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Lower back pain: clinical features and examination of patients

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This article discusses the clinical and paraclinical aspects of pain syndromes of the lumbosacral localization. The past medical history (including the working conditions of the patient and the presence of constant stress), physical and paraclinical examination, and assessment of psychological condition are important for establishing the correct diagnosis. It should be noted that there is no strict parallelism between the presence of back pain and the results of paraclinical examination of the spine. Therefore, the comprehensive assessment of the patient's clinical status, including the state of the musculoskeletal system, has a leading value for correct diagnosis and selection of therapy.
Increasing pain when coughing or sneezing is noted in patients with discogenic pain syndromes; the development of pain along the root innervation often occurs simultaneously with the reduction of localized pain in the lumbar region.
The diagnostic value of the radiography and neuroimaging data is unquestioned; however, these methods allow one to evaluate mainly the anatomical rather than pathophysiological changes. The direct dependence between the anatomical changes and the clinical situation is not typical of back pain. Magnetic resonance imaging (MRI) is when the injury level is unclear and the clinical examination 
data indicate pathology of the spinal cord or soft tissues. Moreover, MRI data help either to eliminate or confirm a tumor or the inflammatory nature of the pain syndrome. MRI is also an informative method in patients who have undergone surgery for vertebral pathology. Computed tomography is an effective diagnosis method only in those cases where the symptomatology clearly indicates the injury level and the bone changes are the pain cause with a high degree of probability. Electromyography (EMG) is very informative in patients with radiculopathies; it allows one to evaluate the pathophysiological changes in such patients. However, there usually is no need for using EMG upon clinically apparent lesion of the root. In a number of cases, additional information can be obtained using blocks with an analgesics or pain-provoking agents.

The lack of close relation between the neuroimaging data and the clinical aspect of a disease may underlie the unreasonably broad application of these methods and overestimation of their results. Hence, there may emerge undue anxiety, since both the patient and the physician can set an unreasonably high value on paraclinical data, while the actual role of these results is insignificant. Upon that, an incorrect assessment of the situation results in inadequate and ineffective therapy. 

About the Author

I.V. Damulin
Department of Nervous Diseases and Neurosurgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
Russian Federation


1. Алексеев ВВ. Неврологические аспекты лечения острых скелетно-мышечных болевых синдромов. Русский медицинский журнал. 2004;12(5):266-9. [Alekseev VV. Neurologic aspects of treatment of sharp skeletal and muscular pain syndromes. Russkii meditsinskii zhurnal. 2004;12(5):266–9. (In Russ.)]

2. Герасимова ОН, Парфенов ВА. Ведение пациентов с болью в спине в амбулаторной практике. Неврология, психиатрия, психосоматика. 2010;(4):65-71. [Gerasimova ON, Parfenov VA. Management of patients with back pain in outpatient practice. Nevrologiya, psikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(4):65–71. (In Russ.)]. DOI:

3. Подчуфарова ЕВ, Яхно НН, Алексеев ВВ и др. Хронические болевые синдромы пояснично-крестцовой локализации: значение структурных скелетно-мышечных расстройств и психологических факторов. Боль. 2003;(1):38-43. [Podchufarova EV, Yakhno NN, Alekseev VV, et al. Chronic pain syndromes of lumbar and sacral localization: value of structural skeletal and muscular frustration and psychological factors. Bol'. 2003;(1):38–43. (In Russ.)]

4. Чурюканов МВ. Мультидисциплинарные программы лечения хронической боли в спине. Неврология, нейропсихиатрия, психосоматика. 2013;(4):84-7. [Churyukanov MV. Multidisciplinary treatment programs for chronic back pain. Nevrologiya, psikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(4):84–7. (In Russ.)]. DOI:].

5. Hall H. Back Pain. In: Neurological Therapeutics Principles and Practice. Noseworthy JH, editor-in-chief . 2nd ed. Vol. I. Chapter 21. Oxon: Informa Healthcare; 2006. P. 240–56.

6. Braddom RL. Perils and pointers in the evaluation and management of back pain. Semin Neurol. 1998;18(2):197–210. DOI:

7. Patel N. Surgical disorders of the thoracic and lumbar spine: a guide for neurologists. J Neurol Neurosurg Psychiatry. 2002;73 Suppl 1:i42–8.

8. Belgrade MJ, Charry O. Radicular Limb Pain. In: Neurological Therapeutics Principles and Practice. Noseworthy JH, editor-in-chief. 2nd ed. Vol. I. Chapter 20. Oxon: Informa Healthcare; 2006. P. 223–39.

9. Дамулин ИВ, Оразмурадов ГО. Боли в спине: диагностические аспекты. Российский медицинский журнал. 2010;(4):40-5. [Damulin IV, Orazmuradov GO. Back pains: diagnostic aspects. Rossiiskii meditsinskii zhurnal. 2010;(4):40–5. (In Russ.)]

10. Greenberg DA, Aminoff MJ, Simon RP. Clinical Neurology. 5th ed. Chapter 6. Disorders of Somatic Sensation. New York etc.: Lange Medical Books/McGraw-Hill; 2002. P. 200–31.

11. Ketonen LM, Berg MJ. Clinical Neuroradiology 100 Maxims. London etc.: Arnold; 1997. 178 p.

12. Доронин БМ, Доронина ОБ. Некоторые актуальные вопросы диагностики и лечения боли в спине. Неврология, нейропсихиатрия, психосоматика. 2010;(4):24-8. [Doronin BM, Doronina OB. Some topical problems in the diagnosis and treatment of back pain. Nevrologiya, psikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(4):24–8. (In Russ.)]. DOI:

13. Подчуфарова ЕВ. Тактика обследования и лечения пациентов с болью в нижней части спины. Русский медицинский журнал. 2006;14(9):679-83. [Podchufarova EV. Tactics of inspection and treatment of patients with pain in the lower part of a back. Russkii meditsinskii zhurnal. 2006;14(9):679–83. (In Russ.)]

14. Дамулин ИВ, Алешина ЕД. Осторожная походка пожилых. Российский медицинский журнал. 2008;(2):50-4. [Damulin IV, Aleshina YeD. Careful gait of the elderly. Rossiiskii meditsinskii zhurnal. 2008;(2):50-4. (In Russ.)]

15. Вознесенская ТГ. Депрессии в неврологической практике. Трудный пациент. 2003;1(2):26-30. [Voznesenskaya TG. Depressions in neurologic practice. Trudnyi patsient. 2003;1(2):26–30. (In Russ.)]


For citations:

Damulin I. Lower back pain: clinical features and examination of patients. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(1):9-15. (In Russ.)

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