Low Back Pain

Low Back Pain

Definition

Low back pain refers to any of several types of pain or discomfort in the lower back.

What is going on in the body?

Low back pain may involve the muscles, joints, or nerves of the lower back. It may also be referred pain, which means the pain is actually coming from another organ, such as a kidney.

Risks

What are the causes and risks of the condition?

Low back pain may be caused by a number of spinal disorders. Some common causes include:
  • fibromyalgia, a condition that causes trigger points in body tissues, including the low back
  • osteomyelitis, or bone infection
  • ruptured disks, which involve the soft disks between the vertebrae of the spine
  • spinal degeneration, which may involve arthritis
  • spinal stenosis (narrowing of the spinal canal)
  • narrowing of the disk spaces with aging
  • sprains or strains of the muscles and other soft tissue in the back
  • tumors of the spine
A person with disorders of certain body organs may experience referred pain in the low back. These disorders include:
  • aneurysms (abnormal outpouchings of blood vessels)
  • appendicitis
  • kidney disease
  • ovarian disorders
  • pelvic inflammatory disease, and other infections in the pelvic area
  • urinary tract infection
Risk factors that increase a person's risk for low back pain include:
  • activities, such as driving a car, that pass vibrations along the spine
  • lack of physical activity
  • previous back injury
  • obesity
  • old age
  • smoking

Prevention

What can be done to prevent the condition?

Proper lifting techniques are important to avoid a ruptured disk. These techniques can be enhanced by the use of an abdominal support belt.
Other preventive measures include:
  • regular physical activity including exercises which strengthen the abdominal muscles.
  • rest breaks to interrupt long periods of vibration, such as driving a car
  • smoking cessation for individuals who smoke
  • weight management for people who are obese

Diagnosed

How is the condition diagnosed?

Diagnosis of low back pain begins with a medical history and thorough physical exam. Depending on the suspected cause of the problem, the healthcare professional may order diagnostic tests, such as:
  • blood and urine tests
  • a bone scan
  • CT or MRI scans
  • an electromyogram (EMG), which measures muscle response to nerve stimulation
  • a myelogram, which uses a contrast agent and X-rays to detect abnormalities along the spine
  • a nerve conduction velocity test (NCV), which measures transmission along the nerve

Long Term Effects

What are the long-term effects of the condition?

Low back pain is a leading cause of disability and missed work in developed countries. Those affected may be unable to perform activities they enjoy. Chronic pain can result in depression, lack of productivity, and drug abuse. If there is nerve damage, the person may have weakness, numbness, and loss of muscle mass.

Other Risks

What are the risks to others?

Low back pain is not contagious and poses no risk to others.

Treatments

What are the treatments for the condition?

Low back pain caused by strains or sprains will get better on its own within four weeks, with or without treatment. People with more serious conditions, such as a ruptured disk, may benefit from treatment. A ruptured disk is generally treated conservatively at first.
Some initial treatments that may be used include:
  • anti-inflammatory pain medication, such as ibuprofen (i.e., Advil, Motrin), naproxen (i.e., Anaprox, Aleve, Naprosyn), ketoprofen (i.e., Oruvail), flurbiprofen (i.e., Ansaid), or diclofenac (i.e., Cataflam), celecoxib (i.e., Celebrex), sulindac (i.e., Clinoril), oxaprozin (i.e., Daypro), piroxicam (i.e., Feldene) and many others.
  • some activity limitations
  • application of heat or cold
  • massage or other physical or manipulative therapy
  • muscle relaxants, such as carisoprodol (i.e., Soma), cyclobenzaprine (i.e., Flexeril), orphenadrine (i.e., Norflex), metaxalone (i.e., Skelaxin), tizanidine (i.e., Zanaflex) among many others.
  • a specialized exercise program
Many people with low back pain will try natural medications (herbs, vitamins or supplements). The Natural Medicines Comprehensive Database names the following as "possibly effective" for back pain: devil's claw and willow bark.
If conservative treatment is not successful, the healthcare professional may recommend surgery. The following operations may be helpful for some people who have a ruptured disk:
  • diskectomy or laminectomy, which allows the surgeon to remove the ruptured disk and relieve nerve pressure
  • nucleoplasty, which involves inserting a needle into the disk and applying heat with a special instrument
  • spinal fusion, which involves the joining of two or more vertebrae
Choosing back surgery over exercise or other forms of physical therapy was compared in a large study published in 2006 which involved more than 1,200 patients at 13 U.S. hospitals. The study found either surgery to remove a bulging back disc or a course of physical therapy both helped ease the pain and discomfort two years after treatment.
Based on patients' responses, surgery tended to provide somewhat more relief than physical therapy, especially at first, for their sciatica and other pain. However the difference was not statistically significant, narrowed over time, and likely was exaggerated because worse-off patients opted for surgery and tended to believe that surgery must be more effective. Fears related to skipping surgery by both people with back pain and their surgeons were unfounded.
One editorialist concluded, "These findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference."

Side Effects

What are the side effects of the treatments?

Side effects of medicines include allergic reactions and stomach upset. Surgery can be complicated by infection, bleeding, or a reaction to the anesthetic.

After Treatment

What happens after treatment for the condition?

After conservative treatment of a ruptured disk, a person can usually resume activity as tolerated. Symptoms may recur periodically, requiring repeated treatment. Ninety percent of the time, surgery relieves symptoms and the person can slowly resume normal activities. Physical therapy can be helpful to teach appropriate body mechanics and lifting techniques.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

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