Diagnostic points include:
• Young adult females predominantly affected
• Continuous unvarying pain, often described in vivid terms; no relief from rest, which usually helps even the most severe organic conditions
• Long history of treatment failures, including with analgesics
• Associated symptoms, e.g. headaches; history of fruitless investigation of symptoms from other systems
• Sometimes depression but more often difficult life situations
• No signs-normal tests
• Reassure and explain
• Explore causes
• Treat depression if appropriate
• Avoid inappropriate diagnoses, e.g. ‘arthritis of the spine’ and repeated referrals
• Avoid confrontation
• Avoid prescribing drugs or predicting cures-the drugs will not work and the cures will not happen.
Non-specific low back pain
This is an appropriate term for those cases that defy diagnosis with current knowledge and techniques. Patients will vary from those with acute pain that will quickly resolve to those with long-standing symptoms and little prospect of recovery. Without the possibility of definitive treatment, one must rely on simple symptomatic measures such as analgesic drugs.