Back Pain: pearls, pebbles and gems

Paivi Miettunen, MD, Roberta Schellenberg, MD

Back pain is a common presenting problem for medical professionals. The role of the physician is to discern if the cause of the pain is serious in nature. Red flags to seek out are:
 • Trauma history
 • Constitutional symptoms
 • Symptoms of nerve impingement/spinal cord involvement
 • Risk factors for spinal infection.

A physical exam should be used in a logical fashion to support and/or exclude the differential diagnosis of the diseases identified on history. Radiological investigations must be clinically correlated, as some radiological abnormalities may be incidental findings. The use of pain mapping may be a useful diagnostic and follow up tool.
Treatment options include:
 •  Acupuncture
 •  Injections
 •  Bracing devices
 •  Physical therapy
 •  Neuropathic medications
 •  Chiropractic therapy.

Finally, prevention of (further) back injury should be stressed to all patients. "Back first, back flat, back straight and back last" are the keys to back protection.


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This program has been provided through an unrestricted educational grant from McNeil Consumer Healthcare, the makers of TYLENOL*(acetaminophen).

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