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Treating Low Back Pain

Updated on November 29, 2018
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Ian is a Senior Orthopedic Officer, and a palliative care specialist currently working at Fort portal Regional Referral Hospital.

What is low back pain?

Low back pain is pain felt in the lower part of the back. If you were to draw a horizontal line that divides the back into two equal parts, the lower back in this regard would be the part of the back starting slightly below this line(about 2cm) and ending at the waistline. Pain in this area may be sharp, of sudden onset and can limit or interfere with daily activity. It can also be a dull ache, which at times radiates around the waistline, and into the thigh, leg or foot (Sciatica). Pain that is confined to the back without radiating into the leg is more common. Low back pain can be classified as:

  1. Acute low back pain -- This is usually of sudden onset and lasts a few days or a few weeks, usually not longer than 6 weeks.
  2. Chronic low back pain-- This refers to pain that lasts more than 3 months. The pain may be a constant dull nagging pain, may be progressive, or may only be aggravated by certain activities.

Low back pain (sometimes referred to as lumbago) is one of the commonest complaints that patients present with in the out patients department. About 55% of all visits to the orthopedic clinic will be about or related to back pain. Although the condition is commonest in people of advanced age, it can occur in younger people. The predisposing factors and causes may differ in relation to age group. (See low back pain—what you need to know for details on the causes)

Areas of low back pain Radiation
Areas of low back pain Radiation | Source

Causes of low back pain

The commonest causes include:

- Injury to the structures of the spine resulting from accidents such as falling from a height

- Poor posture during sitting or sleeping.

- Poor lifting techniques

- Degenerative conditions such as osteoarthritis

- Some medical conditions such as Pelvic inflammatory disease.

- Infections like tuberculosis

Common underlying Causes of Low Back Pain(LBP) in Relation to Age

(click column header to sort results)
   
Younger Adults( 25-50 yrs)  
Older Adults(Over 50 yrs)  
Acute LBP
Muscle strain or ligament strain, Disc prolapse, Vertebral fracture, Nerve irritation
Compression verebral Fracture, Muscle strain or ligament strain,Disc prolapse, Nerve irritation
Chronic LBP
Degenerative Disc disease
Facet joint osteo arthritis, spinal stenosis, Degenerative disc disease
 
 
 
The table Shows some of the possible pathologies that can cause pain in the lower back. Notice that the causes of acute LBP are similar in both age groups
Bones and joints of the lower back (lumbar spine)
Bones and joints of the lower back (lumbar spine)

How is low back pain treated

Majority of low back pain cases are not severe enough to require urgent medical attention. You may need urgent medical attention if the pain is as a result of trauma, or is associated with other symptoms such as fever, abdominal pain, or sudden weakness in the lower limbs.

To provide comprehensive treatment the doctor needs to determine the underlying cause. He will ask several questions, which will be aimed at establishing the underlying cause and help develop a treatment plan. You will be required to give information about how long you have had the pain, how it started, severity, what aggravates or relives it, any other symptoms associated with it and any other information the doctor may find relevant to your condition. The doctor will then perform a physical exam to explore any physical signs on the back.

The spine is made up of many structures and the pain could originate from any of them. This can make finding the exact cause of the pain a complex task. The structures include; the bones, ligaments, inter-vertebral discs, nerve roots and muscles.

- Sometimes the large muscles that support the back may be strained as a result of sudden twisting motion, or poor posture such as those assumed during long hours of sitting.

- If you have been involved in an accident, you might have a fracture on one of the vertebral bones, or one of the inter-vertebral discs may prolapse. The pain may also be due to microscopic tears in the muscles or ligaments. This pain is usually severe and can be localized.

- The inter-vertebral discs may be degenerating or there may be osteoarthritis in the facet joints of the vertebrae.

- The nerve roots which originate from the spine to the legs may be irritated as they leave the spine.

Because of the complexity of the structure of the lower back, additional diagnostic tests may be required to determine the precise origin of the pain. These may include X-ray or plain radio-graphs, CT scan (computerized tomography scan), MRI scan (Magnetic Resonance Imaging scan). At times these tests may not show any anatomical origin of the pain, but the doctor will treat the pain anyway.

Treatment sually depends on the underlying cause, the classification of the pain and how it affects daily life activities. Treatment for majority of low back pain cases is conservative (non-surgical) and can generally be grouped into three steps or interventions.

X-ray of the spine showing Degeneration
X-ray of the spine showing Degeneration | Source

Activity modification

In my eight years of managing patients with back pain, I have found that activity modification is one of the most important steps in treating back pain regardless of the underlying problem. Many of the other interventions may depend on this.

The doctor will advise that you try as much as possible to identify any activities that cause the pain or make it worse, so that you minimize them, or avoid them completely. Activities particularly those that aggravate the pain need to be avoided if the pain is to be managed effectively.

Activities that are notorious for causing and aggravating back pain include repeated bending work, lifting heavy objects, sitting for long hours and poor posture.

If the pain is severe, or is as a result of injury to the structures of the spine, a device to provide support for the back may be prescribed. This support may be in form of a rigid or semi-rigid lumbo-sacral belt or corset, which may be worn for a few weeks to allow the tissues time to heal.

Medication

Medication will depend on the underlying cause. If there is possibility of a bacterial infection such as tuberculosis, antibiotics will be prescribed to get rid of the infection.

Pain medications used for treating back pain typically include non-steroidal anti-inflammatory drugs (NSAIDS) which are the commonest medications used in low back pain. These drugs are commonly available over the counter in most countries, but it is important to take them with guidance from your doctor because of the adverse effects associated with them such as gastritis, peptic Ulcer disease among others. Remember to tell your doctor if you have any of those conditions or any other allergy to medicines.

It is important to note that in order to have the pain medicines work effectively, you have to minimise those activities that aggravate the pain. Interventions for managing back pain complement each other. It is therefore not advisable to undermine any of them as you implement the treatment plan. It is also true that pain occurring as a result of a degenerative process either in the discs or facet joins is more common in elderly people, but can occur in younger people who do excessive heavy lifting and bending work . This kind of pain is often chronic and has more chances of recurring. Avoiding such activities will significantly improve the long term outcomes.

Does herbal medicine relieve low back pain?

See results

Physiotherapy

When the pain has subsided, you may be sent to a physiotherapist who will train you on back muscle strengthening exercise. The muscles that keep the back erect need to be strong enough to support the spine in bearing the weight of the body.

Lack of exercise can cause recurring chronic back pain because weak muscles cannot adequately support the spine and the weight of the body. The physiotherapist may use other techniques like massage, and heat therapy to hasten pain relief.

Further reading

Watson, S. (2017). '10 ways to manage back pain at home' . Available at: https://www.webmd.com/back-pain/features/manage-low-back-pain-home


William, C. S. (2018). 'What is the treatment for low back pain?' Available at: https://www.medicinenet.com/low_back_pain/article.htm#


© 2015 Ian Batanda

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