🔑 Key Learning

  • Common cause of pain in umbosacral spine
    • Worse with movement, improves with rest
  • Most cases resolve within 3–4 weeks
  • NSAIDs = 1st line; avoid paracetamol alone

🧬 Pathophysiology

Mechanical or musculoskeletal back pain refers to pain arising from muscles, joints, ligaments, or discs in the absence of a specific underlying pathology.

👀 Clinical Features

  • Dull ache or stiffness in the lower back
  • Pain worsens with movement, improves with rest
  • May follow strain, lifting, or minor trauma
  • No neurological signs
  • Red flags must be excluded:
    • Cauda equina
    • Malignancy/infection
    • Vertebral fracture
    • Ankylosing spondylitis
    • Radiculopathy or myelopathy

🧪 Investigations

  • Diagnosis is clinical
  • Imaging not required unless red flags or persistent symptoms >6 weeks
  • Rule out other causes with appropriate history and exam

💊 Management

First-line

  • NSAIDs (e.g. ibuprofen) for the shortest effective time (if no contraindications)

If NSAIDs contraindicated

  • Short course of codeine ± paracetamol
  • Avoid paracetamol monotherapy
  • Avoid benzodiazepines, tramadol, and long-term opioids for chronic LBP

Supportive

  • Reassure: most cases resolve within 3–4 weeks
  • Encourage return to normal activity and movement
  • Provide patient info and back care advice

📝 Exam Clues & Clinchers

  • NSAID 1st line, short course of codeine if NSAIDs unsuitable

🔗 Useful Links and References