Low back pain is a major burden to society. It is one of the most common causes of seeking physician office visits, the second cause of sick leave and, because of high direct and indirect costs, it has great medical, social and economic impact for the individual, family and society. Low back pain is defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain.
Many people will experience an episode of low back pain during their life. Some people develop chronic low back pain, which can be very disabling. Low back pain is not simply either acute or chronic but fluctuates over time with frequent recurrences or exacerbations. Also, low back pain may frequently be part of a widespread pain problem instead of being isolated, regional pain.
The causes of low back pain can be very complex, and there are many structures in the spine that can cause pain. To discover the causes of lower back pain and develop a treatment plan, doctors will ask patients to describe the location, severity and type of pain, in addition to the history of the pain: when the patient started to feel it, and any activities that might be associated with the pain.
Lower Back Pain Classifications
A diagnosis will typically classify the patient’s condition as one of three types of pain. Patients can experience one type, and based on the progression of their condition, may experience another.
- Axial low back pain, the most common type of back pain, is confined to the lower back only and does not travel into the buttocks or legs. The pain can be sharp or dull, and can be severe enough to limit everyday activities, such as standing and walking. It usually worsens with certain activities (such as sports) or physical positions (such as sitting for long periods) and is relieved by rest. Most low axial back pain is acute – meaning it is short-lived and heals within six to 12 weeks – but can last longer and become chronic.
- Lumbar radiculopathy (sciatica) is the second most common type of pain caused by a lower back problem. Caused by conditions that compress the nerve roots of the sciatic nerve, the pain is more severe in the leg than in the back. Symptoms are pain, numbness and/or weakness that is felt in the lower back (if at all) and on only on one side of the lower body, affecting the buttock, leg, foot, or the entire length of the leg.
- Low back pain with referred pain is pain in the lower back that also radiates to the groin, buttock and upper thigh, but rarely below the knee. Patients describe the pain as dull and achy with varying intensities. Low back pain with referred pain is similar to axial pain and is managed with similar treatments.
Acute Pain vs. Chronic Pain
In addition to identifying pain based on location, symptoms of lower back pain are typically classified as acute or chronic.
- Acute lower back pain is short term, generally lasting from a few days to a few weeks. Some acute pain syndromes can become more serious if left untreated. Chronic lower back pain is generally defined as pain that persists for more than three months. The pain may be progressive, or may occasionally intensify for a period of days or weeks and then return to a lower level of pain. With chronic pain, the exact cause of the pain can sometimes be difficult to determine. Certain common causes of lower back pain have a tendency to occur more often in younger individuals versus older adults:
- Younger adults (e.g. 30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease) or from a back muscle or other soft tissue strain.
- Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis or spinal stenosis) or from a fracture.
Diagnostic Tests for Lower Back Pain
When pain is severe and is not relieved within 6 to 12 weeks, a specific diagnosis becomes more important to determine further treatment. Typically, the spine specialist will have a good idea of the cause of the patient’s pain from their symptoms and physical exam and will use diagnostic tests to confirm and clarify the diagnosis and/or to rule out other possible causes of the patient’s symptoms. Diagnostic tests can include: X-rays, CT scan, Myelogram and MRI scan.
Treatment for Back Pain Relief and Diagnosis
Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.
- Rest. Ceasing activity for a few days allows injured tissue and even nerve roots to begin to heal, which in turn will help relieve lower back pain. However, more than a few days of rest can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the spine. Patients who do not regularly exercise to build strength and flexibility are more likely to experience recurrent or prolonged lower back pain.
- Heat and Ice Packs help relieve most types of low back pain by reducing inflammation. Often patients use ice, but some prefer heat. Both may be used alternately.
- Medications. A wide variety of over-the-counter and prescription medications is available to help reduce symptoms of lower back pain. Many medications reduce inflammation, which is often a cause of pain, while others work to inhibit the transmission of pain signals from reaching the brain. Each medication has multiple unique risks, possible side effects and drug (or food or supplement) interactions, which need to be evaluated by a physician.
- Spinal Steroid Injections deliver steroids directly into the painful area of the lower back to reduce inflammation. The steroids do not heal the components of the back, but often provide enough pain relief to allow patients to move, exercise and heal. Some injections are used both for back pain relief and diagnostic purposes.
Our Mission
To offer hope and relief to the physical and emotional suffering that afflicts the patient affected by pain.
Evaluate and alleviate pain by means of medications and interventions.
High quality staff with the highest care standards and ethics.
Bradenton Pain & Wellness Center
2001 Manatee Avenue East, Suite 103
Bradenton, FL 34208
941-803-8395
www.drycaza.com