Unfortunately, low back pain is a common clinical condition which causes a significant amount of pain and discomfort. It is debilitating and can cause significant financial stress for the patient and their family. It is estimated that more than 80% of adults have experienced back pain at some point in time. Of these, 10% have a significant disability as a result. Lower back pain and osteoarthritis now rank second only to cancer as a leading cause of disease burden in Australia.
It is also rated as a significant cause of absence from work and loss of productivity. The condition has a significant burden on healthcare budgets, resources and health workers. Low back pain also results in a lot of personal distress. This is due to its impact on families. As such, it can also have significant psychosocial impact.
How does lower back pain occur?
The majority of lower back pain result from wear and tear of the spine, injury or degeneration of the supporting structures. The known risk factors and causes for wear and tear in the spine include:
- ongoing degeneration related to age
- genetic factors
- anxiety and depression
- sedentary lifestyle
- excessively strenuous physical activity
There are multiple known “pain generators” within the spine. These include:
- the intervertebral disc
- the covering layer of the bone
- the periosteum
- the facet joints of the spine
- the paraspinal muscles and fascia
- the supporting spinal ligaments
- narrowing of the spinal canal
- pressure onto the neural structures
More sinister causes of back pain include infections, fractures or malignancies of the spine.
Lower Back Pain Symptoms
The presenting complaint of such problem can range from being a focused pain at a particular spot or one that spans across the whole of the low back.
It is advisable to seek medical attention when low back pain is accompanied with:
- pain that radiates into areas down the buttock or the leg
- tingling or numbness
- any perception of weakness
In addition, if there are symptoms associated to a change in control of the bowel or bladder it requires an emergent medical opinion.
The majority of back pain is of an acute nature where the onset is sudden. It will usually resolve itself with rest over a short period of time. The more debilitating low back pain is the chronic variety where the patient can be affected for longer durations of time. They experience repeated flare ups, which results in a significant impairment of function.
Lower Back Pain Diagnosis
The diagnosis of possible causes of back pain includes getting good history of the disease in the patient. This is correlated with the findings of a clinical examination and any relevant tests.
Testing may include x-rays, CT scans and MRI scans. X-rays may need to be dynamic, whereby the spine is examined in various positions of movement. The MRI scan is the one radiological test that provides the most amount of information to assist making a diagnosis of the cause of low back pain.
Lower Back Pain Treatment
The vast majority of low back pain is treated conservatively. Upon diagnosis, a comprehensive treatment plan which will put in place. This will enlist the support of your general practitioner and physiotherapist.
If you have any factors that increase the chance of back pain, guidance will be given to you to make lifestyle modifications. These factors could include (but are not limited to) poor posture, being a smoker or carrying excessive weight etc. Making modifications to your lifestyle will help improve your condition. It will also reduce the chance of having further recurrences of pain symptoms.
Surgery may be discussed as an option in the following situations:
- your tests reveal an instability of your spine
- your tests reveal significant degenerative changes accounting for malalignment of your spine
- advanced imaging techniques reveal a specific focus of your back pain
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