The Various Categories for Low Back Pain

spinal stenosis

Diagnostic Categories for Low Back Pain (LBP)

Back pain represents a tremendous problem in the US which can be extremely frustrating for both patients and medical providers. Patients have to live with the pain and providers need to diagnose why the pain is occurring. Finding the cause of pain, known as the pain generator, is not easy despite all the diagnostic techniques and studies modern medicine has to offer.

Thankfully, even if the exact cause is not known for certain, 90% of LBP resolves on its own within 6 to 12 weeks. Help can be obtained with physical therapy, chiropractic treatment, spinal decompression, pain medications, and interventional pain management.

In 2007, the American College Physicians along with the American Pain Society issued comprehensive joint clinical practice guidelines for the diagnosis and treatment of LBP.

Low Back Pain (LBP) should be placed initially into one of three categories. These include:

1) Nonspecific LBP - this can be occurring from a spinal disc problem like degenerative disc disease, facet joint disease, degenerative spinal arthritis, or a stress fracture or acute fracture like a vertebral compression fracture.

2) LBP potentially associated with radiculopathy (radiating pain into the legs also called sciatica) or spinal stenosis. Spinal stenosis may be associated with slippage of one vertebrae on another which is called degenerative spondylolisthesis.

3) Back pain potentially associated with another specific spinal cause that may be very serious and require immediate or emergency evaluation

a. Tumor

b. Infection

c. Fracture

d. Cauda Equina Syndrome

e. Other spinal issues like ankylosing spondylitis

f. Problems outside the back such as pancreatitis, aneurysm, systemic illness, kidney stone, etc.

In the primary care setting, LBP is caused by cancer 0.7% of the time, infection 0.01% of the time, vertebral compression fracture 4% of the time, spinal stenosis 3%, herniated disc 4%, and cauda equina syndrome 0.04%. Upwards of 85% of the time, no definitive diagnosis for the low back pain can be established.

In the initial visit and starting the workup for what's causing low back pain, it is important for the pain doctor to effectively categorize the type of pain in order to achieve the proper diagnosis to maximize treatment success.