Low Back Pain

Lumbago, Low Back Syndrome, Backache

Basic Information

What is Low back pain?

Low back pain is a symptom, not a specific disease. Low back pain is discomfort in the lumbosacral area of the back that may or may not radiate to the legs, hips, and buttocks. It is a symptom that can have many causes. As many as 90% of all individuals may never have a clear diagnosis for the cause of the pain. A small percentage may have a more serious disease not related to the back.

Low back pain ranks second only to upper respiratory infections as a source of loss of work, and the direct cost is estimated to be 30 billion dollars annually in the US.

Mechanical or musculoskeletal disorders such as lumbosacral sprains and strains, degenerative disc disease, herniated discs, slippage of a disc (spondylolisthesis), spinal stenosis, and fractures comprise the vast majority of low back pain cases, and this group is the focus of this section. Other sources of low back pain are infection of the vertebral bodies and the discs (pyogenic or tubulous vertebral osteomyelitis), inflammations of the vertebrae (spondylitis) such as ankylosing spondylitis and other cases of spondylitis associated with other diseases, and visceral disorders, where diseases of the kidneys, pancreas, the aorta, and tumors of this region (the retroperitoneum) have referred pain to the lower back.

Low back pain signs and symptoms

  • Pain. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending or twisting.
  • Stiffness.

Causes

  • Exertion or lifting.
  • Severe blow or fall.
  • Back disorders.
  • Infections.
  • Ruptured lumbar disk.
  • Nerve dysfunction.
  • Osteoporosis.
  • Tumors.
  • Spondylosis (hardening and stiffening of the spinal column).
  • Congenital problem.
  • Childbirth.
  • Often there is no obvious cause.

Risk increases with

  • Biomechanical risk factors.
  • Sedentary occupations.
  • Gardening and other yard work.
  • Sports and exercise participation, especially if infrequent.
  • Obesity.

Preventive measures

  • Exercises to strengthen lower back muscles.
  • Learn how to lift heavy objects.
  • Sit properly.
  • Back support in bed.
  • Lose weight, if obese.
  • Choose proper footwear.
  • Wear special back support devices.

Expected outcomes

Individuals suffering from uncomplicated back pain usually recover from the acute episode, though recurrence is common. Eighty-five percent of individuals are free of back pain by three months, and 95% are pain-free in six months.

Possible complications

When the low back pain is simple muscle strain, there are not any real complications. Complications will result if the individual learns the secondary gains of an injury and does not participate fully in a recovery plan. Any lower back problem that involves the vertebral discs carries the risk of nerve root impingement.

Low back pain treatment

General measures

  • Diagnostic tests may include laboratory blood studies to determine if there is an underlying disorder, X-rays of the spine, CT or MRI scan.
  • Bed rest for first 24 hours. Additional bed rest will be determined by severity of the problem. Recent medical studies indicate that staying more active is better for back disorders than prolonged bed rest.
  • Use a firm mattress (place a bed board under the mattress if needed).
  • Ice pack or cold massage or heat applied to affected area with heating pad or hot water bottle.
  • Physical therapy.
  • Massage may help. Be sure person is well-trained or massage could cause more harm than help.
  • Wear a special back support device.
  • Other options are available depending on degree of injury, such as surgery (if disk damaged), electrical nerve stimulation, acupuncture, special shoes, etc.
  • Stress reduction techniques, if needed.

How is Low back pain treated?

Pain without an underlying diagnosis is treated conservatively with tolerable activity and reassurance. Simple analgesics may be appropriate. Muscle relaxants could be beneficial to relieve pain and muscle spasm. Use of light support corsets may help with the pain. Physical therapy, exercises to strengthen the muscle, especially the abdominal muscles, and education in proper body mechanics begin after the acute phase has passed. Spinal manipulation may be helpful.

Medications

  • Mild pain medications such as aspirin or acetaminophen.
  • Stronger pain medicine or a muscle relaxant may be prescribed.
  • Note: Medications do not hasten healing. They only help to reduce symptoms.
Information Brand Generic Label Rating
Uses for Amitriptyline Elavil Amitriptyline Off-Label
Gabapentin 300mg Neurontin Gabapentin Off-Label
Motrin tablets Motrin Ibuprofen On-Label

Imuran (Azathioprine), Valium (Diazepam), Pamelor (Nortriptyline), Celebrex (Celecoxib), Naprosyn (Naproxen), Soma (Carisoprodol)

Alternatives

Many other conditions besides lumbosacral strain can cause low back pain. These include cardiovascular, respiratory, gastrointestinal, urological and gynecological disorders. Pain originating in the spine could be from tumor, infection, inflammatory conditions, metabolic disorders, degenerative disc disease, instability, spondylosis, and spondylitis.

Rehabilitation

Physical therapy, three times a week, for a period of two to four weeks, or chiropractic treatment for two to four weeks.

Activity

  • Try to continue with daily work or school schedules to the extent possible. Use care in resuming normal activities.
  • Avoid strenuous activity for 6 weeks.
  • After healing, an exercise program will help prevent re-injury.

Diet

No special diet. A weight reduction diet is recommended if obesity is a problem.

Appropriate specialists

Physiatrist, orthopedic surgeon, neurologist, rheumatologist, internist, sports medicine specialist, and anesthesiologist.

Notify your physician if

  • You or a family member has mild, low back pain that persists for 3 or 4 days after self-treatment.
  • Back pain is severe or recurrent.
  • New or unexplained symptoms appear. Medications used in treatment may cause side effects.

Last updated 21 December 2011


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