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Low back pain: Types, causes and treatments
By Gregory R. Polston, M.D.
Low back pain is the fifth most common reason patients visit a physicianÕs office and the second most common symptomatic reason. Fifty to 80 percent of all adults experience low back pain during their lifetime. The prevalence of low back pain makes it the leading cause disability and lost productivity in the United States, with associated direct and indirect costs estimated to exceed $50 billion per year!
Medical studies have shown that 75 percent to 90 percent of patients with acute low back pain recover within six weeks, irrespective of treatment. Nevertheless, pain may persist in up to 72 percent and disability in up to 12 percent of patients one year after the first episode. Predictors of low back pain include poor physical health, occupation, increasing age up to 55 years, obesity, smoking, history of substance abuse and hard physical labor. Chronicity and disability are predicted by poor health status, pain radiating down to the feet, poor coping strategies, lower activity level and anxiety.
Low back pain can be classified on symptom duration. Transient low back pain is short-lived (hours), activity related and rarely initiates a doctor visit. Acute low back pain lasts up to three months and occurs spontaneously in approximately half of all cases. Chronic low back pain persists for years and may develop into a chronic pain syndrome with a significant negative impact to personality, social activity and overall health.
Most patients have mechanical low back pain and its sources include the vertebral body, discs, ligaments, muscles, spinal cord, spinal nerves, facet joints and sacroiliac joints. Non-mechanical low back pain includes infection, inflammatory arthritis and cancer. Pelvic, kidney, vascular and gastrointestinal diseases can also produce low back pain and should not be forgotten when evaluating the patient.
Focused treatment involves formulating an accurate diagnosis. This includes a detailed history of the pain, comprehensive physical exam, and appropriate imaging studies and laboratory tests. For patients with acute, non-specific low back pain, the primary treatment emphasis should be non-operative care, time, reassurance and education. Patients should be encouraged to return to normal activity, begin light aerobic exercise immediately, and avoid strenuous activities until symptoms resolve. Only 1 percent of patients have a medical condition requiring surgical intervention.
Effective treatment for patients with persistent pain and symptoms rarely involves a single intervention. Treating this type of pain requires not only identifying the pain generators of acute pain, but also addressing the associated physiologic, psychological and social issues. In addition, successful medical and surgical intervention cannot restore function and relieve the pain without the integration of specific therapeutic exercise programs, education and vocational rehabilitation. Thus, a multidisciplinary approach is needed to optimize therapeutic relief, allow patients to return to good health, and prevent further injury.
The Advanced Pain Centers of Alaska is one of the few facilities in the country that has integrated all the necessary specialties to treat both acute and chronic low back pain. With specialists in physical medicine, pain management, health psychology and physical therapy, we work side by side to ensure the highest standard of care for integrated low back pain treatment. We are located in Anchorage, Fairbanks and the Matanuska Valley.
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