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Chronic Low Back Pain

 

Low back pain is a universal human experience -- almost everyone has it at some point. The lower back, which starts below the ribcage, is called the lumbar region. Pain here can be intense and is one of the top causes of missed work. Fortunately, low back pain often gets better on its own. When it doesn't, there are effective treatments.

 

- Chronic back pain is the pain persists for more than 3 months

 

  • The lifetime low back pain is 70 to 80% in our population

  • About 80 to 90% will settle spontaneously within 4 to 6 months

  • Those with a previous history of back pain are twice as likely to have a new episode of back pain

  • The pain is very frustrating and can cause debilitation for some people

 

Symptoms of Low Back Pain

Symptoms range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. Pain that lasts more than three months is considered chronic. 

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Symptoms That Require Urgent Care

Severe back pain after a fall or injury should be checked out by a health care professional. Other warning signs include a loss of bowel or bladder control, numbness in the groin area, leg weakness, fever, and pain when coughing or urinating. If you have any of these symptoms along with your back pain, contact your doctor.

Also contact your doctor right away if you have back pain and you have any of these:  a history of cancer, unintentional weight loss, long-term steroid use, weak immune system, history of IV drug use, or your pain gets worse with rest.

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Muscle Strain or Sciatica?

The kind of back pain that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes back pain can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, pain may run from the buttock down one leg. This is called sciatica.

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Back Pain Culprit: Your Posture

Mom was right when she said, "Stand up straight!" Your back supports weight best when you don't slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.

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Back Pain : Herniated Disc

The spine's vertebrae are cushioned by gel-like discs that are prone to wear and tear from aging or injuries. A weakened disc may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disc and can cause intense pain.

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Back Pain : Chronic Conditions

Several chronic conditions can lead to low back pain.

  • Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.

  • Spondylitis refers to chronic back pain and stiffness due to severe inflammation of the spinal joints.

  • Fibromyalgia causes widespread muscle aches, including back pain.

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Who's at Risk for Low Back Pain?

Most people experience back pain first when they're in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

  • Being overweight

  • Being sedentary

  • Lifting heavy stuff on the job

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Diagnosing Low Back Pain

To help your doctor diagnose the source of low back pain, be specific in describing the type of pain, when it started, related symptoms, and any history of chronic conditions.  Your doctor will probably not need to order X-rays, CT or MRI scans before starting treatment.

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Home Care for Low Back Pain

Back pain due to muscle strain will usually get better on its own, but you can take steps to make yourself more comfortable. A heating pad or warm baths may provide temporary pain relief.

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The Bed Rest Debate

When your back hurts, you may not feel like getting out of bed. But if the problem is muscle strain, doctors recommend returning to your normal activities as soon as possible. Studies suggest that any more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility.

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Yoga

If back pain doesn't go away in three months, there's evidence that yoga can help. In one study, people who took 12 weeks of yoga classes had fewer symptoms of low back pain than people who were given a book about care for back pain. The benefits lasted several months after the classes were finished. The study suggests conventional stretching also works just as well. Make sure your instructor is experienced at teaching people with back pain and will modify postures for you as needed.

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Spinal Manipulation

Chiropractors and some osteopathic doctors use spinal manipulation to treat low back pain by applying pressure with their hands to bones and surrounding tissues. This treatment is not appropriate for everyone.

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Massage Therapy

Massage may relieve chronic low back pain, especially when combined with exercise and stretching.  Researchers noted patients who did all 3 were able to move around easier and had less short term and long term pain.

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Acupuncture

Can acupuncture treat back pain? The evidence is mixed for people with short-term back pain. Research showed that these people benefited from sham acupuncture as much as from real acupuncture. However in other studies, people with chronic or long-lasting backpain did show improvement after receiving acupuncture treatments.

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Medications

Mild back pain often feels better with over-the-counter pain relievers, such as Paracetamol, Ibuprofen, or naproxen. Pain-relieving creams may be helpful for muscle aches. For severe pain or chronic pain, your doctor may recommend prescription medication.

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Injections

If simpler therapies and medications aren't helping, your doctor may recommend injections to the back. 

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Injection treatment for back pain

- Epidurals

- Facet joint injections

- Facet denervation

- Doral root ganglion pulsed radiofrequency denervation.

- Racz catheters

- Sympathetic blocks

- Sacroiliac joint blocks / denervation

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Surgery

If long-lasting back pain is interfering with your daily life, and other treatments have not provided relief, you may be a candidate for surgery. Depending on the cause of your pain, a surgeon may remove a herniated disc, widen the space around the spinal cord, and/or fuse two spinal vertebrae together.

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