Introduction

Low back pain is a worldwide health problem, affecting millions of population and greatly impacting quality of life. Back pain does not discriminate based on age, culture, or geographic location and it is among the leading causes of medical consultations, ranking second after respiratory infections.

what are the Prevalence and global health concern?

Back pain affects an estimated 20% of the global population annually, with up to half i.e. 50% experiencing recurrent episodes within the same year. In the United States alone, healthcare spending for LBP reached a staggering $134.5 billion annually between 1996 and 2016, continuing to rise. Beyond economic costs, LBP profoundly affects productivity, mental health, and overall quality of life. 

WHO-COPORD (Community Oriented Program for Control of Rheumatic Diseases) studies have confirmed its prevalence even in less-developed regions, dispelling the myth that back pain is a “Western“ or industrialized problem.

what are the Types and stages of LBP?

It is broadly classified in to three categories based on severity and duration:

Acute Low Back pain

It is self limiting pain , in most cases it resolve spontaneously with in weeks. According to WHO acute LBP hardly requires any treatment, which lasts up to 6 weeks.

Subacute Low Back Pain

If the pain didn’t resolve and last up to more than 12 weeks then it is consider as subacute LBP.

Chronic Low Back Pain

If the pain lasts more than 3 months then it is consider as chronic pain, which requires medical attention as soon as possible to prevent from disability.

what are the red flags of Low back pain?

These are various signs of serious underlying conditions: cancers, infections, fractures, or cauda equina syndrome. Such causes account for less than 0.2% of back pain.

The following are the red flags for above mentioned conditions;

• History of trauma
• Unexplained weight loss,
• Fever
• Age over 50.
• Neurologic symptoms include bowel/bladder dysfunction or progressive motor weakness.

what are the causes of Low back pain?

The causes of non specific back pain are still unknown and is diagnosed as non specific, when the cause of LBP is not associated with specific LBP. According to research around 80% cases of LBP are associated with non specific LBP whose causes are still idiopathic (unknown).

Here are the some specific causes of LBP:

• Pulled muscles or muscle strain

It occurs due to heavy lifting and sudden twisting movement while lifting and playing sports. The most commonly injured muscles in lower back are erector spinae, multifidus, quadratus lumborum, gluteal, and iliopsoas muscles.

• Lumbar herniated disc

The adjacent nerve root may be compressed, or “pinch,” by the disc’s section that herniates through the disc wall.
Often called sciatica or radicular pain, low back pain with or without leg discomfort can be caused by a herniated disc.

• Osteoarthritis

It is the degenerative disease which occurs when cartilage between the vertebrae in the spine breaks down, which leads to pain in the lower back.

• Spondylolisthesis

It occurs when one vertebra slips over the adjacent one, commonly occurs in L5/S1 vertebral level. Instability causes the lower back pain, and nerve compression causes the legs to hurt and/or become weak.

• Deformity

The deformity in the spine like scoliosis or kyphosis causes pain in the lower back due to uneven distribution of body weight.

• Trauma

Trauma causes acute fracture and dislocation of the vertebra which cause the pain in the lower back.

• Spinal infection

Spinal cord infection like Osteomyelitis, which is the inflammation of bone mainly occurs due to bacterial infections. It causes lots of pain in the lower back.

• Tumor

Sometime tumor becomes the causes of low back pain which is spread from other parts of the body like breast, prostate, kidney, thyroid or lungs.

• Autoimmune disease

Autoimmune disease like rheumatoid arthritis, ankylosing spondylitis,  lupus, Crohn’s disease, fibromyalgia can be the cause the low back pain.

What are the risk of Low back pain?

• Low back pain due to Physical condition

Physical conditions like poor abdominal and back muscle strength, poor posture, repeated twisting/bending, and lifting heavy loads are associated with low back pain. The change in posture  spine due to obesity and pregnancy can leads to LBP.

• Low back pain due to Lifestyle and Environment

Sedentary lifestyle, long driving hours, poor seating posture, construction workers are at more risk due to their lifestyle and working environment.

• Low back pain due to Psychosocial

Psychosocial factors like work stress can be the cause of pain.

• Low back pain due to Age and gender

LBP is more commonly seen in older age as compared to young age group.

What are the diagnosis procedure of Low back pain?

A health care professional will do your physical examination first like ability to sit, stand, walk and ability to lift the leg as well as history of pain. They might ask you to rate your pain between 0 to 10 by using visual analogue scale (VAS)  , where 0 is no pain, 5 is the moderate pain and 10 is the severe pain. This will give  brief idea about the conditions.

Some examination can be done to rule out serious conditions.

• X-ray
• MRI or CT-Scan
• Blood test
• Nerve Conduction Test etc.

DO

1.  Stay active
2. Practice good posture
3. Do back specific exercises
4. Maintain heavy weight
5. Lift correctly
6. Sleep in a comfortable position

   

DON’T

1. Avoid Prolong Bed Rest
2. Avoid poor posture
3. Don’t ignore pain that radiates
4. Avoid high impact activities
5. Avoid smoking
6. Avoid dependency on passive treatment

what are the treatment of Low back pain?

Most of the LBP reduced itself within weeks or months without  any medical intervention. If your Low back pain won’t reduce then you most take some pain killers or muscle relaxant.

Back pain can be treated in conservative in early stage or surgical intervention on severe cases.

• Conservative treatment

1. Medical intervention

Medicines are prescribed to reduce pain for short period of time and depending upon types of various types of medicines are prescribed such as;

a. NSAIDS

b. Muscle relaxants

c. Topical pain relievers

d. Narcotics

e. Antidepressents

        2. Physical therapy

a. Cryo-therapy

b. Electro-therapy

c. Moist Heat Therapy

d. Exercise therapy

e. Manual therapy

      3. Alternative therapy

a. Yoga therapy

b. Cupping therapy

c. Acupuncture

d. Cognitive behavioural therapy (CBT).

• Surgical Intervention

If conservative treatment fails then surgical intervention is recommended to prevent surgical complications.

a. Injection therapy/Cortisone injection

b. Radiofrequency Ablation

c. Implanted nerve stimulator

d. Surgical excision. etc.

When to seek medical attention?

a. High temperature 

b. Unexplained Weight Loss

c. Lump or Swelling

d. Persistent or Night Pain

e. Pain with Sneezing or Coughing

f. Pain in Upper Back
If you are experiencing any of these symptoms, you should seek medical attention immediately.

When to seek doctor?

a. Spinal cord compression can be manifested as pain, tingling, weakness, or numbness in both legs.

b. Numbness or tingling involving the genitals or buttocks may indicate nerve damage, such as cauda equina syndrome.

c. Difficulty urinating or loss of bladder/bowel control: Seek immediate medical attention.

d. Chest Pain: Could signal a heart or upper spine issue.

e. After a Serious Accident: Trauma can cause fractures and other types of injuries.

If you experience these symptoms, call the doctor or emergency services.