4^th International Anesthesia and Pain Medicine Conference

Over 80% of the population will suffer from lower back pain during their lives; it is the fifth most common reason for all physician visits in the US. Most cases of lower back pain can be linked to a general cause such as muscle strain, injury or overuse or can be attributed to a specific condition of the spine, most commonly: Herniated disc, degenerative disc disease, spondylolisthesis, spinal stenosis and osteoarthritis. A number of less common conditions can cause low back pain as well, such as sacroiliac joint dysfunction, spinal tumors, fibromyalgia and piriformis syndrome. Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone. In primary care, approximately 60% of patients presenting with Low Back Pain (LBP) also report pain in the leg(s). Leg pain associated with LBP is generally considered to be either referred or radicular pain. The latter is commonly labelled sciatica and is often characterized by pain radiating to below the knee, into the foot and toes and may be accompanied by objective findings of nerve root entrapment such as sensory deficits, reflex changes or muscle weakness. The most common reasons for sciatica are a disc bulge/prolapse or stenosis (either of the central canal or the foramen) impinging or irritating a nerve root(s). Referred leg pain from the low back is unrelated to nerve root involvement and is considered as pain referred from any other structure such as muscle, ligament, joint or intervertebral disc. It is generally acknowledged that the differentiation between sciatica and referred leg pain is not always straightforward in clinical practice but ultimately it is a clinical diagnosis. Overall, patients who complain of back and leg pain and/or sciatica suffer more severe pain and disability, take longer to recover and incur most of the indirect costs and lost workdays compared to those with back pain alone. When determining the underlying cause of lower back and lower extremity pain, both the type (a description of how the pain feels) and the area of pain distribution (where the pain is felt) help guide the physician in making a preliminary diagnosis and determining the appropriate treatment plan.