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Lower Back Pain
About 80% of people experience one or more stints of lower back pain. Often, the exact cause of the pain is unclear. Also, there could be no underlying problem. The condition is called nonspecific lower back pain. Further, there are a variety of methods on how to avoid lower back pain.
What are the types of lower back pain?
1. Nonspecific low back pain
This is the most common type of back pain and the onset is often sudden, sometimes acute. There is no specific problem or disease to identify and treat the pain. Thus, the pain is referred to as nonspecific low back pain. Lastly, the spectrum of pain can vary from very mild to very severe.
When a nerve coming out from the spinal cord – or the root of the nerve – is irritated, inflamed or pressed upon, you may experience nerve root pain or sciatica. Sometimes it is also called a trapped nerve and it occurs in less than 1 out of every 20 people who complain of acute low back pain. In sciatica you may experience the following symptoms:
- Pain along the length of the nerve.
- Pain extending down a leg, sometimes as far as the calf or foot.
- Pins and needles, weakness or numbness in part of a buttock, leg or foot.
90% of nerve root pain cases are due to prolapsed disc – commonly called a slipped disc. While the terminology is misleading, a disc does not actually slip. In reality, a part of the inner gel-like part of the disc bulges outwards through a weak spot in the outer part of the disc. Moreover, the prolapsed part of the disc might put pressure on a nerve nearby and that sets off the condition.
3. Cauda equina syndrome
Cauda equina syndrome is a very rare disorder where the nerves at the very bottom of the spinal cord are pressed upon. This disorder can cause
- lower back pain
- problems relating to the bowel
- problems relating to bladder function (usually being unable to urinate)
- numbness in the saddle area (the groin, buttocks, and upper thighs) around the anus
- weakness in either or both legs
In brief, this syndrome must be treated as an emergency. It requires urgent medical treatment so that the bladder and bowel do not become permanently damaged.
Other causes of lower back pain
- Arthritis: The condition where the joints of the spine become inflamed and painful, is called arthritis. Elderly people usually suffer from Osteoarthritis.
- Ankylosing spondylitis: Young adults in sedentary jobs where they have to sit or stand for extended periods of time may experience pain and stiffness in the lower back. This condition is called Ankylosing spondylitis.
- Rheumatoid arthritis: Another cause for lower back pain is the swelling of joints in the spine or elsewhere, called Rheumatoid arthritis.
- Some rare bone diseases, tumors, infection and pressure from structures close to the spine may also trigger lower back pain.
General advice for nonspecific back pain and how to avoid lower back pain
To start, the pain is usually confined to one area of the lower back. But, sometimes it could spread down to one or both buttocks. Additionally, it can sometimes even radiate to the thighs. Some tips on how to avoid lower back pain and reasons for lower back pain include:
- Firstly, lying down flat may provide some pain relief.
- Secondly, pain is often worsened if you move your back too much, cough, or sneeze.
- Thirdly, posture and activity may affect the severity of the condition.
Most people with a spell of nonspecific low back pain improve rather quickly. In fact, usually within a week. Although, it could take longer.
Once the pain has eased significantly or gone away completely, it is not uncommon to experience recurrences of pain now and then. In a very small number of cases, the pain may persist for several months.
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How is it diagnosed?
First, a physician will usually want to ask questions about your symptoms. Questions may include: how long they have been present or what measures you have taken to relieve pain. Then, they will physically examine you. Finally, a doctor can usually rule out any other underlying problem and be confident that you have nonspecific back pain.
Some red flags of other serious issues could be:
- Gradually and steadily progressing pain that gets worse over days or weeks.
- Persistent back pain that does not improve by resting/lying down.
- Pain traveling upwards towards the chest, or higher up in the back behind the chest/ribcage.
- A weakness of any muscles, lower limbs, or extremities.
- Numbness in any part of your buttock or leg.
- If a long course of steroids have not helped you recover.
Symptoms that may indicate ankylosing spondylitis:
- Pain that is worse after waking up or in the second half of the night.
- Stiffness of the back muscles in the morning after getting up from bed that lasts for longer than a few minutes.
- The pain is eased or relieved by activity.
Symptoms indicative of cauda equina syndrome:
- Numbness around the anus and the saddle area.
- Bladder related issues.
- Incontinence of stools.
Symptoms indicative of a fracture in the spine:
- Physical trauma-induced back pain.
- Experiencing back pain following minor trauma in people suffering from osteoporosis.
Symptoms indicating onset and spread of cancer affecting the spine:
- The onset of pain in an elderly person or someone aged over 60 years, or under 20 years.
- Also, pain that does not ease when lying down; terrible night-time pains that disturb sleep patterns.
- Symptoms or issues in addition to severe pain such as:
- If you are already suffering from cancer.
- Sudden weight loss, high fever, etc.
- If you take intravenous drugs.
- If you have a poor immune system from previous treatments like chemotherapy or suffer from HIV/AIDS.
What tests will I need to get done?
Your doctor will usually be able to diagnose nonspecific low back pain from the description of the pain you provide and by physically examining you. But, tests such as X-rays, scans or blood tests may be advised in certain situations especially if there are other conditions present.
Treatment for lower back pain and how to avoid lower back pain
- Try to continue with normal activities as far as possible.
- Don’t do anything that causes or increases existing pain.
- Remember to sleep in the most comfortable position on whatever surface is the most comfortable- it does not matter if it is hard or soft.
- Some people reported that a small firm pillow tucked between the knees when sleeping on the side helps relieve pain.
Returning to work
- Aim to get back to work as soon as you can manage.
- Overall, there is no need to wait for the pain to completely go away before returning to work as that could take several weeks.
- Some exercises designed by Physiotherapists to work on at home may aid a speedy recovery.
- They may help strengthen lower back muscles in the long run.
- They could reduce the chances, recurrence or severity of the pain when it does come again.
- Taking complete bed rest is not the best way to go about managing back pain.
- Painkillers like ibuprofen, diclofenac or naproxen can manage the pain. If anti-inflammatories do not work well, codeine may be an option. Constipation is a common side-effect of codeine. Also, this may aggravate back pain if you need to strain to go to the toilet. To circumvent this problem, be sure to drink lots of fluids, like water, and eat fiber-rich foods.
- Physicians rarely prescribe Diazepam- a muscle relaxant. They only prescribe it for a few days if the back muscles become very tense. Thus, making the pain bearable. Diazepam can be habit forming. It provides quick and significant relief from pain. Therefore, one should only take it for very short periods.
If you take painkillers, it is best to take them regularly. This is better than taking them only when the pain is very bad. Taking them regularly ensures pain relief for longer periods of time. This allows you to exercise better and be more active.
What is the prognosis?
- Many nonspecific back pains go away quickly, usually within a week.
- Additionally, in about 7 out of 10 cases, the pain goes away completely or significantly reduces within four weeks.
- To add, in about 9 out of 10 cases, nonspecific back pain goes away in 6 weeks or has reduced in severity by then.
- Importantly, even if the pain has eased or gone away, it may come back.
Chronic low back pain
Chronic back pain is nonspecific low back pain lasting for longer than six weeks. Additionally, it may last for months, or even years. Symptoms may or may not follow a pattern. You may experience moderate pain levels for a lengthy period of time and smaller bouts of more severe pain.
What is the treatment for chronic nonspecific low back pain?
- Firstly, be as active as you can and continue doing your everyday activities to avoid lower back pain.
- Also, painkillers can help relieve pain.
- Your doctor may resort to a course of amitriptyline- an antidepressant medicine in the tricyclic group. Doctors prescribe tricyclic antidepressants to treat conditions other than depression. Although rare, doctors may prescribe them to treat back pain.
- Thirdly, perform exercise regimes designed by a physiotherapist. Often, this happens in a group setting and may go up to 8 sessions. Exercises may be a mix of stretching, aerobic activity, muscle strengthening, movement instruction, and posture control.
- Also, acupuncture may serve as an alternative treatment. But, it is unclear how effectively it provides pain relief.
Prevention of back pain
Research suggests that the best way to avoid lower back pain is to keep as active as possible and to exercise regularly. General fitness exercises such as walking, swimming, jogging, and running might help in keeping the lower back active and healthy.