Mechanical or inflammatory low back pain. What are the potential signs and symptoms?

Two commonly used labels for low back pain (LBP) are that of “mechanical” (1) or “inflammatory” (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 (mobilization, 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. Non-specific low back pain (NSLBP) is commonly conceptualized and managed as being inflammatory and/or mechanical. This study was designed to identify common symptoms or signs that may allow discrimination between inflammatory low back pain (ILBP) and mechanical low back pain (MLBP). Experienced health professionals from five professions were surveyed using a questionnaire listing 27 signs/symptoms. Of 129 surveyed, 105 responded (81%). Morning pain on waking demonstrated high levels of agreement as an indicator of ILBP. Pain when lifting demonstrated high levels of agreement as an indicator of MLBP. Constant pain, pain that wakes, and stiffness after resting were generally considered as moderate indicators of ILBP, while intermittent pain during the day, pain that develops later in the day, pain on standing for a while, with lifting, bending forward a little, on trunk flexion or extension, doing a sit up, when driving long distances, getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of MLBP. This study identified two groups of factors that were generally considered as indicators of ILBP or MLBP. However, none of these factors were thought to strongly discriminate between ILBP and MLBP.