Back pain—facts and cases

As practicing rheumatologists we have probably never given thought to how common an ailment, back pain is. Two thirds to almost three fourths of the population would have suffered at least a single episode of back pain in their lifespan. Usually the first episode of back pain occurs in the third or the fourth decade of life and increases with advancing age. Most clinicians approach back pain with an algorithm to classify whether back pain is inflammatory or non inflammatory. Amongst Non inflammatory back pain, we first proceed to rule out a prolapsed disc and then sinister causes such as malignancy and infection. Once the above have been ruled out all the leftover complaints are collectively given the label of “Mechanical back pain”. It is precisely this kind of back pain which is more likely to be chronic, unresolved and unrelenting and it is this “Mechanical back pain” that we would like to focus on rather than the whole list of differential diagnosis.