A Spectrum Estimation and Clinical Evaluation of Low Back Pain in General Practice

Abstract

Objectives: The primary purpose of this study is to look for the magnitude of the low back pain {LBP} amongst the referred cases and to identify its relation to the underlying conditions in patients presenting to Rheumatology Outpatient Clinic.Methods: One thousand patients who were complaining of LBP were enrolled in this cross-sectional study they consulted Rheumatology outpatient Clinic of Al-Ramadi Teaching Hospital ,Ramadi City, Iraq , from 2 January 2009 to 1 August 2009 . Pregnant women, Patients below 18 years of age and Fibromyalgia syndrome were excluded from the study. When primary diagnosis of LBP of any duration {acute ,subacute and chronic} was confirmed by historical and physical examination ,clinical decision was made to request either conventional X-Ray(for spondylolysis/spondylolisthesis, lumber spondylosis , Ankylosing spondylitis ,Psoriasis and Sacralization ) or MR Imaging (for Intervertebral disc prolapse, spinal canal stenosis , infectious discitis , spondylitis or infiltrative disorders ) .Data obtained from plain X-Ray and MRI were interpreted by consultant Radiologists .The radiological findings and clinical evaluations were assessed ,investigated and analyzed .Results : Out of 1000 patients enrolled in this study with mean age 46 +16 year ,738 (73.8%) were females and 262 (26.2%) were males .Female gender is significantly higher than males with predominance of 40-61 age groups . LBP of Inflammatory causes was reported in 518 (51.8%) patients with predominance of 29-39 (29.9%) ,40-50 (27.9%) age groups , while 482 (48.2%) patients were of mechanical causes predominated in 51-61(29%) and 29-39(17.2%) age groups .inflammatory subtype of LBP was experienced in higher rate among 438 (84.5%) female individuals than that of male individuals 80 (15.4%) ,while mechanical subtype occurred in male patients more than in female patients ,300 (62.3%) and 182 (37.7%) respectively .As mentioned, the commonest causes were disc prolapse and spinal stenosis in 105 males(43.3%) ,90 females (37.9%) ,followed by muscular spasm affecting 70 males(29.1%) and 70 females(28.9%) . The causes of Inflammatory subtype of LBP were distributed in 300 females (74%) due to Reactive arthritis and Pelvic Inflammatory Diseases { PID} , 80 females(19.7%) and 75 males(64.6%) due to Rheumatic disorders (Ankylosing spondylitis ,Psoriasis ) ,40 males(35.3%) and 25 females(6.17%) due to infectious agents (Brucellosis ,T B) .Our data illustrate the relation between Reactive arthritis and PID with Birth control method used females ,out of 300 diseased females, 200 were reported to use of Birth control .Intrauterine device(IUD) in 120 females(60%) ,contraception's (oral and injectable) in 40 females(13.3%) ,and tubal ligation in 40 females(13.3%) .The difference was statistically significant (p<0.05) . Conclusion : Our findings demonstrate that LBP is a common problem results from the reviews can be considered relevant for general population . There were inconsistent findings with respect to categories of LBP ,Inflammatory subtype reported significantly more in female individuals of 40-61 years of age .The issue of Birth control methods are clearly relevant to the concept of LBP which were implicated as potent risk factors .Although no acceptable evidence was found for therapeutic aspects ,misuse of systemic corticosteroids was reported in 144 cases with advers effects and osteoporotic features ,mostly were of iatrogenic in nature .