LOW BACK PAIN

Almost everyone has or will experience low back pain significant enough to affect their daily activities at some point in their lives. Back pain is a leading cause of job-related disability and a major contributor to missed work. Over $50 billion is spent on the treatment of low back pain each year in the United States. For most people, the pain is self-limited and is relieved by rest and over-the-counter pain medication. For many people, however, the pain is chronic and disabling.

Acute Back Pain

Acute back pain is short-term and usually lasts from a few days to a few weeks. This type of pain is typically mechanical in nature and caused by trauma or excessive stress to the structures of the lower back such as an automobile accident, sports injury, or wrong posture when lifting a heavy object. Mechanical injuries to the structures of the lower back can cause serious damage that requires surgical or procedural intervention; however, most injuries of this nature are resolved over time with physical therapy, rest, or medication.

Chronic Back Pain

Chronic back pain is long-term and usually defined as pain lasting for longer than three months. Damage from trauma that does not heal properly can lead to chronic pain. However, other changes to the structures of the back, for example degeneration that can occur with aging, may lead to persistent pain that does not resolve with rest and pain medications. Diagnosing the cause of low back pain can be very challenging for even the most experienced physician.

The back is a highly complex structure of bones, ligaments, connective tissue, and nerves that make up the spine. The spine is composed of 33 vertebrae, which are stacked on each other. The skull rests on the uppermost vertebra, and the lowermost vertebra sits on top of the pelvic bone. Each vertebra is composed of a solid section called the vertebral body. Vertebral bodies are attached to each other by a strong elastic structure called the intervertebral disc.

Behind each vertebral body are sections of bone called the pedicle and transverse process and within this section of bone is an opening through which the spinal cord passes and distributes nerves to the body. From top down, the spine is divided into four regions: seven cervical vertebrae (C1–C7), 12 thoracic vertebrae (T1–T12), five (sometimes six) lumbar vertebrae (L1–L5), and the lowermost vertebrae, the sacrum and coccyx, which are fused together at the base of the spine and attached to the pelvic bone. It is problems with the five lumbar vertebrae that cause the majority of low back pain.

	Structural damage to the five lumbar discs, numbered L1 through L5, cause the majority of low back pain.

Causes of Low Back Pain

There are many conditions that affect the lumbar vertebrae and lead to low back pain. Some of the more common are:

• Spinal degeneration is usually caused by “wear and tear” of the bones, discs, and ligaments that make up the spine, causing narrowing of the spinal canal and pressure on the nerves.
• Spinal stenosis is a congenital narrowing of the spinal canal that predisposes individuals to damage of the intervertebral discs.
• Skeletal abnormalities, the most well known is scoliosis, which is a curving of the spin to the side, can exert pressure on the structures of the spine leading to bone and nerve damage.
• Osteoporosis is a bone disease in which progressive demineralization of the bone occurs leading to fractures and changes in bone structure. It most commonly affects women.
• Spondylitis is pain and stiffness of the spinal joints usually caused by severe infection or inflammation.
• Herniated disc is when the strong elastic structure between the vertebral bodies bulges from its normal position. This expanded disc then presses against the nerves of the spinal cord and causes pain. Sciatica is the special case of a herniated disc in which the sciatic nerve—the large nerve leading to the legs—is affected. Patients with sciatica experience severe pain radiating to the buttocks and down their legs. In advanced cases, the individual may not be able to walk.

Diagnosing Low Back Pain

The diagnosis of the cause of low back pain typically begins with a complete physical and neurological examination. Blood tests may be done to eliminate the possibility of systemic diseases such as infection or rheumatoid arthritis. Imaging studies of the lower back may include x-rays. CT, and/or MRI scans to view the exact structure of the bones, discs, and nerves.

	The causes of low back pain can usually be determined with different forms of imaging such as x-ray, CT, and MRI scans.

Treating Low Back Pain

The treatment of low back pain depends on the underlying condition, and in conditions in which the pain is severe and there is danger of permanent nerve damage, surgery may be indicated. In most cases, initial treatment is conservative and may consist of pain medications, rest, massage, hot/cold treatments, or oral steroids. In some instances, physical therapy or chiropractic may be recommended. When severe inflammation is present, steroids may be injected directly into the back in an effort to reduce the pain.

Return to Top

Copyright © 2009. All rights reserved. I Privacy Policy