The main objective of this study is to describe the characteristics, imaging findings and clinician defined specific diagnosis, in patients with low back and leg pain seeking treatment in a primary care setting. Information about the broad group of patients with LBP and leg pain presenting to primary care will contribute to our understanding of the characteristics and clinical features of this population, and will help patients, health care practitioners and managers better define and deliver appropriate health care provision. Robust evidence regarding the epidemiology of low back related leg pain (including sciatica) is lacking from primary care, the setting where the majority of these patients will present and be managed. Most studies focus on patients with back pain alone, include mixed populations with back and leg pain (without differentiating between them), or are concerned with describing the characteristics of highly selected populations from tertiary care settings (including surgical candidates).
One reason for this confusion and lack of clarity in the guidelines relates to the poor evidence base regarding outcome and treatment effectiveness for LBP patients with related leg pain.įew studies exist which describe the characteristics and clinical course of the full range of patients seeking care for low back and leg pain/sciatica. However, there is an inherent contradiction in the guidelines as despite the call for accurate and early diagnosis of low back related leg pain, the recommendations for initial treatment of patients with leg pain, including sciatica, appear to be similar to those for non-specific LBP. Hence most back pain national and international guidelines recommend assessing, diagnosing and addressing back related leg pain early in the presentation of patients complaining of back problems, so that treatment can be prioritised and delivered to this subset of LBP patients with increased risk of poor prognosis. Overall, the literature indicates that patients who complain of back and leg pain and/or sciatica suffer more severe pain and disability, take longer to recover and incur most of the indirect costs and lost workdays compared to those with back pain alone. It is generally acknowledged that the differentiation between sciatica and referred leg pain is not always straightforward in clinical practice, but ultimately it is a clinical diagnosis. Referred leg pain from the low back is unrelated to nerve root involvement and is considered as pain referred from any other structure such as muscle, ligament, joint or intervertebral disc. The most common reasons for sciatica are a disc bulge/prolapse or stenosis (either of the central canal or the foramen) impinging or irritating a nerve root(s). The latter is commonly labelled sciatica and is often characterised by pain radiating to below the knee, into the foot and toes, and may be accompanied by objective findings of nerve root entrapment such as sensory deficits, reflex changes or muscle weakness. Leg pain associated with LBP is generally considered to be either referred or radicular pain. 66 Aerolite has been preserved at the National Railway Museum in York.In primary care, approximately 60 % of patients presenting with low back pain (LBP) also report pain in the leg(s). All four were inherited by the London and North Eastern Railway (LNER) at the time of its formation on 1 January 1923, and withdrawn from service between 19. 1, both rebuilt from 2-2-2 tender locomotives. NER 190 Class, later class X3 had two members, nos. 957, which had been rebuilt from a BTP class 0-4-4T in 1903 and later classified as X2 class. 66 Aerolite rebuilt as a 2-2-4T in 1902 and later known as in LNER class X1 No. In the United Kingdom, the North Eastern Railway, had four tank locomotives of this wheel arrangement, all of which had previously been rebuilt from other types.