Lower Back Pain Overview

Back pain is one of the most frequently reported conditions affecting the adult population. The prevalence of lower back pain in the geriatric population is not accurately known, even though musculo-skeletal problems increase with age. The causes of pain in the lower back, or lumbo-sacral region, actually result in problems associated with other parts, as soon after straining back muscles, one tries to walk or move in a different way to prevent pain. This results in unnecessary strain on other muscles as we are not used to moving in a different way. Most common causes of lower back pain are osteoarthritis, disc related problems, spondylytis, fractures unnoticed, less common being tumors and some bacterial infections etc. Risk factors for back pain include leading a sedentary life, heredity, progressing age, lifestyle etc. It is a fact that a majority of adults experience continuous and reoccurring lower back pain at some point in their life.

This health issue is episodic. The expenditure involved is high and so is the disability level. The maximum percentage of patients experience symptoms for less than 3 months, and cases of lower back pain are self-limiting and resolve on their own. But, at the same time, the risk of recurrence and development of chronic disease is significant. The factors which trigger lower back pain range from excess use, damage and strain to muscles, supporting structures of the spinal cord along with other factors. With time, this muscle strain can result in an altogether imbalance in the spinal structure further taking form as stress on the muscles, ligaments, bones, and discs, eventually leading to a more injuries to the lower back.

It is a proven fact that a proportion of patients (around 40%) do not show response to any of the interventions. So, it is essential to determine which characteristics predict a more favorable outcome in order to target limited interventions.

Focused physical examination and detailed analysis of psychological factors which pose a risk in developing chronic back pain, location and duration of pain, symptoms, risk factors etc should be done by clinicians in the first place. Evaluation for the presence of any neurological deficit, other dysfunctions should also be done. Assessment of these factors, in turn, helps to target interventions. A normal clinical examination should be sufficient enough to distinguish between simple lower back pain and other pathological conditions. A battery of blood and urine tests, X-rays, CT scans etc is done, especially when the back pain causes total immobilization. Results are analyzed in order to determine if the cause is due to an infection or other systemic problem. The therapist might carefully examine the level and the exact area of discomfort and nerve function.

Availability of multiple efficacious treatments allows greater opportunity for individual choice, as there is wide variability in the intensity, severity of disability, symptoms from one individual to another which, in turn, is due to many factors. The general advice by clinicians is to remain active but periods of rest is encouraged only in cases where it relieves symptoms followed by resuming normal routine as early as possible. Heat application through pads is also a self care option.

First-line medications prescribed for relieving pain are of the class NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), whereas specific medications are given in more severe cases. Anti-depression drugs are given if the patient suffers from depression, which is very common in patients dealing with consistent pain. Pain lasting for more than 6 weeks and severe in intensity, i.e. chronic pain, is treated using non-pharmacologic therapy, spinal manipulation, acupuncture, massage therapy, inter-disciplinary rehabilitation, behavioral therapy etc.

Self-management of lower back pain can be accomplished by laying focus on treatment recommendations, changes in behavior, exercise regimens, body mechanics, and better awareness through educational programs etc. The importance of exercise is stressed for its innumerable benefits, especially in the case of adults with early onset of disease. Interventions like acupuncture, laser therapy, electric nerve stimulation etc have proved beneficial to many.

Exercise which is well-supported through guidance by clinicians, and awareness through educational programs should be set as goals in self-management strategies for chronic lower back pain. Lower back pain is a persistent or recurrent problem. So, complete cure is unrealistic but goals can still be achieved through active self-care programs and organizational target interventions.