Abstract
Introduction Two commonly used labels for low back pain (LBP) are that of 1Cmechanical 1D (1) or 1C inflammatory 1D (2). These labels have no universally accepted definitions. However, there are two distinct types of treatment for low back pain that seem to follow this definitional separation. That is, mechanical treatments (mobilisation, manipulation, traction and exercise) contrasted with anti-inflammatory treatments (medication and injections). The objective of this study was to obtain the opinion of five groups of experts about symptoms/ signs that may identify inflammatory and mechanical LBP.
Methods A convenience sample of 125 practitioners including spine surgeons, rheumatologists, musculoskeletal physicians, chiropractors and physiotherapists was asked to complete a questionnaire. Participants were asked to use a Likert (0 1310) scale to indicate the strength of agreement or disagreement with respect to potential signs/symptoms identifying inflammatory or mechanical LBP. Ethics approval was obtained.
Results One hundred and five practitioners responded (81% response). No signs/symptoms were found to clearly distinguish between inflammatory and mechanical LBP. Nevertheless, seven signs/symptoms did show a higher score for either inflammatory or mechanical LBP, and a lower score for the other. Morning pain on waking, pain that wakes the person up, constant pain, and stiffness after resting (including sitting) were more likely to suggest inflammatory LBP, while intermittent pain during the day, pain when lifting and pain on repetitive bending were more likely to suggest mechanical LBP. There was however some disagreement between professions about the extent to which these signs/symptoms indicated mechanical or inflammatory LBP.
Discussion There was no clear agreement either within or between professions regarding the signs and symptoms that suggest mechanical or inflammatory low back pain. There was however weak agreement on seven signs/symptoms. Further research should be aimed at testing these for their ability to predict the outcome of mechanical and anti-inflammatory treatments of LBP.