Low and Lower Back Pain
Low and Lower Back Pain
Written by Richard D. Guyer, MD
Lower back pain is one of the most common medical problems in the world. It is a leading reason why people visit a doctor and affects upwards of 80% of adults at some point in their lives. Lower back pain also contributes to lost time at work and limits physical activity that is detrimental to sustaining quality of life. According to the Global Burden of Disease—a significant study published in the Lancet medical journal—lower back pain is estimated to be a leading cause of disability.1
Lower back pain can be acute, subacute or chronic.
Lower back pain can be categorized as acute, subacute or chronic. Acute episodes of lower back pain usually last from a few days to 4 weeks and subacute lower back pain lasts between 4 to 12 weeks.2 However, according to the National Institutes of Health, about 20 percent of people with acute back pain go on to develop chronic back pain—defined as pain that lasts 12 weeks or longer.3 Even in these cases, there are many different treatment options to help relieve lower back pain symptoms.
Sometimes lower back pain can be severe causing worry. However, severe pain is not always an indication something is seriously wrong. Rarely does lower back pain require urgent medical attention.
When to call your doctor about lower back pain.
Most episodes of lower back pain resolve on their own, but there are times when you should call your doctor and/or seek urgent medical attention. Some of these situations include the following:
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- Patient is a child
- Accident, injury, other trauma
- Fever or nausea
- Weakness, numbness and/or tingling sensations develop in the legs and/or feet
- Loss of bladder or bowel control
- Pain is severe, constant, suddenly or progressively worsens, and/or doesn’t go away
- Pain interrupts sleep
Lower back pain causes are diverse.
The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital (at birth) or acquired meaning the disorder develops later in life.
- Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies (vertebrae), ligaments, muscles or soft tissues.
- Organic lower back pain is attributed to disease, such as spinal cancer.
- Idiopathic refers to an unknown cause.
Listed below are potential causes of lower back pain. Some patients’ diagnosis may involve more than one cause.
Mechanical Lower Back Pain
- Abnormal spinal curvature: scoliosis, lordosis, kyphosis
- Degenerative disc disease (eg, disc bulge, herniated disc)
- Ligament sprains
- Muscle strains
- Pinched nerve, such as sciatica or lumbar radiculopathy
- Spondylolisthesis
- Spinal stenosis
Organic Lower Back Pain
- Abdominal aorta aneurysm (weakening and enlargement of the aortic blood vessel)
- Benign or cancerous spinal tumors
- Cauda equina syndrome; compression of the bundle of nerves formed below the spinal cord in the lumbar spine
- Discitis; an infection (bacterial) in an intervertebral disc
- Fibromyalgia
- Kidney stones
- Osteomyelitis; infection (bacterial) in the spinal bone (vertebra)
- Osteoporosis; loss of bone mass causing vertebral fracture
- Rheumatoid arthritis, osteoarthritis, spondylitis
Common nonsurgical lower back pain treatment options.
When lower back pain strikes some people may take to their bed or recliner to rest their body. However, a study found that patients who did so actually experienced more pain and recovered slower than patients who modified their activities.4 The better course of care under your doctor’s direction is to remain active while avoiding physical activity that triggers or increases lower back pain. Staying active while gradually increasing your physical limits helps increase circulation necessary for healing and releases endorphins; your body’s natural painkillers.
Many people find that brief intervals of ice therapy are effective during the acute phase of lower back pain to reduce inflammation. It’s essential not to place ice or an ice pack directly onto skin but wrap it in a towel to create a protective skin barrier. Heat therapy, such as a heating pad, may be helpful thereafter. Again, heat should be carefully used in intervals, not continuously.
Short-term use of an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID, such as ibuprofen and naproxen) may help reduce both lower back inflammation and pain. NSAIDs should be used with care as they can cause stomach and gastrointestinal problems and increase risk for heart attack and stroke in some people. OTC analgesics or pain medications include acetaminophen. These types of medicines are available in prescription strength provided under your doctor’s direction and oversight.
If lower back pain causes lumbar radiculopathy, such as leg pain (eg, sciatica), your doctor may prescribe an anticonvulsant medication (eg, gabapentin, pregabalin) in low doses which can significantly lessen the leg pain without the use of narcotics. A prescription for a muscle relaxant may be given to help reduce painful muscle spasms—a common symptom associated with lower back strain.
An epidural steroid injection or a selective nerve block may provide short-term pain relief when lower back pain causes sciatica symptoms (eg, leg pain). Long-term use of epidural steroid injections has not proven to be beneficial.5
Physical therapy (PT) or rehabilitation may be recommended and included in the patient’s multidisciplinary lower back treatment plan. PT involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and teaches ergonomic principles. Passive therapies may include ice/heat, massage, TENS (transcutaneous electrical nerve stimulation), and ultrasound.
Acupuncture involves careful insertion of fine sterile needles into the body’s meridians associated with lower back pain.6 A meridian is one of 12 Qi pathways (pronounced chee). In traditional Chinese medicine, Qi is recognized as the body’s life force. It is believed that injury and/or disease (among other things) may disrupt the flow of Qi. The acupuncture needles may be twisted and stimulated using low-level electrical current to release naturally occurring endorphins (and other chemicals) that alleviate pain and benefit healing.
When may spine surgery be recommended to treat lower back pain?
Fortunately, in most lower back pain cases, spine surgery is not necessary. Most people find nonsurgical treatments—whether it’s one treatment or a combination of therapies—help relieve and manage lower back symptoms.
Red flags suggesting surgical intervention include: bowel and/or bladder dysfunction, vertebral fracture, worsening pain that may be described as unrelenting (eg, disrupts sleep, not relieved with rest), spinal infection, spinal tumor (benign or cancer), or spinal nerve compression causing neurological dysfunction, weakness or loss of function.
While some ‘red flag’ situations may warrant immediate surgical intervention, most cases are not urgent and can be scheduled at a time convenient for the patient. Many lumbar spine surgical procedures can be performed minimally invasively either in a hospital or in an outpatient surgery center.
Is lower back pain preventable?
While you can’t prevent accidental injury, stop aging or change your genetic makeup, lifestyle changes can help manage and prevent lower back pain.
- Improve your physical fitness; strong core muscles help support the lower back
- Lose weight; even carrying an extra 10 pounds contributes to lower back pain
- Use proper posture and body mechanics
- Choose the best backpack for your body and needs
- Apply ergonomic principles to your work space
- Avoid a sedentary lifestyle; stay active
- Stop tobacco use, smoking and/or vaping
References
1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2.
2. Chou R. Subacute and chronic low back pain. Nonpharmacologic and pharmacologic treatment. UpToDate. June 9, 2019. https://www.uptodate.com/contents/subacute-and-chronic-low-back-pain-nonpharmacologic-and-pharmacologic-treatment?search=low%20back%20pain&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4. Accessed July 24, 2019.
3. Low Back Pain Sheet. National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health (NIH). Last modified: May 14, 2019. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Accessed July 24, 2019.
4. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low back pain and sciatica. Cochrane Library. Cochrane Database Sys Rev. 2010.
5. Turner JA, Comstock BA, Standaert CJ, et al. Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms? Spine J. 2015;15(11):2319-31.
6. National Center for Complementary and Integrative Health (NCCIH). Acupuncture: In depth. January 2016. https://nccih.nih.gov/health/acupuncture/introduction. Accessed July 24, 2019.