Low Back Pain

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Important Clinical Distinctions: Nerve Pain and Root Pain.

Nerve root pain is usually brief, sharp and shooting, often increased by coughing or straining, standing or sitting, and usually relieved by lying down. In comparison, pain originating in the peripheral nerves or lumbosacral plexus tends to be described as burning, like

Table 1: Red flags in the evaluation of Low Back Pain that may point to a more serious disorder

Possible condition Findings from Medical history

Fracture Major trauma (motor vehicle accident, fall from height)


Minor trauma or strenuous lifting in an older or osteoporotic patient

Tumor or infection age>

50 years or < 20 years

History of cancer

Constitutional symptoms (fever, chills, unexplained

weight loss)

Recent bacterial infection

Intravenous drug use

Immunosuppression (corticosteroid use, transplant recipient, HIV infection)

Pain worse at night or in the supine position

Cauda equina syndrome Saddle anesthesia

Recent onset of bladder dysfunction

Severe or progressive neurologic deficit in the lower extremity

Table 2: Differences between root pain and nerve pain

Characteristic Root pain Nerve pain

Duration Brief Persistent

Quality Sharp, shooting Burning, numb

Aggravating factor Coughing,straining, Lying in bed, standing, lifting

Releived by Lying down pins and needles, "asleep" or numb in quality; it is usually worse when the patient is lying in bed at night. (Table 2)

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Lyndeanw 

Im a 53 y/o healthy, weight appropriate female. I was diagnosed with degenerative lumbar spinal disease, including stenosis at the age of 38. I have a history of several low back injuries, including dislocation of my coccyx, due to falls from horseback riding
I've also worked as an EMT/Paramedic for over 32 years in several different ED units. Long hours on my feet in physically demanding situations.
I developed right hip pain with occasional leg weakness a few years ago, but managed to perform daily tasks without severe discomfort.
I've started to have increased (R) hip/glut pain in the past three months, radiating laterally through my thigh, calf and ankle. This frequently causes thigh and calf spasms that have been debilitating In all of my daily activities. I've seen my PCP, and an Orthopaedic surgeon, with negative findings on exam and MRI.
Any idea what the possible problem could be? Then, how to manage the pain and be able to work, sleep, clean my home and enjoy life again?
Thank you
Lyndean W

md111 

i am unable to bend my knee without severe pain. Very difficult and painful. My lower back always has a stifness and throbing pressure.
I also have servere shooting pain across my back periodically.

thersea 

I have been diagnosed with spinal stenosis & spondolylesis. I have pain radiating from my butt down leg top of foot. Sometimes bottom of foot & also in the groin area. 1 side or the other every day. The pain is horrible. Sometimes both sides. Can't sit can't stand hardly sleep. Help? Have had 2 cortizone shots in a 6mo. period.1st helped. 2nd to a small degree. Unable to take pain meds.

colatulgupta 

Very good material. I wonder if some photographs and radio graphs could be added. Dr Atul Gupta

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