Low Back Pain Health Article

Definition

Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a variety of diseases and disorders that affect the lumbar spine. Low back pain is often accompanied by sciatica, which is pain that involves the sciatic nerve and is felt in the lower back, the buttocks, and the backs of the thighs.

Description

Low back pain is a symptom that affects 80% of the general United States population at some point in life with sufficient severity to cause absence from work. It is the second most common reason for visits to primary care doctors, and is estimated to cost the American economy $75 billion every year.

Low back pain may be experienced in several different ways:

• Localized. In localized pain the patient will feel soreness or discomfort when the doctor palpates, or presses on, a specific surface area of the lower back.
• Diffuse. Diffuse pain is spread over a larger area and comes from deep tissue layers.
• Radicular. The pain is caused by irritation of a nerve root. Sciatica is an example of radicular pain.
• Referred. The pain is perceived in the lower back but is caused by inflammation elsewhere—often in the kidneys or lower abdomen.

Acute pain

Acute back pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, muscle relaxants, or aspirin. Applications of heat or cold compresses are also helpful to most patients. If the patient has not experienced some improvement after several weeks of treatment, the doctor will reinvestigate the cause of the pain.

Chronic pain

Patients with chronic back pain are treated witha combination of medications, physical therapy, andoccupational or lifestyle modification. The medicationsgiven are usually NSAIDs, although patients withhypertension, kidney problems, or stomach ulcers should not take these drugs. Patients who take NSAIDs for longer than six weeks should be monitored periodically for complications.

Physical therapy for chronic low back pain usually includes regular exercise for fitness and flexibility, and massage or application of heat if necessary.

Lifestyle modifications include giving up smoking, weight reduction (if necessary), and evaluation of the patient's occupation or other customary activities.

Patients with herniated disks are treated surgically if the pain does not respond to medication.

Patients with chronic low back pain sometimes benefit from pain management techniques, including biofeedback, acupuncture, and chiropractic manipulation of the spine.

Psychotherapy is recommended for patients whose back pain is associated with a somatoform, anxiety,or depressive disorder.

Low back pain with leg involvement

Treatment of sciatica and other disorders that involve the legs may include NSAIDs. Patients with long-standing sciatica or spinal stenosis that do not respond to NSAIDs are treated surgically. Although some doctors use cortisone injections to relieve the pain, this form of treatment is still debated.

Diagnosis

The diagnosis of low back pain can be complicated. Most cases are initially evaluated by primary care physicians rather than by specialists.

Initial workup

PATIENT HISTORY. The doctor will ask the patient specific questions about the location of the pain, its characteristics, its onset, and the body positions or activities that make it better or worse. If the doctor suspects that the pain is referred from other organs, he or she will ask about a history of diabetes, peptic ulcers, kidney stones, urinary tract infections, or heart murmurs.

PHYSICAL EXAMINATION. The doctor will examine the patient's back and hips to check for conditions that require surgery or emergency treatment. The examination includes several tests that involve moving the patient's legs in specific positions to test for nerve root irritation or disk herniation. The flexibility of the lumbar vertebrae may be measured to rule out ankylosing spondylitis.

Imaging studies

Imaging studies are not usually performed on patients whose history and physical examination suggest routine muscle strain or overuse. X rays are ordered for patients whose symptoms suggest cancer, infection, inflammation, pelvic or abdominal disease, or bone fractures. MRIs are usually ordered only for patients with certain types of masses or tumors.

It is important to know that the appearance of some abnormalities on imaging studies of the lower back does not necessarily indicate that they cause the pain. Many patients have minor deformities that do not create symptoms. The doctor must compare the results of imaging studies very carefully with information from the patient's history and physical examination.

Treatment

All forms of treatment of low back pain are aimed either at symptom relief or to prevent interference with the processes of healing. None of these methods appear to speed up healing.

Alternative treatment

A thorough differential diagnosis is important before any treatment is considered. There are times when alternative therapies are the most beneficial, and other times when more invasive treatments are needed.