Chronic Lower Back Pain
Low back pain is a common musculoskeletal disorder causing back pain in the lumbar vertebrae. It can be either acute, subacute or chronic in its clinical presentation. Typically, the symptoms of low back pain do show significant improvement within two to three months from its onset. In a significant number of individuals, low back pain tends to be recurrent in nature with a waxing and waning quality to it. In a small proportion of sufferers this condition can become chronic. Population studies show that back pain affects most adults at some stages in their life and accounts for more sick leave and disability than any other single medical condition.
An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue like muscles, ligaments and tendons. With a serious accident or due to osteoporosis or other causes of weakened vertebral bones, vertebral fractures in the lumbar spine may also occur. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain). Others may have pain from their sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint disfunction. Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae, or a spine disc herniation, a vertebral fracture or rarely, a tumor (including cancer) or infection. The cause may also be psychological or emotional or due to other non-anatomical factors.
Diagnosing the underlying cause of low back pain us usually done by a medical doctor, osteopathic physician, physical therapist or by a chiropractor. Often, getting a diagnosis of the underlying cause of low back pain is quite complex. A complete diagnosis is usually made through a combination of a patient’s medical history, physical exam and when necessary diagnostic testing such as an MRI scan or x-ray.
The course of treatment for low back pain will usually be dictated by the clinical diagnosis of the underlying cause of the pain. This includes, staying active, analgesics, spinal manipulation, muscle relaxants, antidepressants, exercises, behavioral therapy or acupuncture. Massage therapy may benefit some patients and the use of ice and/or heat application. Lumbar surgery is indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence.