ABSTRACT
The management of back pain is a huge subject and it remains controversial. Lower back pain (LBP) is the most common musculoskeletal disorder and it is the leading cause of disability on a global scale. The cause is probably multifactorial: increased sedentary lifestyle, reduced physical activity levels and ageing populations. The risk factors for chronicity are past history of back pain, current widespread bodily pain, and psychosocial factors, including depression and anxiety. Health beliefs leading to fear and avoidance behaviour, external locus of control and catastrophising are significant determinants. Cauda equina syndrome is a surgical emergency and full neurological recovery generally occurs when the cauda equina is decompressed within 24 hours. The doctor needs to be aware of the conditions that are most common in different age groups. A thorough history includes enquiring about occupation, social and psychological factors, medication, past medical history, injury mechanisms and experience of previous back pain episodes.
