One of the most discomforting pains a person would seek medication for is back pain. In fact, every year, more than 200 million dollars are spent on managing back pain. Sadly, the pain might be a problem that persists into adulthood, causing significant disability rates. In this situation, it is imperative to diagnose patients of all ages and understand the differences between various populations. Because of back pain, the function of the back is restricted, daily activities are compromised and people’s quality of life is miserable. Indeed, most of the times the pain revokes easily by using a different lifestyle, fixing an overweight, exercising or using pain killers. However, below we discuss serious back pain scenarios that requires more serious measures for both adults and children.

Causes of back pain:

Obviously, back pain is a very broad topic, which implies a wide spectrum of causes. Indeed, etiologies involves 5 groups including mechanical, inflammatory, degenerative, oncologic and infectious reasons.

1. Mechanical: there are several causes of mechanical pain such as a fracture in the spine, disc injury, or damage to the soft tissues. When fractures (example: spondylolisthesis) can be acute or chronic, lumbago is either an acute pain or a strain. Actually, the strain is at the level of the paraspinal muscles or the quadratus lumborum. Also, pregnancy and traumatic back pain (Disc herniation) are mechanically-induced.
2. Inflammatory: such as ankylosing spondylitis where spine bones fuse, and sacroiliitis where the sacroiliac joints have inflammation. Moreover, back pain can be correlated with acute inflammatory response.
3. Degenerative: degenerative changes of the spine include sacroiliac joint osteoarthritis, facet joint osteoarthritis, degenerative disc disease, spinal stenosis, and osteoporotic compressive fractures.
4. Oncologic: it’s caused by diseases of the spine, marrow cancers, or compressive nerve events leading to pathological fracture.
5. Infectious: where the discs, spine, epidural abscesses or soft tissue abscesses are under infection.

Notably, the pain may result from some unrelated disorders such as pneumonia, biliary colic, and infectious or obstructive renal disease.

When to see a doctor:

It is very important to seek medication upon experiencing any of the conditions below since it can be an indication of a serious pathology.

• Fever
• Weakness
• Unreasonable weight loss
• Had a spinal procedure within the last year interval
• Numbness (motor/sensory loss)

Prevalence of back pain:

It only makes sense that back pain is way more common in adults than in children and adolescents. As a matter of fact, studies shows percentages of those who suffer pain in the back:

• 24-80% of adults
• 50% for 20 years old males
• 50% for 18 years old females
• 5% for the 15 years old
• 1% for the 12 years old

History and physical evaluation:

Whether diagnosing adults or children, the historical characteristics of both are very alike. Thus, among the conditions that must be clarified according to historical examination are:

• Way of injury.
• Pain strength and its grade.
• What amplifies and what diminishes the pain.
• Former treatments.
• Degree of impairment at the level of work or school.
• Family history of cancer and inflammatory diseases.
• Social history from encounter with tuberculosis to exercising regimens and injectable drug usage duration.
• Pain nature (nociceptive or neuropathic pain).
• Pain intervals (acute or chronic).
• Chronic pain includes symptoms of hyperalgesia and allodynia.
• Having acute muscle spasm or herniated disc is indicated by how the back operates.
• Pain location can translate the cause among degenerative arthritic changes, compression fracture, and sacroiliac joint injury.
• Positive response to certain medication.
• Ruling out the exact pathology through related symptoms such as fever, chills, weakness, sudden weight loss, etc...

Physical examination includes:

• Palpation.
• Body check-up.
• How much a patient can move.
• Testing the patients strength.
• Neurological analysis such as tendon reflex, limb strength and sensation.
• Asking for certain exercises.
• If raising legs provokes ipsilateral pain at less than 60°, the patient has lumbar disk herniation.
• To test for pars interarticularis defects, perform one leg hypertension or stork test.
• To test for scoliosis, the patient must undergo Adam test where a thoracic lump is observed.

Treatment:

According to the age, etiology, and chronicity of the condition, back pain treatment is ruled out. To illustrate, the most effective treatments for adults are those covered in the "Noninvasive treatments for low back pain: current state of the evidence" published by the Agency for Healthcare Research and Quality.

For adults:

• Radicular low back pain treatment: Moderate benefit received by Non steroidal anti-inflammatory drugs (NSAIDs), but little benefit seen after exercising, traction and spinal manipulation.
• Non-radicular subacute or acute back pain treatment: Moderate benefit is met by NSAIDs, muscle relaxants and heat. Also, massaging has little benefit.
• Non-radicular chronic low back pain: Physical therapy (McKenzie), and acupuncture has moderate benefit. Duloxetine and NSAIDs provide open-ended help. Yoga, spinal manipulation, tai chi, and multidisciplinary rehab all have little benefit.

It only makes sense to go the direction of surgery as a treatment when the severe pain lasts more than a year. Such pain can ruin many work opportunities for the patient and renders them with disability.

For children:

The standard therapy is physical therapy, NSAIDs, and change of activities. Besides, in the case of spondylolysis might need a surgical approach. Furthermore, physical therapy and proper exercising are options to treat Scheunemann's kyphosis with less than 60° patients. However, more than 75° curvature needs surgery to correct the spine. After full maturation, a scoliosis of 20 degrees or more, severe scoliosis, progressive curvature, and atypical scoliosis require surgical intervention.

References:

-Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

-Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2008 Jul 15;33(16):1766-74.

-M Das J, Nadi M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 31, 2021. Lasegue Sign.