chronic

Acute non-specific low back pain

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 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 against3 documents

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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Low Back Pain: Evaluation and Management" - disease-level clinical article

Presentation findings are traced to the source above.

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally 3 times daily with food - shortest duration needed (up to 1-2 weeks)

Paediatric dose

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.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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 > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose 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.

Cautions

RED FLAG - Nighttime pain, fever, bowel or bladder dysfunction, or progressive neurologic deficits require urgent evaluation and referral.

METHOCARBAMOL + PARACETAMOL

add-on - not a substitute

Formoral.solid

Adult dose and duration

1-2 tablets (400 mg methocarbamol / 325 mg paracetamol) 3-4 times daily x up to 5 days max

Paediatric dose

Not recommended in pediatric care

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AWADIST RELAX 20 F.C. TABS.	HIGH PERFORMANCE PHARMA (HP PHARMA)	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 > ORIGINAL GROUP	46.00 EGP (2.30/unit)
METHORELAX 30 TAB.	SIGMA > GENNECS PHARMACEUTICALS	81.00 EGP (2.70/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.