Overview Of Low Back Pain

Q: I have suffered off and on with lower back pain for years. Which is better, rest or exercise?

80% of us will experience low back pain (LBP) during our lifetime. The causes of LBP are varied. LBP may originate in the ligaments, muscles, joints, fascia, vertebra, disks, nerves, or blood vessels of the lumbar region. While there are many potential causes of LBP, in most instances, regardless of the reason, 90% of cases resolve within 4-6 weeks with little to no treatment.

Predisposing factors to LBP include:

• Physically demanding jobs requiring heavy lifting and bending.
• Physical or psychological co-morbidities.
• Female.
• Cigarette smoking.
• Obesity.
• Sedentary lifestyle.
• Scoliosis.
• Degenerative lumbar spinal changes.
• Slipped or bulging intervertebral disc.
• Lower socioeconomic status.

More Common Types Of LBP

Simple acute LBP – Up to 90% of patients with LBP have simple-acute LBP. “Routine” x-rays, CT Scans, and or MRIs are not recommended. While pinpointing the exact cause of simple-acute LBP can be challenging, however, most are muscular, ligament, disc, or bony in origin and normally resolves within 4-6 weeks. Such patients are routinely offered self-care advice and medication.

Complicated LBP (with red flags)-The presence of “red flags” can be one of the first indicators that the cause of the LBP is serious in nature and there is a need for additional investigations. These “red flags” include:

• Pain lasting more than 6 weeks.
• Pain radiating below the knee.
• History of significant trauma.
• Fever.

NEW ONSET LBP in someone <16 or >50

• Fecal or urinary incontinence.
• Unexplained weight loss.
• History of cancer.
• Long-term steroid use.
• IV drug abuse.
• Intense localized pain.
• Pain resulting in insomnia.
• Inability to find a comfortable position.

LBP with pain radiating down the back of the leg (sciatica)- Such patients are referred for an MRI and EMG Nerve Conduction Study (EMGNCS) once available.

Treatments:

The majority of cases of LBP have an excellent prognosis. While many treatment modalities are available, most cases of LBP will improve on their own. However, for those who are desirous of treatment, some of the more common treatment options are outlined below.

Medicines:

•  Paracetamol/ Acetaminophen/ Non-Steroidal Anti-inflammatories (NSAIDs): These are considered first-line treatments for LBP. Neither the NSAIDs nor paracetamol has been shown to be superior to the other. And combining both has shown no additional benefits.
• Muscle relaxants: Work best when combined with NSAIDs.
• Opioids: If used, should only be used for very short periods, since NSAIDs or acetaminophen suffice in most instances.
• Other pharmacological therapies: Antidepressants, oral and parenteral corticosteroids, and gabapentinoids.

 Non-pharmacological treatment:

• Physical and exercise therapy has been found to be moderately effective in patients with LBP. Research supports strength/resistance and coordination/stabilization exercises.
• Spinal manipulation/ chiropractic care: Most effective in reducing pain when the pain has been present for less than six weeks.
• Acupuncture has been shown to be moderately effective in treating LBP.
• Bed rest: Those who rested extensively had poorer LBP outcomes when compared to those who remained active.
• Surgery: This is very rarely a treatment option for LBP.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
 Disclaimer: The information provided in the above article is for educational purposes treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or aper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.