Lower Back Pain and Its Symptoms

Overview

Low back pain, characterized by discomfort in the lower back, often accompanies stiffness and a decreased range of motion in the affected area. Many individuals experience back pain at least once in their lives. While back pain can occur in any part of the back, the lower back is particularly susceptible due to its role in supporting a significant portion of the body’s weight. Importantly, anyone can suffer from low back pain at any time, regardless of prior injuries or risk factors. Fortunately, this condition is often not serious and can resolve on its own. According to a 2018 publication in The Lancet, low back pain is a prevalent complaint across various age groups, from children to the elderly, and among individuals of all income levels. Currently, low back pain is the leading cause of disability worldwide, hindering many from working effectively.

The lower back consists of five lumbar vertebrae that lie between the ribcage and pelvis. Between these vertebrae are circular and flattened discs characterized by a robust outer layer surrounding jelly-like material. These discs function as shock absorbers for the spine. Thick ligaments attached to the vertebrae help keep the discs in place, while the lumbar region contains fewer vertebrae than the neck and middle back. However, these lumbar vertebrae bear the weight of the upper body, making them susceptible to high levels of movement and stress, leading to injuries, wear, and tear. Furthermore, the spine consists of 31 pairs of nerves and spinal roots, with the lower back serving as the origin point for five pairs of lumbar and five pairs of sacral nerves combined.

Types of Low Back Pain

Low back pain can be categorized into three primary types based on the duration of symptoms: acute, subacute, and chronic pain. The distinctions are as follows:

Acute Pain: Typically lasts from a few days to four weeks. Most low back pain cases fall into this category, and symptoms often resolve with self-care within several days without significant loss of functional ability. However, some cases may require several months for symptoms to dissipate.
Subacute Pain: This type lasts between four to twelve weeks and generally has a mechanical nature, manifesting as muscle strain or joint pain over a relatively prolonged period. Medical intervention may be necessary, especially if the pain is severe enough to limit daily activities, sleep, or work.
Chronic Pain: According to the National Institutes of Health, individuals with acute low back pain may develop chronic pain if it persists for twelve weeks or longer, even after the initial injury has been treated. Notably, ongoing pain does not always indicate a serious medical issue that can be easily identified and treated. While medical treatment can alleviate chronic low back pain in some instances, unfortunately, pain may persist despite adequate medical and surgical interventions.

Signs and Symptoms of Low Back Pain

Low back pain itself serves as a symptom of an underlying medical condition or injury. The nature and pattern of the pain experienced by the patient can vary depending on the underlying cause. Pain may be mild or severe, intermittent, or chronic, and can manifest as deep ache, stabbing discomfort, or throbbing pain. It can onset suddenly or gradually worsen over time, intensifying after prolonged standing or sitting. Other manifestations may include muscle spasms and tightness in the lower back, pelvis, or hips, or difficulty with standing erect, walking, or changing posture.

The radiation of pain from the lower back to other body areas suggests the underlying issue may be affecting the nerves. For example, a sharp, burning pain traveling from the lower back down the back of the thighs may indicate sciatica, which can extend down to the legs or feet, possibly accompanied by tingling or numbness. Pain that is worse in the morning but lessens with movement throughout the day typically points to muscular strain. In contrast, pain that exacerbates in the evening and does not improve with exercise may indicate referred back pain or a bony issue. Key symptoms suggesting a herniated disc or nerve compression include increased pain during coughing, sneezing, or straining, and difficulty in lifting a straightened leg.

Determining the cause of low back pain can sometimes be challenging, and while many cases improve without treatment, it is advisable to consult a physician if the pain is severe, doesn’t improve over time, or is accompanied by additional symptoms like leg numbness or tingling. Immediate medical care is essential if an individual experiences difficulties walking, moving their legs, loss of bowel or bladder function, sensitivity loss in the legs, or severe pain.

Causes of Low Back Pain

Low back issues may be congenital, known as congenital defects, or can develop later in life as acquired disorders. Causes may range from one or more of the following:

Mechanical Causes: These often arise from spinal movement and involve various spinal structures, such as facet joints, intervertebral discs, vertebrae, ligaments, muscles, and soft tissues. Examples include abnormal spinal curvature, degenerative disc disease, ligament sprains, muscle strains, nerve compression (as seen in sciatica), spondylolisthesis, and spinal stenosis.
Organic Causes: These are associated with specific medical conditions, such as abdominal aortic aneurysm, spinal tumors (benign or malignant), cauda equina syndrome, bacterial discitis, fibromyalgia, kidney stones, bacterial osteomyelitis, osteoporosis, and rheumatoid arthritis.
Unknown Causes.

Diagnosis of Low Back Pain

Identifying the specific cause of low back pain can be challenging. Generally, a doctor needs to gather information regarding the patient’s symptoms, including the quality of the pain, its intensity, aggravating or alleviating factors, as well as performing a physical examination that includes reflex testing and strength assessments, along with a comprehensive medical history. If the cause remains unclear, further diagnostic tests may include neurological assessments and imaging studies, which are determined based on possible causes for the individual’s low back pain. Several diagnostic tests include:

Blood Tests: These may include searching for signs of inflammation, infection, cancers, or arthritis. Blood tests are rarely used to diagnose back pain.
Bone Scans: Bone scans help identify infections, fractures, or bone disorders by injecting a small amount of radioactive material into the bloodstream, which accumulates in areas of bone where abnormalities exist.
Discography: This imaging technique involves injecting contrast dye into a suspected problematic intervertebral disc. If the disc is the source of pain, pressure from the dye will reproduce the patient’s pain, aiding in identifying damaged areas on CT scans.
Electrodiagnostics: This diagnostic method identifies issues related to the nerves in the back and legs.
Imaging Tests: While not always necessary, imaging techniques are utilized to rule out specific conditions, such as tumors or spinal stenosis. Common imaging tests include:
- X-rays: These can diagnose bone fractures and vertebral injuries.
- CT Scans: This method examines soft tissue structures that X-rays cannot visualize, identifying conditions like disc tears, spinal stenosis, and tumors.
- MRIs: This modality produces detailed images of bone and soft tissue structures, such as muscles and ligaments. MRI is used when there are suspicions of infection, tumors, inflammation, disc herniation, or nerve compression.

Home Care Tips for Low Back Pain

Here are some valuable tips for managing low back pain at home:

Document Symptoms: It is advisable to keep a record of symptoms, including the pain’s onset, activities that trigger it, and factors that alleviate or worsen the discomfort. This information can assist the family doctor in diagnosing the issue if further intervention is needed.
Maintain Physical Activity: Initially, daily activities might be challenging if the pain is severe. However, it is vital to resume normal activities as soon as possible while avoiding movements that exacerbate the pain. Engaging in light activities can distract from the pain and promote a return to normalcy. Research indicates that returning to routine activities hastens recovery and reduces the likelihood of chronic pain development.
Sleep Comfortably: It’s beneficial to sleep in a comfortable position on a supportive surface, without strictly adhering to traditional advice about using a firm mattress for back pain. Some individuals find relief from sleeping on their side with a pillow between their knees, while others may prefer sleeping on their back with a pillow under their knees.
Practice Therapeutic Exercises: Following the guidance of a physical therapist, individuals should engage in prescribed therapeutic exercises at home to alleviate pain and strengthen the lower back muscles, thereby reducing the risk of recurrence.
Heat and Cold Therapy: Home treatment using heat and ice can help relieve mild or acute muscle pain and reduce the effects of chronic conditions. Heat sources can include warm baths, heating pads, chemical heat packs, or hot water bottles, promoting muscle relaxation and increased blood flow, essential for muscle healing. Conversely, ice can alleviate inflammation-related swelling. Alternating between heat and cold during activities can enhance muscle flexibility before exercises and minimize irritation following physical activity.
Pain Relievers: Over-the-counter pain medications can help manage pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen can mitigate inflammation-related discomfort. Acetaminophen is another option for pain relief, but it is advisable to consult a physician to determine the most suitable pain medication.

Treatment for Low Back Pain

Most cases of low back pain generally improve with basic first aid, light physical activity, and over-the-counter pain relievers as needed.

Non-Surgical Treatments

Non-surgical treatment typically includes therapeutic medications prescribed by a doctor alongside physical therapy or alternative treatments. Although non-surgical interventions can relieve pain, they often do not address the underlying cause. Common medical treatments include:

Muscle Relaxants: These medications inhibit the central nervous system, increasing movement in tensed muscles and relieving discomfort from muscle strains or spasms. However, muscle relaxants are not recommended for chronic pain management.
Opioids: Known as narcotics, these medications alter the perception of pain by dampening the nerve signals sent to the brain. They are generally used for severe, short-term pain associated with surgeries but are often avoided for long-term pain due to potential side effects and addiction risk.
Back Braces: Utilizing a back brace or support can alleviate pain and enhance comfort. Some studies suggest that wearing a non-restrictive brace daily along with physical therapy can expedite recovery from low back pain.
Epidural Steroid Injections: These injections are administered to temporarily alleviate back pain by reducing inflammation surrounding a compressed nerve root. The steroid is directly injected into the epidural space around the spinal cord, often guided by fluoroscopic imaging to ensure accurate placement.
Physical Therapy: Various physical therapy techniques, such as superficial heat, ultrasound, cold packs, and massage, may alleviate symptoms of acute back pain under professional guidance.

Surgical Treatments

In certain situations, surgical intervention may be necessary if an individual’s health permits. Surgical options may be considered for:

Failure of non-surgical treatments to relieve pain.
Severe neurological symptoms.
Worsening of neurological symptoms over time.
Specific health indicators suggesting surgical need, including:
- Severe back and leg pain that significantly impacts daily activities and quality of life.
- Progressive neurological deficits, such as leg weakness or sensory loss.
- Loss of normal bowel or bladder function.
- Difficulty standing or walking.
- Ineffective pain relief from medications or physical therapy.

Neurosurgeons have several methods available to relieve pressure on nerve roots. Depending on whether pain arises from specific nerve roots and discs, or if degenerative changes impact the spine’s stability, a surgeon may choose an appropriate method. Techniques can range from minimally invasive approaches to more extensive procedures aimed at decompressing or fusing vertebrae using suitable medical instruments like plates, screws, rods, or cages. Although many patients report improvements post-surgery, outcomes are not guaranteed, and it is essential to weigh the potential benefits and risks of surgery carefully.