Lower Back Pain

Lower back pain is an extremely common condition where every person will have at least one episode in their lives. Lower back pain can be mild and last only for a short duration or severe and chronic. Most patients with lower back pain will resolve within a few weeks however up to 30% of patients may have some other underlying condition

Causes of Lower Back Pain

Patients with lower back pain are often plagued with frustration and distress. They may seek consults with multiple physicians and depending on whom they consult (for example, orthopaedic, neurosurgeon, traditional medicine practitioner, physiotherapist and chiropractor), they may be told different things. These may range from muscle strain, bone degeneration to spinal pain. Doctors may have many ideas about what causes lower back pain, but no single explanation applies to everyone because every patient’s back pain is different.

Common Causes of Back Pain 

1. 1. Prolapsed Intervertebral Disc – This occurs when a degenerated or injured disc protrudes out
   2. Intervertebral Disc Inflammation and Denegeration
   3. Lumbar nerve compression – When nerves are compressed by a disc or degenerated bones
   4. Facet Joint Syndrome – An arthritis-like condition of the spine that is due to degenerative changes to the joints between spine bones
   5. Muscle and Ligamental Pain Syndrome – Fibromyalgia
   6. Spinal Fractures – may be due to injuries, osteoporosis or metastatic cancer
   7. Degeneration of the spine (spondylosis)
   8. Spondylolisthesis (an abnormal slippage of the the vertebrae)

Lower back pain is commonly related to ageing and stress.  This occurs as a result of wear-and-tear on the spine, ligaments and discs, increased pressure applied axially. As such, a disc may begin to protrude or collapse and put pressure on the nerve root leading to a leg or foot, causing pain in those areas (sciatica). The problem can be aggravated by associated conditions, such as narrowing of the canal or shifting of the vertebra (slippage of spine on top of one another).

Occasionally, back pain can also occur with no apparent cause. Nonetheless, the pain experienced is real and should be treated. Neglected, this can become chronic and disabling.  Advanced investigations and imaging may not pick up any abnormalities in the spine.  Muscle sprains causing back pain may present this way. This type of back pain will need less invasive treatment.

Symptoms of Lower Back Pain

Pain is often felt with lower back movement such as flexion or extension. Most back pain improves with lying down. After the initial severe episode, most will be able to rest at night without severe pain. Pain may exacerbate with carrying heavy loads and some may get relief with stretching or extending their back. Occasionally back pain may accompany pain shooting down to leg and thigh and even down to the foot. This is called sciatica because it follows the course of the nerve. This can be made worse by coughing, sneezing or straining.

60% of back pain may be very severe for a few days or a week and then will often improve. Most will recover by the 2nd to fourth week. This is most often due to injury to the muscles or ligaments. The remaining 40% of patients may experience symptoms including disabling effects which affect standing, sitting and walking, which may result in hospitalization and prolonged medication. These patients usually have a spine disorder, involving nerves, discs and facet joints.

Diagnosis of Lower Back Pain

Determining where the pain originates is the key to the treatment of your lower back pain. During your visit, your physician will take a complete history and examine you thoroughly. Some other important pieces of information will include any other medical conditions or injuries/illnesses that you may have had before or if you have already received any treatment or procedures to your spine.

Radiological investigations may also be done to allow a better look at the structures in your spine

1. Lumbar Spine Xray
2. CT (computed tomography)
3. MRI (magnetic resonance imaging)
4. Myelogram (injection of a dye or contrast material into the spinal canal)
5. EMG (nerve conduction and electromyogram)

Treatment is then tailored specifically to what is the source of your pain.

Treatment of Lower Back Pain

A range of treatment range from nonsurgical to surgical treatment methods.

Non surgical modalities include rest, bracing, local muscle injections, exercise and stretching, proper posture and lifting techniques, medication, physiotherapy, and activity modifications.

Surgical methods include open surgery such as laminectomy decompression and instrumental fusion of spine or Interventional Pain Procedures such as needle laser decompression or needle ballooning decompression.

When should you seek medical care?

You should consider seeing a doctor when the pain is persistent and affecting your lifestyle. The following symptoms will require urgent consult

1. 1. Sudden bowel and/or bladder incontinence
   2. Progresssive weakness in the legs
   3. Severe, continuous abdominal accompanied by low back pain (possibly leaking/ruptured abdominal aortic aneurysm)
   4. Back pain with fever and chills
   5. Back pain accompanied by a history of cancer with recent weight loss
   6. Recent severe trauma