Lower Back Pain, Clinical Reasoning, Contextualised Care & Learning From Complications

What if it's not arthritis?Lower back pain can look like hip osteoarthritis, behavioural change, skin disease, anal gland problems or simply people thinking it's just ‘old age’. Diagnosing it requires far more than finding one painful spot—it takes careful history-taking, clinical reasoning and seeing the bigger picture.In this episode of Vet Voices on Air, we sit down with RCVS and European Specialist in Veterinary Neurology Colin Driver to explore the complexities of diagnosing and managing chronic lower back pain, particularly degenerative lumbosacral stenosis (DLSS). From recognising subtle behavioural changes and differentiating neurological from orthopaedic disease, to understanding when imaging, medical management or surgery may be appropriate, Colin shares practical advice that every veterinary professional can take back into practice.But this conversation quickly becomes about much more than spinal disease.We discuss what contextualised care really means, why there is rarely a single "right" answer for every patient, and how balancing evidence, patient welfare, owner circumstances, ethics and finances is one of the greatest challenges in modern veterinary medicine.The episode also takes an honest look behind the scenes of specialist practice. Colin speaks openly about complications, cognitive bias, decision-making under pressure and the emotional burden of making mistakes—topics that are rarely discussed publicly but affect every veterinary professional.