Back pain DDx

Osteopathy for Back pain

Common causes

• Mechanical back pain
• Disc disease (radiculopathy)
• Spondylosis (degenerative)
• Psychogenic

Must Not Miss

• AAA
• Cauda Equina Syndrome
• Pulmonary embolism
• Malignancy
  • Multiple myeloma
  • Metastases
• Infection
  • Osteomyelitis
  • Discitis
  • Tuberculosis
  • Pelvic Inflammatory Disease
  • Pelvic abscess
  • Pneumonia
• Osteoporotic vertebral fracture

Easily missed

• Peptic ulcer disease
• Pancreatitis
• Spinal canal stenosis
• Spondylolisthesis
• UTI / Prostatitis
• Endometriosis
• Spondyloarthropathies
  • AS
  • Crohn’s dis/ Ulcerative colitis
  • Psoriasis
  • Reiter’s syndrome

Red flags

• Cauda equina syndrome
  • Bilateral Sciatica
  • Saddle anaesthesia
  • Bladder or bowel dysfunction
  • Major motor weakness
  • Gait problems (e.g. foot drop)
• Thoracic pain
• Major recent trauma
  • (RTA, fall from a height)
• Minor trauma or lifting in people with Osteoporosis
• Age >50 years or <20 years
• History of Cancer, HIV, Drug abuse
• Constant, progressive or night pain disturbing sleep
• Systemic symptoms
  • (fever, night sweat, weight loss)
• Immunosuppression
  • (HIV, Chemotherapy, Steroids)

Investigations to consider

• FBC, CRP/ESR
• U&Es, LFTs, Bone profile
• Auto antibody screen
• Myeloma screen
• PSA
• Urinalysis
• X-ray Spine
• MRI scan
• Bone scan
• CXR, CT chest/ abdo & pelvis

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