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

Non-specific low back pain (NS-LBP) is commonly conceptualised, categorised and treated as inflammatory and/or mechanical in nature. There is no universally accepted definition for mechanical or inflammatory LBP, however, there is evidence to support the involvement of both mechanical and inflammatory factors in its generation. Following from this nosological separation, there are two distinct approaches to treatment for LBP: treatment involving “mechanical” intervention, such as mobilisation, manipulation, traction and exercise are contrasted with ‘‘anti-inflammatory’’ treatments like non-steroidal anti-inflammatory medications and corticosteroid injections.

In an effort to identify common symptoms or signs that may allow discrimination between inflammatory low back pain (ILBP) and mechanical low back pain (MLBP), Walker and Williamson recently surveyed experienced health professionals from five professions using a questionnaire listing 27 signs/symptoms. Of 129 surveyed, 105 responded (81%). According to their results, constant pain, pain that wakes, and stiffness after resting  were generally considered as moderate indicators of inflammatory LBP. Intermittent pain during the day, pain that develops later in the day, pain on standing for a while, pain bending forward a little, pain on trunk flexion or extension, pain doing a sit up, pain when driving long distances, pain getting out of a chair, and pain on repetitive bending, running, coughing or sneezing were all generally considered as moderate indicators of MLBP. There was, however, no consistency of agreement either between or within professional groups.

While the general absence of agreement regarding signs and symptoms of ILBP and MLBP does not invalidate the pathophysiological paradigms of mechanical and inflammatory pains, it does, however, signal the need for further research. This research should be aimed at testing the indicators identified in this study for their ability to predict the outcome of mechanical and anti-inflammatory treatments of LBP.

Walker BF, Williamson OD. Mechanical or inflammatory low back pain. What are the potential signs and symptoms? Man Ther. 2009 Jun;14(3):314-20. Epub 2008 Jun 13.