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From mechanical low back pain to radiculopathy — evidence-based spine care
Low back pain is the leading cause of disability worldwide, affecting over 540 million people at any given time. Neck pain affects 20–40% of adults annually. At Dr. Bodh Raj’s clinic, spine pain management follows a biopsychosocial model: accurate diagnosis (red flag screening, clinical examination, targeted imaging), classification by pain generator (disc, facet, sacroiliac joint, radiculopathy, stenosis), evidence-based non-operative care (exercise therapy, manual therapy, psychological support), and interventional procedures or surgery when conservative measures fail.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Bodh Raj Gautam (MBBS (KU), MS-Orthopedics (GMC), Cert. Podiatry & Diabetic Foot (India), NMC 23071). Evidence-based, no fabricated outcomes.
Low back pain is the leading cause of disability worldwide, affecting over 540 million people at any given time. Neck pain affects 20–40% of adults annually. At Dr. Bodh Raj’s clinic, spine pain management follows a biopsychosocial model: accurate diagnosis (red flag screening, clinical examination, targeted imaging), classification by pain generator (disc, facet, sacroiliac joint, radiculopathy, stenosis), evidence-based non-operative care (exercise therapy, manual therapy, psychological support), and interventional procedures or surgery when conservative measures fail.
Reviewed by Dr. Bodh Raj Gautam, MBBS, MS-Orthopedics — Consultant Orthopedic Surgeon & Foot Nail Specialist (NMC 23071), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Spine pain assessment begins with red flag screening (cauda equina syndrome, infection, malignancy, fracture) that requires urgent investigation. Non-specific low back pain accounts for 85–90% of presentations and is a clinical diagnosis of exclusion. Specific diagnoses include disc herniation with radiculopathy (dermatomal pain, positive straight leg raise), spinal stenosis (neurogenic claudication, flexion-relief pattern), facet joint pain (extension-related, referred pain), and sacroiliac joint dysfunction (FABER test, Gaenslen’s test). The Keele STarT Back Tool stratifies risk for chronicity to match treatment intensity to prognosis.
Exercise therapy is the cornerstone: graded activity, motor control exercises, McKenzie approach, and cognitive functional therapy for fear-avoidance. Manual therapy (spinal manipulation, mobilization) provides short-term pain relief as an adjunct to exercise. Psychological interventions (CBT, ACT) address catastrophizing, fear-avoidance, and depression that perpetuate chronic pain. Interventional procedures (epidural steroid injection, facet joint injection, medial branch blocks, sacroiliac joint injection) provide targeted relief for specific pain generators. Surgical referral (discectomy, decompression, fusion) is reserved for progressive neurological deficit, cauda equina syndrome, or failed conservative care.
Guidelines referenced:
Foster NE et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. LancetNICE NG59 — Low back pain and sciatica in over 16sQaseem A et al. Noninvasive treatments for acute, subacute, and chronic low back pain. Ann Intern MedContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.