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NHSLIntegratedBackPainPathway.aspx
History
- Low back pain and stiffness in sacroiliac region sometimes radiating to buttocks
- Marked early morning stiffness improving as the day goes on
- Onset late teens or early 20’s.
- May be associated with iritis and inflammatory bowel disease
Examination
- Reduced range of spine movements
- Chest expansion reduced
Investigations
- ESR and CRP (often raised but may be normal)
- X-rays of pelvis and lumbar spine (sacroileitis and possibly syndesmophytes but may be normal in early disease)
Referral
Patients with a characteristic history should be referred to the rheumatology service, even if bloods and x-rays are normal.
Main differential diagnoses
Prolapse intervertebral disc – Pain follows nerve root distribution.
Mechanical back pain – Worse on movement, relieved by rest
Initial management
Treat symptoms with full dose NSAID / and or analgesics pending clinic review.
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