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Treating Low Back Pain

Updated on February 3, 2016
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Ian is a Senior Orthopedic Officer currently working with Fort portal regional referral hospital - Fort portal western Uganda

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

What is low back pain.

Low back pain can be defined as 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 is 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 also occur in younger people, although 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)

Causes of low back pain

- 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 for heavy objects

- Degenerative conditions such as osteoarthritis

- Some medical conditions such as Pelvic inflammatory disease

Bones and joints of the lower back (lumbar spine)
Bones and joints of the lower back (lumbar spine)

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

Does herbal medicine relieve low back pain?

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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 diagnose the condition, the doctor will ask several questions. These 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

This usually 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;

  1. 1. Activity modification

In this step the doctor will advise that you cease or minimize activities particularly those that aggravate the pain. This period of rest should be for a few days to allow injured tissues or irritated nerves to heal and therefore relieve the pain. You will also be advised to avoid work which requires excessive bending as well as refraining from poor lifting techniques. Activity modification is vital because it helps prevent recurrence. See Low back pain—what you need to Know for information on prevention of low back pain.

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

  1. 2. Physiotherapy

After the pain has subsided, you will be sent to a physiotherapist who will train you on muscle strengthening exercise. 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 techniques such as heat therapy, and massage to further relieve the pain.

  1. 3. Medication

The third intervention is medication. The doctor will prescribe some pain medication to help relieve the pain. Non steroid anti-inflammatory drugs (NSAIDS) are the commonest medications given in low back pain. These drugs are notorious for Aggravating and sometimes causing Gastritis and Peptic Ulcer disease. Remember to tell your doctor if you have any of those conditions or any other allergy to drugs.

It is important to note that these interventions complement each other. It is therefore not advisable to undermine any of them during 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, and people who do excessive heavy lifting work. This kind of pain is often chronic and has more chances of recurring.

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