What Is Lower Back Pain?
Lower back pain
, also referred to as lumbar spine pain, is a common ailment that is experienced by millions of people in the United States. If you suffer from lower back pain, you’re not alone. Recent reports suggest that the majority of adults in the U.S. (84%) will suffer from some type of low back pain during their lifetime.
Also of concern is the relapse rate of lower back pain, with reports suggesting that a large percentage (44% to 78%) of individuals who suffer from one occurrence of lower back pain reporting a future pain episode. The CDC reports that lower back pain is associated with significant disability and has a negative impact on both the personal and work life of those who suffer from the condition. Lower back pain also has a significant economic impact in the United States. The National Institutes of Health (NIH) has stated that an estimated 50 billion dollars per year is spent in the United States due to lower back pain.
If you suffer from lower back pain, there are multiple treatments that can help. These range from targeted exercise programs to more interventional treatments like spinal cord stimulation. Read on to learn more about these options for lower back pain relief.
Must-watch lower back pain video
Lumbar spine pain is a leading cause for individuals missing time from work and is the leading cause of work-related disability. Furthermore, lower back pain is a main cause for decreased work productivity and increased use of medical resources. For these reasons, low back pain has received considerable attention in the research world. Over the past ten years the amount of research investigating prognostic factors that relate to lower back pain, and randomized controlled studies testing the various treatment methods that are available to treat low back pain patients, has increased dramatically.
Acute versus chronic lower back pain
Lumbar spine pain is generally classified as either acute or chronic, depending on the length of time that a patient suffers with the pain. Acute pain is described as short-term pain that typically lasts no longer than three months. Conversely, chronic pain refers to long-term pain that persists for a period of longer than three months. Acute lower back pain episodes can sometimes lead to persistent lower back pain in some patients. Chronic lower back pain generally progresses over time, initially presenting as a dull ache and progressively worsening to severe, unrelenting pain. Chronic lower back pain can lead to significant impairments in an individual’s functioning, often resulting in disability. It has been reported that a significant percentage of the U.S. population (12%) report disability due to their chronic lower back pain symptoms.
Chronic lower back pain that cannot be attributed to a specific cause, including disease, trauma, or tumor is referred to as non-specific lower back pain. There is little evidence that has investigated the prevalence of non-specific, lower back pain. However, some researchers suggest that the incidence rates may be quite high (23%). This statistic suggests that a significant percentage of the population deals with chronic lower back pain every day. Further, several of these patients are unlikely to be able to carry on with their normal work duties due to their significant pain symptoms.
Lower back pain anatomy
Before beginning treatment for the management of lumbar spine pain, it is important that the physician determines the source of a patient’s pain. The back is a complex structure that consists of a network of tissues, muscles, bones, and nerves that runs from the base of the skull to the pelvis. The vertebral column is a structure that provides support for the body and protection for the fragile spinal cord. Twenty-four individual vertebrae connected to each other make up the fairly flexible vertebral column, as well as nine fused vertebrae, which form the sacrum and coccyx (tailbone).
In between each vertebra are intervertebral discs that provide cushioning and shock absorption and contribute to the overall flexibility of the lumbar spine. Muscles and ligaments connect to the vertebrae of the spine, which provide strength as well as mobility. Inside the vertebral column is the spinal cord, which descends from the brain through the vertebral column to just inferior to the 12th rib in most adults. Each component of the vertebral column is at risk for injury due to disease, wear and tear, or trauma, which can ultimately result in lower back pain.
Lumbar spine pain is characterized by pain or discomfort that originates in the lower back region, specifically from the area inferior to the costal margin and superior to the inferior gluteal folds. Additionally, lower back pain may radiate into the lower extremities. Symptoms of lower back pain vary widely, with some patients reporting a dull, diffuse ache and other reporting a sharp, localized pain. Furthermore, lower back pain symptoms can change overtime with patients reporting episodes of exacerbation of pain. While specific symptoms of low back pain vary among patients, common complaints include muscle spasms and cramping, stiffness, radiating pain into the lower extremities, numbness, tingling, or weakness, as well as an altered sensation to touch.
Diagnosing Lower Back Pain
The work-up of a patient with lower back pain symptoms typically begins with a detailed medical history and focused physical examination. The expectation of the work-up is to determine the cause of a patient’s pain. In some cases, the exact cause of an individual’s pain cannot be determined; in these cases, the practitioner will look to exclude certain ominous diagnoses, including nerve root pain and spinal pathology. Additionally, the practitioner will address certain prognostic factors that are related to lower back pain by inquiring about specific issues related to work, depressed mood, psychosocial distress, pain severity, patient perceptions to pain, previous lower back pain, over-exaggeration of symptom reporting, and degree of impairment. These “yellow flags” help the practitioner develop the most ideal treatment plan and reassessment schedule for each patient.
Moreover, the practitioner will address other areas including patient age (20 years and younger or 55 and older), thoracic pain, pain that is non-mechanical, corticosteroid use, previous cancer, unexplained weight loss, general unwellness, structural changes, and wide-spread neurological discrepancies. These factors are known as “red flags” and may be indicative of serious underlying pathology, including infection, tumor, inflammatory disorders, cauda equina syndrome, or fracture. Patients exhibiting these red flags may not have a serious underlying issue; however, they are at a heightened risk. If a patient presents with multiple red flags, they should be further evaluated.