June 27th, 2009
Hemant Yagnick, M.D. asked:
Acute back pain may begin suddenly and usually lasts around 3 months. Chronic back pain sometimes lasts throughout life.
The most common back pain is low back pain (LBP). It is is often described as sudden, sharp, persistent, or dull pain felt below the waist. LBP is very common and affects the majority of people at some point during their life. Up to 70%–85% of all people have back pain at some time in their lives. LBP is the most common cause of a limitation of activity in people younger than 45 years of age. It is the second most frequent reason for visits to a physician, and the third most common indication for surgery. It is the fifth-ranking cause of hospital admissions and is one of the leading causes of disability.
Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder. Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).
Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting fewer than three months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain. Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, general aching, and/or pain that radiates into the low back, buttocks and leg(s). Sometimes pain is accompanied by neurological symptoms such as numbness, tingling, or weakness. Neurological symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities.
Pain felt in the low back is not always indicative of a spinal problem. A thorough physical and neurological assessment may reveal the cause of the low back pain. The physical examination begins with the patient’s current condition and medical history. Examination of a patient with low back pain involves examining the patient’s range of spinal motion while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas). The neurological assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement.
If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis. In some cases electrodiagnostic studies such as electromyography (EMG) or nerve condition velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury. Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurological dysfunction is suspected. A MRI represents the gold standard in imaging today. A MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back. The results of the physical and neurological examinations combines with test results are carefully evaluated to confirm a diagnosis.
Most patients with low back pain are treated without surgery. A conventional treatment plan may include bed rest for a day or two combines with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient’s medical condition, age, other drugs the patient currently takes, and safety. The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase and often for chronic pain management in appropriate patients.
Other modalities to treat low back pain might include physical therapy (PT), transcutaneous electrical nerve stimulator (TENS) trial, ultrasound therapy, acupuncture and massage therapy. A managed PT program can help build muscle strength and flexibility, improve mobility, coordination, stability and balance, and promote relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist.
Although the number of spinal surgeries done every year is on the rise, it is rarely required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain. To prevent low back pain, first and foremost, follow the treatment plan outlined by the physician. To enhance recovery from an episode of low back pain, or to help prevent future exacerbation, try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.
About Walton Rehabilitation Health System:
Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.
NICOLE
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