Back pain

Abstract

Low back pain is a major cause of disability worldwide. Data on the prevalence of low back pain are presented. Information on the pathogenesis of pain is given. The temporal characteristics of pain are presented. Risk factors and triggers for episodes of low back pain are reviewed. The most common causes of specific and non-specific low back pain are described. Non-specific low back pain is more common, as no specific pathological-anatomical cause can be identified. Specific pain includes nociceptive and neuropathic pain. In order to make a correct diagnosis in a patient with low back pain, a thorough medical history must be taken, which usually provides important information in identifying the cause of the pain syndrome. The warning signs (‘red flags’) for specific causes of low back pain requiring urgent treatment and specific psychosocial factors contributing to chronic pain (‘yellow flags’) are considered separately. ‘Red flags’ include conditions such as suspected traumatic injury, tumour, infection or radiculopathy and cauda equina syndrome. «Yellow flags» include individual cognitive, emotional and behavioural factors that contribute to the development of chronic pain. The main aim of pharmacotherapy for low back pain is to enable patients to continue or resume their normal daily activities. The main recommended approaches in the treatment of acute and chronic low back pain are presented. The main non-steroidal anti-inflammatory drugs for the oral drug treatment of non-specific low back pain are described, with evidence-based doses. Special attention is given to the role of diclofenac in the treatment of pain. The authors present the results of systematic reviews that analyse the available data on the efficacy and safety of topical transdermal dosage forms that contain NSAIDs.