# Acute non-specific low back pain - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian Drug Authority (EDA) Prescribing Information · Ibuprofen 400 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7020) - Verified date: 2026-08 ## Verified against - Egyptian Drug Authority (EDA) Prescribing Information - Ibuprofen 400 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7020) - Acute non-specific low back pain - disease-level clinical article (low-back-pain-clinical.txt) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Methocarbamol + Paracetamol — oral.solid ## Complete treatment card ```text ACUTE NON-SPECIFIC LOW BACK PAIN Sources: Egyptian Drug Authority (EDA) Prescribing Information · Ibuprofen 400 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7020) Review status: REVIEWED against Egyptian Drug Authority (EDA) Prescribing Information, Ibuprofen 400 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7020), Acute non-specific low back pain - disease-level clinical article (low-back-pain-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Pain present under 6 weeks is usually mechanical strain, while pain over 12 weeks reflects a longstanding mechanical or other condition [back pain] - New difficulty starting urination, bowel changes, or numbness around the saddle area are key cauda equina warning symptoms [numbness] - Sciatica affecting both legs, rapidly worsening leg pain, or new weakness in both legs raises serious concern for nerve root compression [back pain · sciatica] - In children, night-time pain and age under 4 raise concern for tumour or infection [back pain] - Morning stiffness lasting more than 30 minutes that eases with movement or heat points toward an inflammatory cause [joint stiffness] SIGNS - what you find (8) - The straight-leg-raise test is positive for disc herniation if raising the leg to under 60 degrees reproduces pain on that side [back pain · disc herniation] - The crossed straight-leg-raise (raising the other leg) is more specific than the standard test for disc herniation [disc herniation] - The Stork test for spondylolysis is positive if standing on one leg and arching backward reproduces the pain [back pain] - The Adam forward-bend test can reveal a rib or back hump pointing to scoliosis - Bruising, scrapes, or tenderness over the spinous processes can suggest a fracture [bruising] - Progressive limb weakness or numbness, new loss of bladder or bowel control, saddle numbness, or a slack anal sphincter suggest cauda equina compression [numbness] - Leg weakness or numbness that eases with rest (neurogenic claudication) suggests spinal stenosis [claudication · leg weakness · numbness · stricture] - A vertebral compression fracture causes pain that worsens on bending forward with a tender point on palpation [back pain] TESTS (10) - Fewer than 5-10% of low back pain cases have a specific spinal cause; 90-95% are nonspecific mechanical pain that does not need routine imaging - Disc degeneration shows up on imaging in more than 80% of adults over 50 even without symptoms - In adults, imaging is reserved for pain lasting over 6 weeks despite conservative treatment; in children, pain lasting over 4 weeks - MRI is favoured when nerves, discs, or other soft tissue are suspected to be involved - CT or MR angiography is used when aortic dissection is suspected - Rheumatology panels (HLA-B27, ANA, rheumatoid factor, Lyme antibodies) are usually nonspecific and not routinely useful - CRP and ESR are useful inflammatory markers when infection or an inflammatory disease is suspected - Raised LDH and uric acid can point to a rapid marrow turnover process such as leukaemia - Around 97% of spinal tumours found are metastatic rather than a primary cancer - Vertebral fractures account for roughly 0.4-5.6% of low back pain presentations IF NOT THIS - what else fits (12) - A muscle or ligament strain causes pain that worsens with movement and eases with rest, with restricted movement and tenderness on palpation - Lumbar spondylosis affects those over 40 and may bring hip pain - Disc herniation, usually at L4-S1, causes numbness, sensory change, and weakness along the affected nerve root - Spondylolysis or spondylolisthesis pain can radiate into the buttock and back of the thigh - A spinal tumour is suggested by unexplained weight loss and focal tenderness along with malignancy risk factors - A spinal infection is suggested by recent spinal surgery, IV drug use, or immune suppression together with fever, localized pain, or a wound - Aortic dissection can cause tearing back pain, more common in older adults with vascular disease - In younger patients, aortic dissection is often linked to a connective tissue disorder such as Marfan, Ehlers-Danlos, or Loeys-Dietz syndrome - In children, a bone tumour causing back pain, especially osteoid osteoma, classically eases with NSAIDs - Childhood epidural abscess should be suspected if there are neurological deficits or nerve- root pain - Scheuermann kyphosis presents with chronic back pain and a rigid, fixed curve - A psychological cause (conversion or somatisation) is suggested by persistent pain despite a normal physical exam Source StatPearls "Low Back Pain: Evaluation and Management" - disease-level clinical article Status traced to the source above 1. IBUPROFEN [1st line] Adult 400 mg orally 3 times daily with food - shortest duration needed (up to 1-2 weeks) Peds Low back pain in children <16 years requires urgent pediatric evaluation to exclude serious organic etiology (discitis, infection, tumor); routine primary care NSAID management is not recommended. Source Ibuprofen 400 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7020) Why NSAID that reduces pain and inflammation through COX inhibition; first-line analgesic for acute non-specific low back pain, used to keep the patient mobile rather than confined to bed rest. Caution Screen for RED FLAGS (cauda equina, fever, weight loss, progressive deficit). Encourage remaining active; avoid prolonged bed rest. Co-prescribe PPI in elderly or high GI risk patients. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute non-specific low back pain - disease-level clinical article (low-back-pain- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Nighttime pain, fever, bowel or bladder dysfunction, or progressive neurologic deficits require urgent evaluation and referral. 3. METHOCARBAMOL + PARACETAMOL [add-on - not a substitute] Adult 1-2 tablets (400 mg methocarbamol / 325 mg paracetamol) 3-4 times daily x up to 5 days max Peds Not recommended in pediatric care Source Egyptian Drug Authority (EDA) Prescribing Information Why Included per Egyptian Drug Authority (EDA) prescribing practice as a short-term adjunct for acute severe muscle spasm. NICE NG59 does not name muscle relaxants at all - this is EDA practice alone, not a NICE-supported exception. Caution This is a short-term adjunct for severe painful muscle spasm in acute strain. May cause drowsiness and dizziness; caution when driving. Avoid alcohol and sedatives during therapy. Egypt AWADIST RELAX 20 F.C. TABS. HIGH PERFORMA... 30.00 EGP (1.50/unit) FLEXPRO EXTRA 20 F.C.TABS. MUP 46.00 EGP (2.30/unit) METHOBAMOL 20 F.C. TABS. ARAB CAPS > O... 46.00 EGP (2.30/unit) METHORELAX 30 TAB. SIGMA > GENNE... 81.00 EGP (2.70/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)