back dominant pain

We've got your back: HealthPlexus and the Canadian Spine Society Announce the Launch of the Back Health CME Resource


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For immediate release:
January 7th 2014

The Canadian Spine Society (CSS), as part of its educational mandate, is partnering with (HealthPlexus) and the Journal of Current Clinical Care (JCCC) to promote best practices and knowledge translation for fast and effective diagnosis and management of back pain.

As part of the multi-faceted collaboration, CSS and HealthPlexus will work on a comprehensive continuing education program aimed at healthcare professionals that will be delivered via and the Journal of Current Clinical Care.

Dr. Hamilton Hall is a well-recognized key opinion leader both nationally and internationally on the subject of back pain. He has taken on the position of Editor-in-Chief for the Back Health Resource Center @HealthPlexus.

Dr. Hall and his colleagues from the CSS will present an ongoing series of Clinical Reviews and Case Studies, which will be available through the HealthPlexus channels. Their goal is to provide those healthcare professionals who are managing patients with back health issues with deeper knowledge and increased ability to address their patients' needs.

"Numerous population wide surveys have confirmed that arthritic disorders that limit mobility are the most important factors in impairing quality of life for older adults. Back pain is one of the key issues limiting mobility, and I applaud HealthPlexus for addressing this very important topic."

-Barry J. Goldlist, MD, FRCPC, FACP, AGSF, senior member of the advisory board for [Geriatrics and Dementia] and the Journal of Current Clinical Care. Dr. Goldlist is a nationally recognized geriatrician with a long standing interest in medical education and medical journalism.

“For practitioners who look after the adult population, especially those in the middle and later years, disorders of musculo-skeletal mobility and acute and chronic pain is one of the most common challenges they face with their patients. There is enormous suffering and impairment of full function and ability to participate in normal activities much less those of a recreational nature when someone experiences back pain that is unrelieved by simple and safe methods. Having an additional means to learn about and find methods to address the issues of back pain with all its complexities of diagnosis and treatment, is an important addition to the HealthPlexus spectrum of clinical support for practicing physicians.”

-Michael Gordon, MD, MSc, FRCPC, FACP, the Editor-in-Chief of the Dementia Educational Resource. Dr. Gordon is the Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System

"As a medical professional who has trained as both a Radiologist and a Family physician, I have seen many patients who suffer from the entire spectrum of lower back pain. I don't think that medical school and residency prepares you enough to adequately to deal with the complexity of this condition. A dedicated CME resource focusing on back health is a much needed tool for both students and practicing physicians who wish to acquire skills and keep their skills up to date on this subject. Dr. Hall is eminently qualified for such an endeavor. I still recall his teachings, some years ago now, in my medical school class at the University of Toronto vividly. As medical editor of the Journal of Current clinical Care, I encourage you to take advantage of this learning opportunity."

-D’Arcy Little, MD, CCFP, FRCPC, the editorial director of and its sister publication, the Journal of Current Clinical Care. Dr. Little is a family physician, diagnostic radiologist and medical writer. He completed fellowships in Care of the Elderly and Academic Medicine

About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Back Health Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.

About The Canadian Spine Society:

The CSS is a collaborative body of Canadian neurosurgical and orthopaedic spine surgeons and other spine care professionals with a primary interest in advancing excellence in spine patient care, research and education.

Contact Person:
Mark Varnovitski

Managing Back Dominant Pain

Managing Back Dominant Pain


Hamilton Hall, MD, FRCSC,1 Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,2 Yoga Raja Rampersaud, MD, FRCSC,3

1Professor, Department of Surgery, University of Toronto; Medical Director, Canadian Back Institute; Executive Director, Canadian Spine Society, Toronto, ON.
2Associate Professor, Department of Family and Community Medicine, University of Toronto, Medical Director, Sport CARE, Women’s College Hospital, Toronto, ON.
3Associate Professor Department of Surgery, University of Toronto, Divisions of Orthopaedic and Neurosurgery, University Health Network Medical Director, Back and Neck Specialty Program, Altum Health, Immediate Past President Canadian Spine Society, Toronto, ON.


Abstract: Back dominant pain is either intensified by flexion or is not aggravated by bending forward. The most common pattern, probably discogenic, subdivides into two groups: one with pain on flexion but relief on extension, the other with pain in both directions. The second pattern has symptoms with extension only. Treatment begins with education about the true benign nature of the problem. Mechanical pain responds to posture adjustment and pattern-specific movement. Medication has a secondary role. Imaging is not required for the responding patient. The inability to detect a pattern or a lack of anticipated response combined with non-mechanical findings indicates the need for appropriate referral.
Key Words:back dominant pain, education, medication, imaging, specialist referral.

HealthPlexus is offering an eCME in support of the Back Pain Management Resource

eCME: The Latest in Back Pain Management

This CME activity offers interactive Videos, Animations, Pre- and Post-test Quizzes and you will be able to download a Certificate of Participation upon completion.

Back Dominant pain can be divided into two presentations: pain that is predominantly reproduced with flexion or pain that is reduced or unaffected by flexion.
The recognition of mechanical low back pain is based on a precise history, a validating physical examination and a positive treatment result.
Referred pain to the leg may occur with back dominant pain but, unlike radicular pain, the neurological examination will be normal.
Facilitating the patient to engage in activity that does not aggravate pain is the key to pain management and recovery.
The goal is control, not cure. Anything that relieves the pain and helps to restore mobility is valuable.
Medication has a limited and secondary role. There is no place for the routine use of narcotics or psychotropic drugs.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.