Complex Lower Back Pain: A Case Report

Lower back pain is a common primary care symptom with musculoskeletal, neurological, neoplastic, infectious, or inflammatory causes. It remains the leading cause of years lived with disability, and it is linked to modifiable factors such as occupational exposure, smoking, and high body mass index (BMI), highlighting the need for preventive, lifestyle-focused strategies. To illustrate these challenges, a 60-year-old man is presented with a 20-year history of type 2 diabetes and a background of alcohol use disorder and suboptimal therapeutic compliance, resulting in poor glycemic control. He presented with low back pain radiating to both lower limbs, with a five-day evolution, exhibiting a mechanical pattern, without identifiable relieving or aggravating factors, which progressively progressed to tetraparesis. Following a comprehensive, multisystem evaluation conducted by both the primary care physician and hospital specialists, the etiology was determined to be multifactorial. Cervical spondylotic compressive myelopathy was confirmed through cervical MRI, leading to the indication for surgical intervention. The mixed sensorimotor polyneuropathy with axonal predominance was diagnosed via electromyography and nerve conduction studies, consistent with combined diabetic and toxic etiologies. The patient achieved partial symptom remission; however, significant limitations in activities of daily living persisted, ultimately requiring disability retirement, with substantial psychological and social impact. Grounded in the principles of family medicine, this case illustrates the crucial role of the general practitioner: guiding the evaluation of a common symptom through individualised care; obtaining a medical history that raised diagnostic suspicion; and managing a complex patient with a holistic approach that included physiotherapy, optimisation of diabetes control, medication review, and mental health support. The general practitioner also addressed cardiovascular risk factors to delay or prevent disease progression and promoted sustained healthy lifestyle changes.