released in conjunction with WQMR 101.1 Doctor on Call radio show, May 12
Acute Low Back Pain is one of the most common human afflictions. Approximately ten percent of the U.S. population experiences back pain each year. The lifetime incidence of low back pain has been reported at 60 percent to 80 percent, and has an equally high lifetime recurrence rate.
Disorders of the back and spine are the most frequent and most costly musculoskeletal impairments and rank third behind arthritis/rheumatism and heart disease as a cause of disability in people in their working years.
The total medical cost attributable to this condition has been estimated between $50 billion and $100 billion annually. Individuals with persistent and disabling back pain account for 85 to 90 percent of this cost.
Low back pain is associated with a wide variety of both mechanical and medical disorders. Mechanical disorders of the spine are caused by spinal arthritis, disc degeneration, overuse, trauma or physical deformity. Medical disorders that cause spine pain are associated with other illnesses, diseases in other organ systems, infections and benign or malignant tumors. Mechanical causes account for over 90 percent of low back complaints.
In the initial evaluation of patients with back pain the physician must identify those patients with mechanical disorders from those with systemic illnesses. The patient’s symptoms and physical signs help differentiate mechanical from systemic causes of back pain.
The initial evaluation includes a history and physical examination. In many patients, x-rays and laboratory tests are not necessary. These tests are most helpful in patients who are 50 or older, who have a history of cancer, who have had significant trauma, or have symptoms suggesting other disease processes.
The majority of patients with spinal pain and systemic illnesses can be identified by the presence of one or more of the following fever or weight loss, pain when lying still, prolonged morning stiffness, localized bone pain, and pain originating from abdominal or pelvic organs or blood vessels.
Mechanical disorders are the most common causes of low back pain. These disorders include muscle and ligament strains and sprains, herniated discs, spinal arthritis, spinal stenosis, spondylolisthesis and adult scoliosis.
Back pain arising from a mechanical disorder is frequently described as deep, boring, aching, stabbing or catching. It is typically increased with bending, twisting, lifting or sitting or standing for prolonged periods of time.
This pain is often felt to travel to the hip, buttock, thigh or leg. It may be accompanied by feelings of numbness, pins and needles sensation or weakness of the back or leg. Mechanical pain may be reduced by changing position or lying down in certain positions.
Back strains or sprains are preceded by a recognizable traumatic event that can range from a cough or sneeze to lifting a heavy object.
The lumbar disc is a fibrous shock absorber between the bones of the spine. The disc can weaken from trauma, degeneration or aging. A disc herniation occurs when a portion of disc material displaces into the spinal canal. This can put pressure on the spinal nerves and in addition to back pain can also lead to sciatica, which is pain traveling down the leg, usually below the knee.
Spinal arthritis, also known as spondylosis, is a result of age-related changes that occur almost universally. Symptoms may come and go over time and are often worse at the end of the day.
Spinal stenosis can result from advanced spinal arthritis. The combination of degenerative bulging discs, bone spur formation and thickening of the ligaments decreases the space available for the spinal nerves. This can not only cause back pain, but can also produce leg symptoms, especially when walking. This pain needs to be differentiated from poor circulation, which is also seen in the same population age group.
Spondylolisthesis is slipping forward of one vertebra on another. This is usually secondary to disc degeneration but can also occur as the spine develops.
Scoliosis is an abnormal lateral curvature of the spine. This condition most commonly develops during adolescence and is more common in girls than boys. In the lumbar spine a curve greater than 40 degrees can progress at a rate of one degree per year and cause increasing back pain.
The vast majority of patients with mechanical low back pain will improve within two months. About 50 percent of patients with low back pain will improve after one week. Since the natural history is so favorable, treatment is directed at relieving symptoms.
Individual patients’ response to any one particular treatment can be quite varied. This makes scientific evaluation of treatment methods difficult. Treatment starts with an adequate explanation of the diagnosis and expected outcome. Bed rest for short periods of time provides temporary relief for many patients. The use of nonsteroidal anti-inflammatory medication drugs or Tylenol may be appropriate. Muscle relaxers may help some patients. A short course of narcotic medication may be needed in more painful cases of acute low back pain.
Early movement should be encouraged for most patients. This helps to limit muscular and cardiovascular deconditioning. After acute pain has subsided further, aerobic conditioning is a good idea for most patients. Referral to a physical therapist may be appropriate to provide closer supervision and insure the patient is following the treatment plan, and to individualize an exercise program.
Some patients will benefit from spinal manipulation. Injection therapy is not typically used for acute low back pain. It would also be rare for surgery to be indicated in acute mechanical low back pain.
There is also growing evidence that general fitness measures such as weight reduction, smoking cessation, and regular aerobic exercise may reduce the frequency and severity of back problems.
Acute low back pain is a common malady experienced by most adults during their lifetime. It is usually readily diagnosed by your physician and is generally responsive to simple non-invasive treatments and time.
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