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Lower Back Pain
Three out of four people experience lower back pain. A majority of these pain symptoms normally subside on their own unless they stem from serious back injuries. Keeping fit and maintaining an active lifestyle can keep lower back pain at bay. Painkillers can also alleviate pain symptoms. However, chronic back pain can develop in some people, which may make additional treatment necessary.
The Anatomy of the Lower Back
The lower back is mainly composed of muscles which envelope and connect to the spine. The spine is a column made up of generally circular bones known as the vertebrae. Between each vertebra are tough elastic discs which allow the spine adequate flexibility. Fibrous ligaments connected to each nearby vertebra also work to support and strengthen the spine. The muscles that surround the spine help it accomplish a wide range of motion.
Enclosed within the spine is the spinal cord which houses the nerves connecting to the brain. These nerves which intertwine within the vertebrae are responsible for sending and receiving messages from all the different body parts to the brain, and vice versa.
Types of lower back pain
1.) Simple lower back pain
The most prevalent type of lower back pain is the simple lower back pain, also known as ‘non-specific’ lower back pain. This means that pain symptoms are not caused by any other disease. A sprain, or an overstretched ligament or muscle can be a cause for pain.
So can minimal disc or facet joint problems that occur between vertebrae. Even for a physician performing several tests, it is impossible to determine the cause of pain and where the pain originates from. Because of this, nearly 19 in 20 cases of acute lower back pain have been diagnosed as ‘simpler lower back pain’.
A sudden onset of pain may follow the lifting of a heavy object, or after making an uncomfortable twisting motion. Some people wake up to lower back pain.
Simple lower back pain can range from minimal to severe. The pain may be concentrated on a localized region on the lower back and may spread to the buttocks and thighs. Lying prone on a flat surface can sometimes ease symptoms, but any movement of the back, like a cough or a sneeze can exacerbate the pain. Simple lower back pain is ‘mechanical’ in nature as it can vary depending on posture or movement.
Simple lower back pain can ease by itself within a short period of time, in a week or two. In 3 out of 4 sufferers, pain symptoms disappear entirely or are significantly reduced in a month’s time.
Nine out of ten cases report the absence or considerable reduction of pain within six weeks. Although the pain symptoms do improve, they may reoccur periodically afterwards. Minimal twinges of pain may be felt in one instance or another after the first big bout of back pain. Other sufferers experience a persistence of these minor pains for more than a month or two, giving rise to what is known as chronic back pain.
2.) Nerve root pain
Nerve root pain is caused by a ‘trapped nerve’ from the spinal cord that is subject to compression or constriction. Arising in less than one in twenty cases, the pain is felt along the course of the nerve and may travel down the leg, calf or foot. Often symptoms are more severe in the leg or foot than it is at the nerve origin. An example of nerve root pain is Sciatica, a condition where pressure is placed on the sciatic nerve, irritating it and causing pain.
Pain can range from mild to severe. Similar to simple back pain, symptoms can be alleviated by lying flat on a surface, or aggravated by back movement, coughing or sneezing. Other symptoms include tingling, numbness, and a feeling of weakness along the regions of the buttocks, leg or foot.
One of the causes of nerve irritation or pressure can stem from the inflamed conditions of a sprained ligament or muscle. Another is ‘slipped disc’, where the disc does not literally “slip”, but is manifested when its soft interior portion prolapses or protrudes out of a breach in the harder outer disc perimeter. This protrusion can put pressure on a nearby nerve and cause pain (refer to the separate leaflet on “Prolapsed Disc”). Other lesser known conditions may also cause nerve root pain.
Other Causes of Lower Back Pain
1.) Arthritis – this condition is caused by inflammation of the joints. When it occurs within the spine, it can cause back pain.
2.) Osteoarthritis – the most common form arthritis in older people.
3.) Ankylosing spondylitis – may be manifested in young adults, causing lower back pain and stiffness.
4.) Rheumatoid arthritis – can affect the spine as well as other joints in the body (refer to separate leaflet on the different types of arthritis).
5.) In less than one in a hundred cases, lower back pain can be caused by rare bone disorders, tumors, infectious diseases, and constrictions caused by other bone structures close to the spine.
Determining the Type of Back Pain
In the normal course of events, lower back pain may suddenly occur (acute onset), caused by simple low back pain. In most cases, sufferers bear with the symptoms and undertake self medication, with varying degrees of success. In case of doubt as to the cause of the pain symptoms, it is also advisable to consult with a physician for proper diagnosis.
Some symptoms may arise as a result of an underlying problem related to the pain. It is best to schedule an appointment with a doctor when the following signs are manifested:
1.) Patient is under the age of 20 or over the age of 55.
2.) Pain symptoms are constant, and are not alleviated by either lying down or resting.
3.) Pain runs through to the chest, and originates from the upper back, just behind the chest.
4.) Pain began gradually, and progressed to severe symptoms through the course of days or weeks, differentiated from simple lower back pain which can occur all of a sudden.
5.) Other symptoms may include:
• Weak leg or foot muscles.
• Numbness experienced within the region of the buttocks, around the anal area, or in a leg or foot.
• Bladder or bowel disorders, like inability to urinate or incontinence.
• Fever, loss of weight, and general feeling of poor health.
• Recent occurrence of violent injury or trauma to the back.
• An existing cancer diagnosis.
• Steroid use for more than a month.
• A generally compromised immune system (e.g., usually brought about by chemotherapy or HIV/AIDS).
• Doubt about any of the symptoms manifested.
The Rare but Critical Cauda Equina syndrome
Cauda equine syndrome is a very serious type of nerve root problem that is classified as an emergency case. Although uncommon, this syndrome leads to lower back pain, inability to urinate, numbness within the anal area, and a feeling of weakness in one or both legs. The disorder, which requires urgent medical attention, is caused when the nerves at the end of the spinal cord are subject to constriction. If left unattended, Cauda equine syndrome can permanently destroy the nerves connecting to the bladder and bowels. As soon as symptoms of this ailment put in an appearance, it is advised to consult a doctor as soon as possible.
When Tests are Needed
When a physician has made an accurate diagnosis based on physical examination and evaluation of the pain symptoms, tests are usually unnecessary. Nerve root pain that occurs suddenly and subsides after a few weeks will require no tests. X-rays or back scans will show nothing out of the ordinary for symptoms of simple lower back pain. However, when nerve root pain remains constant or severe, or if there may be a suspected underlying cause for the pain, the doctor may recommend that an x-ray or scan be taken.
Treating Simple Lower Back Pain
1.) Regular Exercise
It is important to maintain regular everyday activities despite the discomfort. Although this may initially prove difficult because of the pain, increasing one’s range of motion incrementally can be bearable if not overdone. Goal setting can be a good idea to track progress and provide encouragement.
Medical advice in the past included recommendations of rest until the pain subsided. This has now been proven inconclusive as prolonged immobility increases the risk of developing chronic back pain. By continuing to move, faster recovery from pain is likely to occur. Likewise, past advice on sleeping positions - flat on one’s back on a firm mattress - has also been unproven in relieving pain symptoms. Current recommendations involve advising patients to sleep in a position and on a mattress they feel most comfortable in.
2.) Pain Medication
When pain medication is necessary, it would be better to take them on a regular basis rather than intermittently as needed. Regular doses work better to ease pain symptoms and enable increased activity in the sufferer. Some examples of pain killing medication include:
1.) Paracetamol – this analgesic works efficiently if full strength doses are taken regularly. Adult dosage amounts to 1000 mg, or two 500 mg tablets, taken four times in a day.
2.) Anti-inflammatory painkillers – some pain sufferers have discovered that these provide more effective pain relief compared to paracetamol. Over-the-counter painkillers like ibuprogen, or prescription medication like diclofenac are widely available in pharmacies. However, anti-inflammatory drugs are dangerous for people suffering from asthma, high blood pressure, kidney ailments or heart disease.
3.) Industrial strength painkillers – like codeine may be taken together with paracetamol. One side-effect of this drug is constipation, and straining during hard bowel movement can worsen back pain symptoms. Constipation can be avoided by consuming fibrous food and increasing fluid intake.
4.) Muscle relaxants – work well if the back muscles are constantly tense. The muscle relaxant diazepam may be prescribed for a minimum of a few days to loosen tight back muscles that worsen back pain.
Physical treatments for Lower Back Pain
Physical remedies that include sessions with a physical therapist, chiropractor or osteopath can aid in providing short-term relief from back pain. Although not backed by scientific evidence, there have been cases where physical treatments have resulted in faster recovery from lower back pain.
There are a lot of treatments for lower back pain, and programs for such should be monitored by a physician to determine whether they make symptoms worse, if pain continues for more than 4 to 6 weeks, or if the symptoms start to change. Trying different kinds of treatments for chronic back pain may be necessary until one finds a treatment that works.
Treatments for Other Types of Back Pain
Nerve root pain
The treatment for nerve root pain is similar to that of simpler lower back pain. Symptoms of this type of disorder usually disappear over a period of one or two weeks. Physical treatments may also provide temporary relief from pain. However, chronic back pain stemming from a ‘slipped disc’ may require surgery for immediate relief of the pressured or irritated nerve.
Other Causes of Back Pain
Treatment for other types of back pain would have to depend on the main cause of pain symptoms. For instance, pain caused by arthritis can be remedied by different kinds of arthritis medications.
Preventing Reoccurrence of Back Pain
There has been a glut of evidence that point toward leading an active lifestyle and regular exercise as the best possible solutions to preventing back pain. Aerobic activities like walking, running or swimming can help keep the body in a general state of fitness. Although there is no supporting evidence that performing back strengthening exercises can prevent reoccurrence of back pain, it is advisable to be well-informed about proper lifting techniques to avoid injury, particularly when lifting objects while in an awkward or twisted position.
A Summary of Back Pain Tips
• Acute lower back pain, even if severe, is normally not considered critical.
• Recovery from lower back pain is a speedy process taking as little as a week.
• Although nerve root pain and prolapsed (‘slipped’) discs are an uncommon occurrence, they usually heal by themselves without requiring surgery.
• Keeping active as much as possible and continuing with routine everyday activities such as going to work, will hasten recovery from lower back pain. Limiting movement and doing little exercise will only increase the risk of developing chronic symptoms.
• Should the pain be severe, initial rest may be necessary, but incremental movement is encouraged for a speedier recovery – something that constant bed rest will not provide. Warming up the muscles through motion is preferable to having them stiffen up from long periods of immobilization.
• Bearing some measure of pain and discomfort may be necessary while returning to everyday activities. Simple lower back pain will not be aggravated by movement. In fact, constant activity will help prevent the development of chronic long-term symptoms.
• Regular use of painkillers can alleviate the pain during the recovery period.
• If pain worsens or continues for more than 4 to 6 weeks, or if other uncommon symptoms develop, it is advisable to consult a doctor immediately.
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