Low back pain is one of the most common complaints that cause patients to seek medical advice. If you personally have not had an issue with low back pain, I would bet that you know a relative, friend, or colleague that has dealt with this debilitating condition. Whether acute or chronic, low back pain can range from an occasional nuisance to an incapacitating condition that affects a patient’s daily life. Regardless of whether the pain is mildly symptomatic or severe in nature, the vast majority of back pain complaints can be treated without surgery.
Inciting events that can cause low back pain range from a laborious day of yard work to poor lifting mechanics. When dealing with the acute onset of low back pain, rest and non-steroidal anti-inflammatories are always a good start. If the pain fails to improve, seeking medical advice is warranted.
To assess for low back pain, your primary care physician will start by obtaining a thorough history and conducting a physical exam. The history helps the physician to diagnose possible inciting events and may include questions such as the location of pain, the frequency of and duration of symptoms, as well as any history of previous symptoms, treatment, and response to treatment. Hopefully, the physician will be able to identify any inciting events that can be avoided in the future. Additionally, a physical exam will help to define musculoskeletal pain from pinched nerves or an arthritic spine. Patients that have decreased sensation or motor function in their lower extremities, bowel or bladder issues, fevers or chills, recent weight loss or weight gain, or strictly night pain, associated with their back pain, may have a more serious condition that will likely require imaging of the spine. For those patients believed to have a musculoskeletal source of pain, no imaging is required or recommended at the initial physician visit.
Once the physician rules out any serious condition that may be the root of a patient’s back pain, the physician will initiate a therapy regiment, as well as possible pharmacologic treatment. Therapy is typically conducted two to three times per week for a period of four weeks, after which the patient will return to the physician in order to undergo re-evaluation. Pharmacologic adjuncts that may help to expedite recovery of low back pain include acetaminophen, nonsteroidal anti-inflammatories, and muscle relaxers. Benzodiazepines and opioids should be avoided. Other treatment modalities that have demonstrated efficacy in treating low back pain include yoga, massage, spinal manipulation, and acupuncture. If a patient’s low back pain fails to improve at the four-week interval, the physician will likely order x-rays of the low back and possibly advanced imaging, such as an MRI scan. It is important to note that it may take patients up to six months of physical therapy to resolve all of their symptoms, and often-curative measures for low back pain include life style changes, such as a healthy diet and exercise.
In summary, the vast majority of patients with low back pain can be treated conservatively, and only on rare occasion is surgery necessary. With physical therapy, diet, and exercise, more often than not back pain can be alleviated on a permanent basis. Though not a quick fix, with good compliance over a period of months, these modalities have a proven track record of effectiveness in treating this disabling condition.
For more information please visit the Academy’s website on low back pain at Orthoinfo.org: