Low back pain is one of the most common conditions an adult will experience in his lifetime. It is not a disease but a constellation of symptoms. An estimated one-third of adults all over the world suffer from some form of back pain that interferes with work, daily living routines, and even recreational activities.
It is one of the leading reasons why people would seek medical consultation, and one of the major causes of disability among people less than 45 years old worldwide, costing lost work hours and decreased work performance. Diagnosis and treatment of low back pain cost billions of dollars from health care insurance and government subsidiaries, but managing this condition remains to be challenging.
Low back pain is categorized according to how long and how frequent it is being experienced. It is either 1) acute or short-term back pain, which is pain occurring on and off for less than 3 months, or 2) chronic or long-term back pain, which is back pain persisting for more than 3 months or longer than the expected healing period.
Acute Low Back Pain
Acute low back pain is usually uncomplicated and goes away on its own. However, it is recommended to seek medical consultation if it goes on for more than 14 days. Usually, causes of acute low back pain are vague and multifactorial, but your doctor might look for these “red flags” that might be causing the back pain and warranting further evaluation. Examples of these red flags are:
- 1. Recent trauma or accident involving your lower back
- 2. If you are more than 50 years old
- 3. Unexplained weight loss
- 4. Unexplained fever
- 5. History of cancer
- 6. Prolonged use of corticosteroids
- 7. History of osteoporosis or osteoarthritis
- 8. Forgetfulness
- 9. Paralysis or numbness of your arms, legs, or any part of your body
If any of these “red flags” are present, your doctor may request for radiologic examinations such as a lumbosacral x-ray or magnetic resonance imaging (MRI) of your lower spine to look for what is causing the pain.
Treatment for acute low back pain is usually not necessary as it resolves spontaneously. Short-course drug therapy with paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) can be given by the doctor to help make the pain tolerable as needed. Some people turn to alternative treatments such as chiropractic adjustments, osteopathic manipulation, yoga, acupuncture, spa therapy, moist heat and physical therapy, and herbal or essential oils. But, regardless of the treatment, acute low back pain improves on its own.
Chronic Low Back Pain
Chronic low back pain is one of the most common and costly musculoskeletal problems in urban and modern society. It is also one of the most difficult conditions to adequately diagnose due to the plethora of its possible causes. It may stem from:
- 1. stress
- 2. work dissatisfaction
- 3. depression
- 4. anxiety
- 1. narrowing of intervertebral spaces
- 2. bulging of intervertebral discs
- 3. damage to the nerve roots, muscles, bones, or joints
- 4. neurological or brain disease that may be causing abnormal pain processing – causing fictitious pain in the lower back
Other factors such as weight, height, lumbar lordosis (exaggerated inward curving of the lower spine), body mass index, or discrepancy between leg lengths have not been proven to cause chronic low back pain.
Finding the cause of chronic low back pain may be costly and time-consuming, even frustrating because oftentimes the tests will show inconclusive results. Psychological factors are more important for diagnosing chronic low back pain. It is rare to find an attributable, identified anatomical cause of the pain, and treatment modalities remain the same in the end.
Multiple treatments for consideration
Treatment for chronic low back pain uses a multidisciplinary approach like surgery, drug therapy, psychotherapy, or non-medical intervention such as physiotherapy. Cognitive-behavioral therapy and exercise have been studied to be the most effective forms of treatment for this condition, as these improve the quality of life and mental well-being of the sufferers.
Pain relievers like opioids may be given short-term, but not recommended for more than 12 days. Antidepressants may also be given by doctors to help alleviate the psychological factors of back pain like depression and anxiety.
Physiotherapy administered by trained physical therapists or occupational therapists includes aerobic exercises, muscle strengthening, flexibility, and stretching exercises. These procedures help improve posture, muscle stability, and breathing control, therefore induces pain reduction.
Pilates, yoga and tai-chi exercises in this respect are also recommended for managing back pain. Bed rest, corsets, and braces are not being prescribed anymore because they impede the necessary muscles for support, rather than help.
Surgery is often thought of as the last resort for treatment because aside from being costly, sometimes the pain remains, and may even exacerbate after surgery.
Low back pain remains to be one of the leading causes of medical consultation and disability among adults. It is not a disease, but rather a constellation of symptoms. Acute low back pain is usually harmless and resolves on its own, but chronic low back pain is more complex, and treatment requires an extensive and multidisciplinary approach. Recommended forms of treatment are behavioral therapy, fitness and exercise, psychotherapy, drug therapy, and physiotherapy.