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Uploaded byDaradia: The Pain Clinic
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Evaluation of Back Pain: Clinical Identification of Pain Generators (Disc, Facet, SI Joint & More)

This presentation provides a structured and clinically practical approach to the evaluation of back pain, with special emphasis on identifying the true pain generators in the lumbar spine and surrounding structures. It systematically explains how different anatomical structures produce characteristic pain patterns, including: Intervertebral disc (internal disc disruption, disc prolapse, canal stenosis) Facet joints Sacroiliac (SI) joint Paraspinal muscles Ligaments Vertebral body Bursae Hip joint Key clinical features such as posture-related pain, walking tolerance, sitting relief, leg pain patterns, neurogenic claudication, and the presence or absence of neurological deficits are clearly correlated with each pain source. This resource is especially useful for: Pain physicians Anesthesiologists Orthopedic surgeons PM&R specialists Spine clinicians Postgraduate medical trainees The goal is to improve diagnostic accuracy, guide rational investigations, and support appropriate interventional or conservative management strategies in patients with acute and chronic low back pain. Read more: https://daradia.com/pain-generators-in-back-pain/

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Evaluation of back pain
Evaluation of back pain Causes Red flags History • Chief Complains • H/O Pr illness • Medical H • Personal H • Family H • Occupation H Clinical exam • Inspection • Palpation • ROM • Neurology exam • Special clinical tests Tests • Blood • USG • X-RAY • CT • MRI Diagn • Prov • D/D
Pain generator It must have a physiological nociceptive innervation It may have pathological innervation or sensitization
Back Pain Causes Generators
Pain generators Disc Facet joints Sacro-iliac joint Muscles Ligaments Vertebral body Bursae Hip Joint Pain generators at lower back
Where? Why???
Disc as pain generator Why? Where? Disc • Internal disc disruption • Disc prolapse • Canal stenosis
Disc as pain generator • Internal disc disruption Pain generators are nerves inside disc • Disc prolapse Pain generators are nerve roots outside disc • Canal stenosis Ischemia of nerves because of compression
Clinical feature • Internal disc disruption/ Degenerated disc disease Back pain on sitting • Disc prolapse Leg pain relieved on sitting, lying; increased on standing and walking • Canal stenosis Leg pain on walking (neurogenic claudication), back pain relieved on sitting, increased on standing
Facet as pain generator Why? Where? Facet • Degeneration • Inflammation • Trauma
Clinical features • Predominant back pain with non- dermatomal leg pain • Pain relieved on sitting and bending forward • Pain increased on ext, lat bending & rotation • Pain decreased on walking • No neuro-deficits
SI joint as pain generator Why? Where? SI Joint • Degeneration • Inflammation • Trauma • Malignancy
Clinical features • Buttock pain or lower back pain which is well localised with non-dermatomal leg pain • Pain increased on sitting and relieved on standing or walking • No neuro-deficits
Muscles as pain generator Why? Where? Muscles • Repetitive stress injury • Trauma • Prolonged muscle spasm • Malignancy
Pain Generators for Back Pain
Ligaments as pain generator Why? Where? Ligaments • Sprain/Trauma • Enthesitis
Vertebral body as pain generator Why? Where? Vertebral Body • Trauma/Fracture • Malignancy
Bursae as pain generator Why? Where? Bursa • Trauma • Inflammation
Hip joint as pain generator Why? Where? Hip Joint • Trauma • Inflammation • Degeneration
Evaluation of back pain Causes Red flags History • Chief Complains • H/O Pr illness • Medical H • Personal H • Family H • Occupation H Clinical exam • Inspection • Palpation • ROM • Neurology exam • Special clinical tests Tests • Blood • USG • X-RAY • CT • MRI Diagn • Prov • D/D