LOWER BACK PAIN - Watsons Health

LOWER BACK PAIN

Lower back pain is any type of pain or discomfort in the lower, rear portion of the trunk to the hips.  This area is also called the lumbar area or the lumbar spine.

Lower back pain is the most common work-related disability or absenteeism.  It may last briefly or it may last for more than three months.  The majority of acute back pain is mechanical in nature, meaning that there is a disruption in the components of the back.  This may be due to:

  • The large nerve roots in the low back that go to the legs may be irritated
  • The smaller nerves that supply the low back may be irritated
  • The large paired lower back muscles (erector spinae) may be strained
  • The bones, ligaments or joints may be damaged
  • An intervertebral disc may be degenerating

What causes low back pain?

Causes of low back pain include:

  • Sprains or strains. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching.
  • Intervertebral disc degeneration. It occurs when the usually rubbery discs lose integrity as a normal process of aging.
  • Herniated or ruptured disc. Occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
  • Radiculopathy. Caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve.
  • Sciatica. Caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot.
  • Spondylolisthesis. A condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
  • Traumatic injury. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. This is caused by playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain.
  • Spinal stenosis. A narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
  • Skeletal irregularities. Include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.

Often doctors don’t really know what causes low back pain.

There are several factors that may increase the chance of having lower back pain.  It includes:

  • Age. As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae.
  • Fitness level. Back pain is more common among people who are not physically fit
  • Pregnancy. Results from pelvic changes and alterations in weight loading. Back symptoms almost always resolve postpartum.
  • Weight gain. This caused increase pressure in the back.
  • Genetics. Conditions such as ankylosing spondylitis, a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine, have a genetic component.
  • Occupational risk factors. Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain.

These lower back pain symptoms include any combination of the following:

  • Difficulty moving that can be severe enough to prevent walking or standing
  • Pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee
  • Pain that tends to be achy and dull
  • Muscle spasms, which can be severe
  • Local soreness upon touch
  • Anxiety
  • Blood in the urine (hematuria)
  • Depression
  • Fatigue
  • Fever
  • Headache
  • Hip pain
  • Morning back stiffness
  • Pain through the buttocks and down one leg to below the knee (sciatica)
  • Paresthesias (stinging, burning, tingling, crawling sensations)
  • Redness, warmth, or swelling of the back
  • Sleep disturbances

DIAGNOSIS

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. During the exam, a health care provider will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.

Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Imaging and other types of tests include:

X-ray is often the first imaging technique used to look for broken bones or an injured vertebra.

Computerized tomography (CT) is used to see spinal structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.

Myelograms enhance the diagnostic imaging of x-rays and CT scans.

Discography may be used when other diagnostic procedures fail to identify the cause of pain.

Magnetic resonance imaging (MRI) uses a magnetic force instead of radiation to create a computer-generated image.

Electrodiagnostics are procedures that, in the setting of low back pain, are primarily used to confirm whether a person has lumbar radiculopathy. The procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies. EMG assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. EP records the nerve’s electrical signals, and from this information nerve damage that slows conduction of the nerve signal can be detected.

Bone scans are used to detect and monitor infection, fracture, or disorders in the bone.

Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body.

Blood tests are not routinely used to diagnose the cause of back pain; however in some cases they may be ordered to look for indications of inflammation, infection, and/or the presence of arthritis. Potential tests include complete blood count, erythrocyte sedimentation rate, and C-reactive protein.

 

RECOMMENDED MEDICATIONS

Conventionally used treatments and their level of supportive evidence include:

Hot or cold packs have never been proven to quickly resolve low back injury; however, they may help ease pain and reduce inflammation for people with acute, subacute, or chronic pain, allowing for greater mobility among some individuals.

Activity: Bed rest should be limited. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain.

Strengthening exercises, beyond general daily activities, are not advised for acute low back pain, but may be an effective way to speed recovery from chronic or subacute low back pain.

Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.

Medicine can decrease low back pain and reduce muscle spasms in some people. But medicine alone isn’t an effective treatment for low back pain. It should be used along with other treatments, such as walking and using heat or ice.

Medicine choices

There are several medicines your doctor may recommend, depending on how long you have had pain, what other symptoms you have, and your medical history. Be safe with medicines. Read and follow all instructions on the label.

The medicines recommended most often are:

  • Acetaminophen. Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugsnonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. You can buy these medicines without a prescription. Some of them also come in stronger doses. For those, you’ll need a prescription.
  • Muscle relaxants. Muscle relaxants. These medicines can help when you get bad muscle spasms along with low back pain. Side effects, such as drowsiness, are common.
  • Opiate pain relievers. Opiate pain relievers. These are very strong medicines that are sometimes tried to ease sudden, severe back pain that has not been controlled by other medicines. They are usually taken for only 1 to 2 weeks.
  • Antidepressants. Some of these medicines, such as amitriptyline and duloxetine, not only treat depression but also may help with chronic pain.

Other medicines sometimes used for low back pain are:

  • Anesthetic or steroid injections. These have been prescribed for chronic low back pain, but they have not been researched enough to know if they work well for back pain. They may give short-term relief from leg pain related to a back problem.
  • Anticonvulsants. These are sometimes used to treat low back pain, even though there isn’t strong evidence that they help.
  • Botox injection. This is a shot into the back muscles. It has not been well tested for chronic low back pain.

Medicines that work for some people don’t work for others. Let your doctor know if the medicine you are taking doesn’t work for you. You may be able to take another medicine for your back pain.

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