American Spine Center

American Spine Center

Low back pain

LOW BACK PAIN

In our modern lifestyle, we are facing certain types of symptoms and diseases which are widely common.

They have a great impact on our lives and on our work performance.

Since a vast majority of modern industrialized society are office-based workers, suffering from low back pain is interfering with the day routine of a large section of the population.

Here in this article, we will discuss the different types of low back pain. And this may give you a clue on how to look at the problem from a professional point of view.

 

How to distinguish different types of low back pain?

Actually, only doctors can answer this question. This is true, in general. But having a scientific background about the problem helps you make a better choice when it comes to the decision of the treatment.

Also knowing the exact description of the situation, you are suffering from, will raise the RED FLAGS for the seriousness of symptoms that may need immediate medical evaluation and treatment.

 

What are the types of low back pain?

Nonspecific Low Back Pain:

This is the type that most people suffer from at some point in their lives. The severity of the pain varies from mild to severe. No clear reason for the pain. Most of the cases are sudden-onset.

Sciatica which is the pain of the nerve root:

This means that the nerve coming out from the spinal cord is irritated or pressed on. The patient feels pain along the course of the nerve. Therefore, in most cases feel the pain down a leg, or even as far as the calf or foot. The patient may feel pins, and needles, numbness, or weakness in part of a buttock, leg, or foot, because of irritation and the pressure on the nerve.

When part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc, this case is described as prolapsed disc, or slipped disc. . The prolapsed part of the disc can press on a nerve nearby.

A rare case called Cauda equine needs urgent medical treatment:

Some of the RED FLAG symptoms we mentioned above occur here,

  1. numbness in the saddle area (around the back passage (anus)) and weakness in one or both legs.
  2. low back pain plus problems with bowel and bladder function, which may cause the inability to pass urine.

But what Cauda equine syndrome means?

This is a disorder where the nerves at the very bottom of the spinal cord are pressed on. Which is really rear. This condition needs URGENT treatment to prevent the nerves in the bladder and bowel from becoming permanently damaged. The patient is highly recommended to see a doctor immediately if you suspect cauda equine syndrome.

 

Less common causes may include:

Osteoarthritis, Ankylosing spondylitis, Rheumatoid arthritis.

These three causes are inflammation of the joints (arthritis) of the spine.

Where Osteoarthritis, usually occurs in older people, Ankylosing spondylitis is another form of arthritis that can occur in young adults, which causes pain and stiffness in the lower back. Rheumatoid arthritis can affect the spine but usually affects other joints too.

 

How low back pain develops?

Either immediately after you lift a heavy object.

Or after forceful twisting movement. In some cases for no known cause.

Some people just wake up one day with low back pain.

Typically, in nonspecific back pain, the pain is located in one area of the lower back but sometimes it spreads to one or both buttocks or thighs.

The pain is eased by lying down flat. And often be worse when you move your back, cough, or sneeze.  So, we can say that nonspecific low back pain is of mechanical nature because it varies with posture or activity.

Even if the attack of low back pain improves quickly, within a week or so. However,

It could be further attacks in the future, (i.e. recurrence).

Also, the patient may experience minor pain in an on-off fashion after the initial bad bout of pain.

If the pain persists for several months or longer, this is called chronic back pain.

When to suspect a more serious underlying cause?

Generally talking, if any of the following occur then it may not be nonspecific low back pain, there may be a more serious cause.

  • Constant back pain that is not eased by lying down or setting.
  • Pain that radiates to the chest or is higher in the back behind the chest.
  • Gradually developing pain which slowly gets worse, over days or weeks.
  • Any weakness in any of the muscles in a leg or foot.
  • Inability to feel anything (numbness) in any part of your bottom or leg.
  • Using steroid tablets for more than a few months.
  • Symptoms that may indicate inflammatory (arthritic) causes such as ankylosing spondylitis.
    1. Pain which is worse in the second half of the night or early morning, after waking.
    2. Stiffness, in addition to pain. Of the back muscles in the morning after getting up from bed.
    3. The pain is partially relieved by activity.
  • Symptoms that may indicate cauda equine syndrome.
    1. Bladder symptoms such as loss of balder sensation, and incontinence.
    2. Numbness around the back passage (anus).
    3. Incontinence of stools.
  • Symptoms that may indicate a fracture in the spine. The main ones are:
    1. Pain following Traumatized events such as road accidents or falls from a height.
    2. Pain after minor trauma in people with the thinning of the bones (osteoporosis).
  • Symptoms that may indicate infection or a spread of cancer: affecting the spine.
    1. Pain onset in a person over 50 year’s age, or under 20 years of age
    2. Pain that disturbs sleep
  • Symptoms or problems in addition to pain such as:
    1. If you have cancer in any part of the body.
    2. High temperature, or unexplained weight loss.
    3. If the patient injects street drugs.
    4. If the patient has a poor immune system. For example, Chemotherapy, or AIDS.

When to do tests?

Tests such as X-rays, MRI scans, and blood tests, may be devised in certain situations. This is mainly if there are symptoms, or signs during a doctor’s examination, to suggest that may be a serious underlying cause for the low back pain.

 

How to treat low back pain?

For sudden–onset (acute) attack of nonspecific low back pain.

Stay active:

Move around as soon as possible. If possible (if the pain is not very severe) keep doing normal life activities. And in general, do not do any activity that may cause more severe pain. Of course, you will feel some discomfort when you are trying to keep active. Maybe having some walking will be a good idea, and then gradually increase the distance as tolerated.

Sleep in the most comfortable position for you, whatever is the comfortable surface. In the past traditionally patients were advised to sleep on a firm mattress. However, no evidence to support that a firm surface has a better outcome.

Try to go back to your job (if any) as soon as possible. There is no need to wait until you feel completely pain-free. Returning to work helps to relieve pain by getting back to a normal pattern of activities.

Physiotherapist-designed exercises at home can help to recover more quickly. It is now known that the advice of having rest until the pain eases, was wrong. Research showed that it is more likely to recover more quickly by getting moving again and by getting back to work as soon as possible.

Medication:

There are commonly 3 categories of medication that can be used for the management of pain.

  • Anti-inflammatory Painkillers: Most commonly used ones are: ibuprofen can be prescribed by your physician, or you can buy directly from Pharmacy (over the counter, without a prescription). Diclofenac, naproxen. Which needs a prescription. Important to know that some people cannot use anti-inflammatory drugs, for example, patients with high blood pressure, Asthma, kidney failure, or heart failure.
  • stronger Pain killers: such as codeine is an option if anti-inflammatory drugs could not be used by the patient. Also, the patient may take (codeine with paracetamol). One of the side effects of using codeine is constipation.  
  • Muscle relaxant: such as diazepam which the physician may prescribe for a few days if the back muscles become very tense and make the pain worse. It is important to know that this medication is a member of a group of medications called benzodiazepines which may be addictive if used for a long time, and should be taken for as short a time as possible.

Other treatments:

Treatment may vary and the situation should be reviewed by a doctor if the pain becomes worse, if the pain persists beyond 4-6 weeks, or if symptoms change.

Other pain-relieving techniques could be applied, and always there are new treatments for back conditions as well.  When? If the pain persists beyond 4-6 weeks, or if symptoms change.

 

Persistent (chronic) low back pain

In the case that the low back pain lasts for longer than six weeks, it will be called chronic. In some cases, it lasts for months or even years. The most common pattern is when the symptoms follow an irregular course. Which usually means long periods of mild or moderate pain may be interrupted by bouts of more severe pain.  In some cases, the symptoms can be constant.

But how to treat chronic back pain?? . Actually, initially the treatment is similar to the sudden-onset (acute attack).  Which means painkillers and staying active as tolerated.

Other groups may be prescribed by doctor antidepressant medicine in the tricyclic group. For instance, amitriptyline. This group of medications has separate other actions separate from their action on depression. They are used in many different painful conditions. Including back pain.

 

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