It is most important to ascertain that the pain is of vertebral origin. Pain due to infection, inflammation, tuberculosis, tumour of the spine, osteomyelitis, cancer or other diseases should be excluded.
A sudden dramatic pain is most likely due to a derangement of the spine. Pain which increases relentlessly without any intermission suggests that it may be due to inflammation or malignancy. In such cases, an X-ray has to be done to check out the condition of the spine and the disc. However if there is an acute prolapse, the X-ray may not show any abnormality, but may show the extent of osteoarthritis as being extensive or mild. It may be remembered that there are many patients with the same radiological changes who do not experience pain, and they continue to show the same changes even after they obtain complete relief.
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