Jun 09, 2014
Low back pain. Some causes and management.
Low back pain is the most frequently reported orthopedic complaint presenting in general practise and to hospital emergency rooms across the world. It can be divided into three different categories for the purpose of description:
Acute lower back pain: This is where the back pain is of sudden onset and is usually associated with some movement or strain such as lifting or pulling or bending down. In the main, rest and simple analgesia is all that is required to fix it. The actual underlying cause may be a pulled muscle, slight disc injury or joint capsular tear. A once off acute lower back pain, that does not radiate down the leg and can be explained on the bases of a strain does not usually warrant any further investigation provided of course that it seems to be resolving over a few days.
Chronic recurring back pain (intractable pain): When back pain becomes a recurring feature of one’s life, when it starts to incur days or weeks out of work, when it radiates down one or both legs, when it keeps the sufferer awake at night and is not responding to the usual analgesics, then investigation is warranted. Today, this investigation will involve an x-ray of lower spine and an MRI scan. Investigation of chronic recurring low back pain will often show up inter-veritable disc damage and/or chronic degenerative changes. In some cases surgery may be required to bring some relief.
Red Flag Lower Back Pain: Because back pain can occasionally signal serious underlying disease like metastatic cancer or serious infection, physicians need to be aware of the back pain that is associated with peculiar circumstances. This requires clinical acumen and judgement. Here are just some of the circumstances that might raise suspicion:
• Back pain occurring in the very young, particularly if not associated with strain or trauma.
• Back pain in one with a history, however distant, of having had cancer.
• Back pain accompanied by unexplained weight loss.
• Pain occurring in the under 18’s or over 50’s with no previous history.
• Pain that does not respond to rest and analgesics..
• Pain that persists for over 6 weeks.
• Night pain.
• Pain radiation down one or both legs. (Sciatica)
• Pain associated with fever and weakness.
• Urinary incontinence or retention associated with back pain.
• Major lower limb muscular wasting associated with back pain.
This is not intended to be an exhaustive list of red flag circumstances that may accompany lower back pain. It is given here only to illustrate the fact that back pain can never be taken for granted and always deserves professional and careful attention to detail.
Psychogenic Back Pain: Back pain for which no explanation can be given after exhaustive investigations may be considered psychogenic. The sufferer feels the pain but the underlying cause may not be organic but rather be caused by stress, anxiety or depression. Also it is worth bearing in mind that chronic back may be used as a pretext to gain sympathy, receive time out of work, receive long-term social benefit payments or court awarded damages.
If you are worried about lower back pain that you or a loved one may be experiencing then we are here to help you with advice and support. It would be our privilege to do so.