<unk>  is one of the most common cause of primary care and emergency department visit. On the basis of origin,<unk>  can be broadly classified into three categories: axial, referred, and radicular.<unk>  can also be classified on the basis of its underlying etiology into mechanical and non-mechanical. On the basis of pathogenesis,<unk>  can be broadly classified into inflammatory, mechanical, degenerative, oncologic and infectious. Genes involved include HLA-B27, SOX5, CCDC26/GSDMC, DCC. Conditions associated with<unk>  are, heavy lifting, ligaments and muscle strain, back injuries/fractures, arthritis, osteoporosis, metastatic cancer, abnormal posturing, degenerative disc disease, depression, pregnancy, fibromyalgia, sciatica, spinal disc herniation, spinal stenosis.The causes of<unk>  can be stratified according to age. Common causes of<unk>  in adults under the age of 50 years include, ligament strain, nerve root irritation, spinal disc herniation, degenerative disc disease and isthmic spondylolisthesis. Common causes in adults over the age of 50 years include osteoarthritis (degenerative joint disease), spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.  Non-anatomical factors can also lead to<unk> , such as stress, repressed anger, or depression. Even if an anatomical cause for the pain is present, a coexistent depression should be treated concurrently. The prevalence of<unk>  in adult population is around ten to thirty percent in the US. Lifetime prevalence in US adult population is estimated to be 65-80 percent. Prevalence of<unk>  is higher in smokers as compared to non-smokers. Risk factors for<unk>  include poor posture, obesity, pregnancy, cancer, weight lifting, psychological stress, smoking, sedentary lifestyle, lack of exercise, autoimmune disease, arthritis and trauma.There is no single diagnostic study of choice for the diagnosis of<unk> .<unk>  is a symptom of an underlying condition, emphasis should be made in identifying the etiology. The diagnostic plan should include, a detailed history, physical examination, identification of red flags, imaging (preferably an MRI) and laboratory evaluation (CBC, ESR, CRP, ANA, RF, LDH, uric acid, HLA-B27). MRI is helpful in the diagnosis of the underlying cause of<unk> . Findings on MRI suggestive of the cause of<unk>  include soft tissue lesions, nerve compression, malignancy, and/or inflammatory  lesions. MRI is indicated in<unk>  if any of following red flags are present, history of cancer, unexplained weight loss, significant trauma, motor weakness, sensory loss, urinary/fecal incontinence. Other diagnostic studies for<unk>   include electromyography, nerve conduction studies, somatosensory evoked potentials, and/or diagnostics injections. Treatment depends on the underlying cause, co-morbidities, age of the patient and chronicity of the pain. A treatment plan including a combination of medical and non-medical therapy should be formulated. Medical therapy includes, muscle relaxants, narcotics, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs), acetaminophen, amitriptyline, tramadol, pregabalin, corticosteroids. Non-Medical therapy include heat massage, physical therapy, exercise, psychotherapy, massages, joint manipulation, managing ergonomics, acupuncture. Surgery is rarely needed for<unk> . Surgery may be required in patients with lumbar disc herniation, degenerative disc disease, spinal stenosis,  spondylolisthesis, scoliosis, compression fracture. Surgical procedure include, diskectomy, laminectomy, joint fusion, artificial disks, interlaminar implant, vertebroplasty, kyphoplasty, and nucleoplasty.
Back pain
Low back pain
Leg pain
Knee pain
Testicular pain
Abdominal pain
Elbow pain
Chest pain  