Lower back pain is one of the commonest health problems one encounters as they get older. It is one of the many reasons why a visit to the doctor is warranted, particularly because how important having a strong back is to help perform all activities of daily living.
Here we discuss the causes of lower back pain, the clinical features and how it is managed.
According to the National Institute of Clinical Excellence, in the United Kingdom, lower back pain affects a third of the adult population. Within the United States, around 60-80% of the population will experience back pain at some point in their lives. As a result, many people who develop this problem can suffer from it for years, thus requires
There are a number of reasons why patients can develop back pain. In most cases it is due to a mechanical cause, but in some cases it can be something a lot more sinister.
Here are some of the common causes –
- Lower back strain due to lifting heavy weights
- Sitting in one position for too long
- Disc prolapse
- Vertebral fracture in patients with osteoporosis (usually due to a fall)
- Spinal tumors, multiple myeloma
- Infections such as spinal abscess and tuberculosis
- Inflammatory conditions – Ankylosing spondylitis.
Lower back problems with Ankylosing Spondylitis.
Fusion of the spine can result in the loss of curvature and pain.
Patients with lower back pain suffer from pain at rest which can be exacerbated on movement. In cases of patients who are suffering from back pain due to a tumor or infection, associated weight loss may be another feature. In addition, patients with an infection can have a fever with associated night sweats. Patients suffering from mechanical back pain usually give a history suggestive of the cause of pain such as lifting a heavy weight or a fall.
On examination, patients with low back pain will have tenderness around the lower back. Certain special tests are helpful to diagnose low back pain. These include straight leg raising test which is extremely useful in diagnosing disc prolapse.
However, most cases of lower back pain require further investigations to confirm the cause of the pain.
The diagnosis of back pain is mostly made from history. However, finding out the cause of pain requires further investigation.
Below is a list of tests that may be performed –
1. Blood tests – If the history of back pain is indicative of an underlying infection, blood test may show elevated levels of inflammatory markers such as erythrocyte sedimentation rate (ESR) and C- reactive protein
2. X-ray – Lumbar spine x-rays are a useful test, but may be normal in some cases. They are useful from diagnosing arthritis of the spine, vertebral collapse and tumors.
Fracture vertebra seen on X-ray
3. CT scan
In cases where the back pain is persistent and the X-ray shows a lesion that is unclear, then a CT scan may be warranted. Of course, if the X-ray is suggestive of a tumor, a CT scan will show if there has been spread to the spine from another site. Eg. Prostate cancer can spread to the spine and cause low back pain.
4. MRI of the spine
This is a more advanced magnetic scan that is extremely sensitive in diagnosing soft tissue lesions. It is usually not performed if a CT scan is done, as this can diagnose most of the lesions.
While a detailed discussion on the management of every cause of back pain in detail is out of the scope of this article, below is a brief description on how most back pains are managed.
There are a variety of pain killers that are available that can be prescribed for lower back pain. These can include simple analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
Newer agents such as cyclo-oxygenase-II (COX-II) inhibitors are also extremely useful as pain killers, but in lower doses. In cases of severe lower back pain, Opioid analgesics will be prescribed. The muscles surrounding the spine that support it can sometimes go into spasm and cause severe pain. In such cases, muscle relaxants may be useful in relieving the spasm and reducing the pain.
2. Physical therapy
In the recent years, physical therapy has become an integral part of managing patients with lower back pain. Different methods of treatment include transcutaneous electrical nerve stimulation (TENS), stretches and range of movement exercises. Ultrasound therapy may be applied to the back which allows for improved joint movement.
However, the ultimate aim of physical therapy is to help relieve pain.
Patients with lower back pain can have spasm of the erector spinae muscle groups, and this can cause a significant amount of pain. Exercises will be prescribed that will help relieve the spasm and allow for greater flexibility of the back.
3. Surgical treatments
In patients with mechanical back pain, diskectomies are a treatment option to help, but is adopted as a last resort if other measures fail.
4. Special treatments
Depending on the cause, treatments for lower back pain can be variable.
- In patients who have a tumor as a cause of pain, surgery and radiotherapy may be the option, depending on what sort of tumor it is.
- In patients with osteoporosis, calcium supplements are useful to help increase bone density. It is essential for patients who are on long term steroid treatment.
- In patients with spinal stenosis, surgical treatment is the way forward.
- In case of infection, depending on the cause, high dose antibiotics may be needed. E.g. While tuberculosis of the spine is uncommon in the western world, it is effectively treated with anti-tubercular medications.
Lower back pain is a common health problem seen in a large population of different age groups. Symptoms can be debilitating and can have a significant impact on the patient’s quality of life. Treatments vary depending on the cause and are aimed at getting rid of
the cause and reducing pain.