Back pain is one of those common occurrences that most of us would have experienced it at least once in our lifetime.
According to the National Medical Care Statistics (NMCS), approximately 12% of the Malaysian population are facing with the issue of back pain1. The condition has always been one of the most common reason for patients to visit the clinic. In fact, it is rated as the fifth and ninth most common complaints received at private and public healthcare clinics, respectively1.
When your ‘back pain’ gets worse!
As common as it may be, back pain is not something to be taken lightly. A back pain that lasts for more than three months is considered as a Chronic Low Back Pain (CLBP)2.
CLBP often leads to challenges that can severely impact a patient’s quality of life, which includes diminished mobility, work absenteeism and can even create a burden on the healthcare system3. Furthermore, severe cases of CLBP are also associated with significant morbidity4.
Inflammatory Back Pain VS Mechanical Back Pain
CLBP can be categorised into one of the two main groups of back pain. The most common type is the Mechanical Back Pain, and the lesser known but more severe type would be the Inflammatory Back Pain.
To understand the difference between Inflammatory Back Pain versus Mechanical Back Pain, you may refer to the table below5:
Inflammatory Back Pain
• Age of onset: below 40 years old
• Insidious onset
• Improvement with exercise
• No improvement with rest
• Pain at night or early morning
• Morning stiffness of more than 30 minutes
• Alternating buttock pain
Mechanical Back Pain
• Age of onset: at any age
• Mostly sudden onset
• Worsens with movement
• Improvement with rest
• Faster recovery with rest and treatments
Inflammatory back pain stems from an overactive immune system that causes joint inflammation in the spine and pelvis. Meanwhile for mechanical back pain, the pain is due to a disruption in the way the components of the back fitting together and move, including the spine, muscles, intervertebral discs, and nerves6.
Typically, Inflammatory Back Pain is related to conditions like ankylosing spondylitis and requires a medical attention by a specialist7.
How do you know that if you are experiencing Inflammatory Back Pain or Mechanical Back Pain?
According to the Assessment of SpondyloArthritis International Society (ASAS), if you have suffered from back pain for more than three months, you will have to ask yourselves the following questions:
1. Did your back pain start before the age of 40?
2. Did your back pain develop gradually?
3. Does your back pain improve with exercise?
4. Does your back pain NOT improve with rest?
5. Do you suffer from back pain at night, which improves after getting up?
If you have answered ‘Yes’ to 4 out of 5 of the questions above, there is a high possibility that you may be suffering from Inflammatory Back Pain and require medical attention8. It is crucial that you speak to your doctor or a rheumatologist immediately to find out what treatments are available for you to manage your condition.
Please download this letter to help you explain your condition and get a referral to a rheumatologist.
References
1Sivasampu S, Yvonne L, Norazida AR, Hwong WY, Goh PP, Hisham AN, National Medical Care Statistics (NMCS), author . Kuala Lumpur: National Clinical Research Centre; 2012. 2014.
2The Malaysian Low Back Pain Management Guidelines (First edition). 2010. Available at https://www.masp.org.my/index.cfm?menuid=23.
3Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther. 2004;27(4):238-44.
4Borenstein DG and Calin A. Fast facts: Low back pain (second edition). Health Press. 2012.
5Harris, Claire et al. “Differentiating Inflammatory and Mechanical Back Pain”. Physiotherapist Module 1. August 2015
6Stanton, C. (2021). Symptoms of Non-Radiographic Axial Spondyloarthritis: Could You Have This Inflammatory Back Pain?. CreakyJoints. Retrieved 5 May 2021, from https://creakyjoints.org/symptoms/non-radiographic-axial-spondyloarthritis-symptoms/.
7Lassiter W, Allam AE. Inflammatory Back Pain. 2021 Feb 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30969575.
8Inflammatory back pain screener adapted from ASAS IBP criteria: Sieper J et al. Ann Rheum Dis 2009;68:784–788.
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