Understanding Low Back Pain


Low back pain is currently the most common and costly musculoskeletal problem in developed countries. If you haven’t experienced it already, you likely will. The reported incidence varies, but at least eight out of ten people will experience an episode of low back pain in their lifetime.

The actual cause of low back pain can vary, as there are many structures in this region of the body that may cause symptoms. In fact, there are so many structures that are so complex, in the majority of cases, the precise cause of the pain cannot be accurately diagnosed — even with the latest technology and imaging studies.

If you have low back pain, some of the possible causes include:

1. Lumbar or sacral radiculopathy: The result of pressure on a nerve coming from the spine — often caused by a bulging or herniated disk. This is often called sciatica.
2. Spinal stenosis: This is a narrowing of the bony spinal canal which causes the nerves to be “squeezed.”
3. Facet arthropathy: This is usually due to aging or “arthritis” of the joints in the spine.
4. Lumbar sprain/stain: This is a common cause of low back pain that may be due to injury to multiple structures, such as muscles and tendons.
5. Tumors: Not a common cause of low back pain, but a worrisome one; a “red flag” for this is pain that awakens you at night.
6. Bony fractures: These may be due to trauma, or sometimes occur without any injury in people with osteoporosis. A specific type of fracture that sometimes occurs in teen athletes, as well as other people, is called spondylolysis or spondylolisthesis.
7. Infection: This is pretty rare, but can be serious. People at risk for infection include those with liver failure, diabetes or AIDS.
8. Spinal cord compression: This is also unusual, but very worrisome and may be associated with weakness, loss of bowel/bladder control and in men, problems with erections. Cauda equina syndrome occurs below the level of the spinal cord, where the nerves bundle together in the spine, and can cause similar symptoms.

When treating back pain, the important thing is to rule out the serious problems — or if one of them is present, treat it urgently and appropriately — and try to discover, if possible, the source of the pain.

There are many different treatment options for low back pain, depending on the problem. I usually tell my patients that there are three categories of treatment options. This is a pretty simplistic way to look at it, but it generally works. They are:

1. Conservative care (e.g., physical therapy, oral or topical medications, chiropractic treatment, acupuncture, etc.)
2. Injections (e.g., trigger point injections, botulinum toxin injections, prolotherapy, facet injections, epidural steroid injections, etc.)
3. Surgery (e.g., diskectomy, lumbar fusion, etc.)

My patients often tell me when they are experiencing symptoms of low back pain that they don’t ever want this to happen again. This is a bit like going to the dentist and saying that you don’t ever want to have another cavity. It would be nice if that happened, but the reality is that like cavities, back pain is something that you may be seeking medical treatment for more than once. The good news is that usually symptoms of low back pain will respond to non-surgical interventions.

I counsel my patients to take care of their backs they way that they do their teeth, which means at least daily attention to proper seating with lumbar support (at work, in the car, and at home), proper lifting techniques (even for carrying laundry baskets or other household items) and supportive shoes. Core strengthening and general physical activity is important regularly, too. If pain does occur, then seek medical attention early in the course of the back pain that doesn’t resolve.

My advice regarding seeking medical care is that if you’ve experienced trauma and have pain, go to the doctor right away. If you haven’t had trauma, but have symptoms of weakness, new bowel/bladder problems or new erectile dysfunction, consult your doctor as soon as possible. If you haven’t had trauma and don’t have any of the symptoms just listed, then it’s probably okay to wait a couple of weeks and employ the first part of the pneumonic PRICE: protect, rest, ice (or heat is okay, whatever you prefer), compress (this isn’t really applicable with low back pain) and elevate (this isn’t applicable either). If you can tolerate over the counter analgesics, such as ibuprofen or acetaminophen, these are worth taking. If your pain lasts longer than two weeks, consult your doctor.

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