the hospitalpharmacyeurope.com | 2019 | 7