Pain – Low back pain
DEFINITION
Low Back Pain may be caused by a variety of conditions or
processes. Low Back Pain is common and is believed to affect up to
90% of people at least once during their lifetime. It can be very
uncomfortable but is usually not serious.
processes. Low Back Pain is common and is believed to affect up to
90% of people at least once during their lifetime. It can be very
uncomfortable but is usually not serious.
DESCRIPTION
As people age, bone strength and muscle elasticity and tone
tend to decrease. The discs between the vertebrae in the spine
begin to lose fluid and flexibility, which decreases cushioning to
the vertebrae. Pain can occur when a sprain, strain, or spasm
occurs in one of the muscles or ligaments in the back. If the spine
becomes overly strained or compressed, a disc may rupture or bulge
outward. This rupture may put pressure on one of the more than 50
nerves rooted to the spinal cord that control body movements and
transmit signals from the body to the brain. When these nerve roots
become compressed or irritated, back pain results.
tend to decrease. The discs between the vertebrae in the spine
begin to lose fluid and flexibility, which decreases cushioning to
the vertebrae. Pain can occur when a sprain, strain, or spasm
occurs in one of the muscles or ligaments in the back. If the spine
becomes overly strained or compressed, a disc may rupture or bulge
outward. This rupture may put pressure on one of the more than 50
nerves rooted to the spinal cord that control body movements and
transmit signals from the body to the brain. When these nerve roots
become compressed or irritated, back pain results.
CAUSE
The exact cause of Low Back Pain may be difficult to identify.
In other cases the pain can be traced to a specific cause. The most
common being sprain, strain, or spasm in one of the muscles or
ligaments in the back caused by lifting a heavy object or
over-stretching
In other cases the pain can be traced to a specific cause. The most
common being sprain, strain, or spasm in one of the muscles or
ligaments in the back caused by lifting a heavy object or
over-stretching
Other causes include;
- Disc protrusion: the discs between the vertebrae may become
weaker and bulge out. In an extreme case this may lead to a
prolapsed disc. - Prolapsed disc (slipped disc or herniated disc): a disc bulges
so far out that it puts pressure on the spinal nerves in the back.
This may cause leg pain (sciatica) since these nerves in the lower
back run all the way down to the legs. - Spinal stenosis: the spinal column runs through a narrow
opening in the vertebrae. If this opening becomes too narrow the
nerves may become trapped, which causes pain. - Collapsed vertebra: the vertebrae give much of the structural
support to the spine but these may become damaged as a result of
disease or injury. Severe osteoporosis may result in a vertebra
collapsing and by doing so disturb the surrounding structures. - Musculoskeletal pain syndromes such as myofascial pain
syndromes and fibromyalgia may cause Low Back Pain. - Infections of the bones of the spine such as osteomyelitis or
sacroiliitis can cause Back pain that is usually worse at night and
worse when sitting or standing for a long time.
Pain may also be caused by degenerative conditions such as
arthritis or disc disease, osteoporosis or other bone diseases,
irritation to joints and discs, or congenital abnormalities in the
spine.
arthritis or disc disease, osteoporosis or other bone diseases,
irritation to joints and discs, or congenital abnormalities in the
spine.
Obesity, smoking, weight gain during pregnancy, stress, poor
physical condition, posture inappropriate for the activity being
performed, and poor sleeping position also may contribute to low
back pain. Additionally, scar tissue created when the injured back
heals itself does not have the strength or flexibility of normal
tissue. Buildup of scar tissue from repeated injuries eventually
weakens the back and can lead to more serious injury.
physical condition, posture inappropriate for the activity being
performed, and poor sleeping position also may contribute to low
back pain. Additionally, scar tissue created when the injured back
heals itself does not have the strength or flexibility of normal
tissue. Buildup of scar tissue from repeated injuries eventually
weakens the back and can lead to more serious injury.
NOTE: Occasionally, low back pain may indicate a more serious
medical problem. Back pain should be discussed with your
Doctor.
medical problem. Back pain should be discussed with your
Doctor.
SIGNS AND SYMPTOMS
Low back pain means a pain or ache somewhere between the
bottom of the ribs, at the back, and the top of the legs. The pain
often begins suddenly, and may follow an obvious strain or injury,
but may develop for no obvious reason. In other cases the pain can
develop slowly.
bottom of the ribs, at the back, and the top of the legs. The pain
often begins suddenly, and may follow an obvious strain or injury,
but may develop for no obvious reason. In other cases the pain can
develop slowly.
The pain may travel to or be felt elsewhere. It often goes
into the buttocks, but may go further down the leg and even into
the foot.
into the buttocks, but may go further down the leg and even into
the foot.
The pain may be worse on bending and is often worse sitting,
especially in an easy chair. Sometimes turning over in bed and
sitting up are agonising. Coughing or sneezing can often make the
pain much worse. The muscles of the back may go into painful
spasm.
especially in an easy chair. Sometimes turning over in bed and
sitting up are agonising. Coughing or sneezing can often make the
pain much worse. The muscles of the back may go into painful
spasm.
TREATMENT OPTIONS
Always consult your Doctor for diagnosis and advice. A
thorough medical history and physical exam can usually identify any
medical conditions or family history that may be associated with
the pain. Medical imaging such as an X-ray, MRI scan or CT scan may
be ordered by your GP or consultant if he or she thinks that your
back pain is associated with a certain structural abnormality in
your spine. In many cases scans and tests show no clear
explanations for the pain.
thorough medical history and physical exam can usually identify any
medical conditions or family history that may be associated with
the pain. Medical imaging such as an X-ray, MRI scan or CT scan may
be ordered by your GP or consultant if he or she thinks that your
back pain is associated with a certain structural abnormality in
your spine. In many cases scans and tests show no clear
explanations for the pain.
In the majority of people, Back Pain usually goes away within one
month. Your Doctor may recommend medications to ease the pain
and/or inflammation, cold/hot packs, osteopathic or chiropractic
manipulation, TENS stimulation, back exercises and in some cases,
surgery. Ask your Doctor if you require bed rest or decreased
activity – in most cases, it is recommended that you have no more
than 2 days of bed rest or decreased activity. People with sciatica
may require 2-4 days of bed rest. Ask your Doctor for advice.
month. Your Doctor may recommend medications to ease the pain
and/or inflammation, cold/hot packs, osteopathic or chiropractic
manipulation, TENS stimulation, back exercises and in some cases,
surgery. Ask your Doctor if you require bed rest or decreased
activity – in most cases, it is recommended that you have no more
than 2 days of bed rest or decreased activity. People with sciatica
may require 2-4 days of bed rest. Ask your Doctor for advice.
In most cases it is advisable to continue normal activities.
Paracetamol or ibuprofen may help to reduce the pain. Some people
find that applying hot or cold packs to the painful area can give
some pain relief. It is advisable to not apply the hot or cold
packs directly on the skin but to wrap the packs in a thin towel or
cloth.
Paracetamol or ibuprofen may help to reduce the pain. Some people
find that applying hot or cold packs to the painful area can give
some pain relief. It is advisable to not apply the hot or cold
packs directly on the skin but to wrap the packs in a thin towel or
cloth.
Transcutaneous electrical nerve stimulation (TENS),
ultrasound, acupuncture, traction and biofeedback are other types
of therapies which may help to relieve Low Back Pain.
ultrasound, acupuncture, traction and biofeedback are other types
of therapies which may help to relieve Low Back Pain.
SURGERY
In the most serious cases where Back Pain has not responded to
other treatments, surgery may be required. It is advisable to
carefully consider the potential benefits and risks of back surgery
before committing to the procedure. There are some types of Low
Back Pain caused by nerve damage and surgery will not restore the
function of these nerves. A small percentage of people will benefit
from back surgery and in other cases surgery may worsen the pain,
cause nerve damage and affect bowel and bladder function.
other treatments, surgery may be required. It is advisable to
carefully consider the potential benefits and risks of back surgery
before committing to the procedure. There are some types of Low
Back Pain caused by nerve damage and surgery will not restore the
function of these nerves. A small percentage of people will benefit
from back surgery and in other cases surgery may worsen the pain,
cause nerve damage and affect bowel and bladder function.
PREVENTION
See the Pain – Back Care Tips topic on the Healthpoint.
PHARMACIST’S ADVICE
- Ask your Pharmacist for advice on Back Pain.Apply an icepack to
the base of your spine for five minutes. Never apply ice directly
to the skin. Follow with 20 minutes of heat e.g a hotwater bottle
wrapped in a towel, placed on the base of the spine. This will help
reduce inflammation. You can use it on the spine while you sit
down, or when you lie on the bed. - If there is swelling and pain your Pharmacist may recommend
some anti-inflammatory and pain relieving tablets containing
ibuprofen. It is important to seek medical advice for any
persistent pain. - Never take pain relievers which have been prescribed for
another person. Not all pain relief tablets are the same. Different
pain relievers have different effects, different dose
recommendations and are suitable for different sorts of pain. Some
types of pain relievers may have side effects which the patient may
not be aware of e.g. Non-steroidal Antiinflammatory Drugs (NSAIDs)
should not be taken by people with an allergy to aspirin, or by
those with asthma, peptic ulcer or with risk factors for
cardiovascular disease. - A transdermal spray containing indomethacin is also available
which penetrates the skin and underlying skin tissue giving relief
to aches and pain. - A cream containing the active ingredients heparinoid and
hyaluronidase might be used to slow any bruising and help prevent
swelling. Ask your Pharmacist. - Lumbar support cushions provide excellent lower back support
while sitting at the office and during travelling. As your
Pharmacist about special support cushions.
Aspirin should not be given to children under 16 years of age
unless specified by a Doctor.
unless specified by a Doctor.
