Diagnosis And Treatment Of Acute Low Back Pain
BRIAN A. CASAZZA, MD, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Am Fam Physician. 2012 Feb 15 85:343-350.
Patient information: Handouts on this topic are available at and .
Most persons will experience acute low back pain during their lifetime. The first episode usually occurs between 20 and 40 years of age. For many, acute low back pain is the first reason to seek medical care as an adult. Pain can be moderate to severe and debilitating, causing anxiety. Many cases are self-limited and resolve with little intervention. However, 31 percent of persons with low back pain will not fully recover within six months,1 although most will improve. Recurrent back pain occurs in 25 to 62 percent of patients within one to two years, with up to 33 percent having moderate pain and 15 percent having severe pain.24
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Red flags are common in patients with acute low back pain and do not necessarily indicate serious pathology therefore, physicians should rely on a comprehensive clinical approach to evaluating red flags in these patients.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Differential Diagnosis of Acute Low Back Pain
Information from references 5 and 6.
Differential Diagnosis of Acute Low Back Pain
Olss Free Condition Check Tool
OLSS offers a free condition check tool to help you understand the source of your back pain. With our condition check tool, you can quickly identify your current neck, back or spine problem so you can obtain treatment as soon as possible.
To complete the condition check tool, describe your pain, tell us about your symptoms and give us additional information about the history of your pain. An OLSS spine specialist will get back to you with the results of your assessment. Keep in mind, however, that an online diagnosis isnt conclusive and you need to be further evaluated by an OLSS specialist at one of our clinics.
Back Pain Quiz #: Did The Pain Occur Overnight
If your answer to this question is yes, your back pain is probably related to a recent activity during which you made a false move or during which you spent too much time in a position that your back did not like.
You have been playing sports without warming up, you have been gardening, doing odd jobs, changed your mattress or office chair: in other words, your back pain is related to a very specific event that happened yesterday or the day before.
Your back pain is related to a specific event that took place yesterday or the day before. It is likely to be a muscle pain of the following type: lumbago
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Do I Have Sciatica Here Are 5 Ways To Tell
With so many possible causes of sciatica and so many other conditions that can easily masquerade as sciatica, is there ever a way to know for sure? How can you definitively determine if your pain is sciatica or not?
The most definitive way is to visit your doctor and receive an official diagnosis. However if youre just looking to get an idea for yourself before you visit your doctor, here is a guide to help you determine if you are truly experiencing sciatica.
Back Pain Quiz #: Is Your Back Pain Worse When You Are Lying Down
For years, I was terrified about going to bed.Lying down would significantly increase my back pain and its not like I could stand or lean against a wall 24 hours a day.
Back pain increasing when lying down is a symptom of lumbar disc herniation.
This compression of the sciatic nerve will cause severe pain throughout this area and in several places along the path of the sciatic nerve, which ends at the tip of the foot.
The sciatic nerve will also suffer from this compression and this will result in pain and tingling or loss of feeling in the affected leg or foot.
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Back Pain Lasting For Months
If you have had back pain for months, a dull, permanent pain, you dont know exactly where it is located And if you are over 40 years old, if you have a lifestyle or a job that requires you to work hard , you may be suffering from degenerative disc disease: DDD is one of the most common causes of back pain. A trauma to one or more intervertebral discs that causes back pain that is bearable in terms of intensity, even if painful and permanent.
You should have already seen a doctor a long time ago: I dont want to push you to consult a doctor, but the best way to treat back pain is to know its origin, and this is done through medicine.
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The Details: But Wait Lower Back Pain Gets More Complicated
Not only is chronic back pain hard to live with, it can also be difficult for practitioners to diagnose due to the overlap of symptoms with other conditions. Traditional diagnostic methods usually begin with a full physical exam and overview of your medical history.
From there, depending on the severity and duration of the pain, your doctor may request blood work to look for signs of inflammation or infection imaging studies such as X-rays, CT scans, or MRIs to look for structural damage or bone or DEXA scans to check for any bone disorders or bone infections and electrodiagnostics to check nerve function with electromyography or nerve conduction studies.11,12
Your observations can provide some of the most important clues to help your doctor make the right diagnosis. Take notes about your condition and bring them with you to your appointment so that you can precisely describe the pain youre experiencing.
Include details about the pain, such as whether its burning, stabbing or aching the time of day when your pain is at its worst and what youre doing at that time and the exact location or locations of the pain within the lower back region.13
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Back Pain And Pregnancy
Back pain during each trimester of your pregnancy can be common, and several causes are to blame. However, you should be sure to talk with your doctor about what youre experiencing, in case the pain may be part of a bigger problem.
Here are a few reasons why you may be experiencing back pain during pregnancy:
Shifting center of gravity
As your baby grows, the center of your bodys gravity moves outward. Your spine and back arch to make up for the change in balance. This put extra stress on the lower lumbar spine.
Weight gain can be a healthy part of pregnancy, but even the little bit youre likely to gain during those 9 months can put more stress on your back and core muscles.
As your body prepares to deliver the baby, it releases hormones that loosen the ligaments that stabilize your pelvis and lumbar spine. These same hormones can cause the bones in your spine to shift, which may lead to discomfort and pain.
How Is Back Pain Treated
Acute back pain usually gets better on its own. Acute back pain is usually treated with:
- Medications designed to relieve pain and/or inflammation
- analgesics such as acetaminophen and aspirin
- non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be sold over the counter some NSAIDS are prescribed by a physician
- muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles
- topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
Exercising, bed rest, and surgery are typically not recommended for acute back pain.Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.
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Movement Posture And Pain
Now, how to differentiate between the different structures that can cause back pain, whether disc, joint, neural structure, muscle, psychological constructs, etc. That is a series of further articles to show the differentiation techniques and subjective history flags that are consistent with them. It is a lot of in-depth understanding. And perhaps weve covered enough already for one session.
So, for now, lets just work on clearly understanding the relationship between movement, posture, and pain behavior as characterized by the centralization and peripheralization phenomenon. This is about pain, not structure. We are using the disc as an example, the most common example, to demonstrate a theoretical model of the cause of the phenomenon.
When you are prescribing and imposing an exercise upon a person with a history of low-back injury, it is imperative you consider the location of the pain and its changes in response to your exercise, not simply the intensity of the pain. And remember, these tools are predictors and benchmarks. Each actual case will be different and your influence as a professional can be one of the most important factors of all. Your ability to communicate your expectations, your prescriptive exercise requirements, and the clients understanding of your approach often are the most important hinges upon which the case may turn.
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The Chronic Back Pain Probably Wont Go Away On Its Own
Unfortunately, many people fail to get proper treatment, or get it quickly, because they think they know best or dont make seeing a doctor for chronic back pain a priority. While back pain is among the most common physical ailments, and low back pain the most common type of back pain, a majority of injuries do improvewith the right diagnosis and treatment.
Although most patients with acute low back pain will improve with conservative treatmenta subset of patients will progress to chronic and sometimes disabling symptoms, said the National Center for Biotechnology Information, U.S. National Library of Medicine .
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Xv Useful Links And References
, Hospital for Special Surgery, Hector Lozada, PT, DPT, OCS, Robert Turner, PT, OCS, MS, Theodore R. Fields, MD, FACP, January 19, 2017.
Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.
Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.
1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
You May Think Its The Same Thing Youve Experienced Before
If youve been living with chronic back pain or if youve had a back injury like a bulging disc or a pinched nerve in the past, you may think you can diagnosis your issue and treat it like you have before. But what if youre wrong? Many symptoms of back pain can masquerade as something else, so it could be that the treatment youre providing is all wrong, or could even be doing more harm. At the very least, delaying the appropriate treatment by having your doctor diagnose your chronic pain can put off healing and keep you in pain unnecessarily.
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Can Pain In The Back Be Prevented
Repeating neck and back pain arising from incorrect body auto mechanics could be prevented by avoiding activities that shake or stress the back, maintaining ideal posture, and also lifting things correctly.
Great deals of work-related injuries are created or worsened by stress factors such as hefty lifting, duplicated or continual call in between soft body cells, resonance, duplicated task, along with unpleasant stance.
Ideas for maintaining ones back healthy and also balanced
Exercise frequently to keep muscles strong along with functional. Seek advice from a medical professional for a listing of low-impact, age-appropriate exercises that are particularly targeted to strengthen lower back and abdominal muscles.
Maintain a healthy and also balanced weight in addition to take in a healthy diet plan with sufficient everyday intake of calcium, phosphorus, as well as likewise vitamin D to market new bone growth.
Use ergonomically developed furniture in addition to devices at home and additionally at the work environment. Ensure job surface areas are at a comfortable elevation.
Back Pain As With Any Physical Condition Is A Multifaceted And Multi
The principle of centralization is an excellent diagnostic tool. Centralization and peripheralization are strongly associated with the symptoms associated with pain of discogenic origin. In a 1997 study by Donelson , centralization was strongly associated with competent annulus compared to peripheralization . In a review of 87 patients with radiating symptoms, centralization occurred in 76 .
The occurrence of centralization during initial mechanical evaluation is a very accurate predictor of successful outcome and it reliably determines the appropriate direction of treatment exercise. On the other side of the coin, the non-occurrence of centralization to imposed examination accurately predicts a poor treatment outcome and is an early predictor for the need of surgical treatment.2
In studies assessing chronic low-back pain, return to work, and centralizers versus non-centralizers before entry-to-work hardening programs, the outcomes showed centralizers had significant decreases in their maximum pain ratings and a higher return-to-work rate. Centralization can help identify individuals with chronic low-back pain who may positively respond to exercise and training outcomes.4
It is imperative to learn the source of your pain before attempting any sort of spinal loading through exercise.
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Is Your Work Contributing To Neck And Back Pain
A job that consists of drawing, hauling, or twisting with the lowered back can trigger injury as well as low neck and back pain. Even long term remaining in an awkward setting can activate low back pain.
Based upon your feet for hrs on end? That can produce lower neck and back pain also. The greatest approach to quit back pain is to understand if you are at threat.
Neck And Back Pain Perpetrator: Your Workout
Overdoing it at the health club or fairway is among among one of the most common reasons for overextended muscles creating low pain in the back. Youre specifically at risk if you typically tend to be non-active throughout the work week and also after that invest hours at the gym or softball location on the weekend.
How To Treat Lower Back Pain
Lower back pain may respond to many different modalities, but it often takes trial and errorand a lot of patienceto find what works for you.
The Tried-and-TrueThe first line of defense is often over-the-counter nonsteroidal anti-inflammatory drugs and/or acetaminophen. Applying topical cold compresses, such as an ice pack, is recommended immediately after first experiencing a lower back injury or onset of pain. Heat therapy, such a heating pad, hot water bottle, or even an Epsom salt bath, can also be used to relax and soothe the surrounding muscles by helping to increase blood flow to the lower back.15
When to Call Your Doctor or SpecialistIf your pain is recent, or mild to moderate but over-the-counter pain relievers and topical compresses dont provide relief, call your primary care doctor. He or she will be able to evaluate what is causing the pain and, if appropriate, prescribe a muscle relaxant. Historically, opioids were commonly prescribed to treat pain, but due to the increasing numbers of opioid-related overdoses and deaths, many practitioners no longer view them as the best strategy for non-cancer-related pain, Jamison explains. However, doctors now can implement opioid risk assessments and monitor urine samples in order to better prevent the risk of opioid abuse, Jamison says.
Depending on your diagnosis, your doctor may refer you to a specialist, such as an orthopedist, physical therapist, or psychotherapist, as needed.
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Can Back Pain Be Prevented
Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress , vibration, repetitive motion, and awkward posture.Recommendations for keeping ones back healthy
Additional Details: Degenerative Disc Disease
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