Low Back Pain

Fifty percent to 80% of the population will experience one episode of low back pain during adult life that temporarily interferes with performance of normal activities. The typical age of onset is in the third decade of life; low back pain reaches its peak in persons 55-64 years old and then decreases drastically in those older than 65 years. Of all patients with low back pain, only ten to twelve percent have concomitant sciatica. Only one to two percent of patients with sciatica secondary to a disc herniation require surgery.

Low back pain is the most common and most costly musculoskeletal ailment. Cost estimates range from $16 billion to $40 billion for actual medical costs and lost productivity. Fifty percent of patients with low back pain recover by two weeks and 90% have no pain by three months. Persistent symptoms are present in seven percent at six months; by one year only two percent still have pain. The seven percent of patients with pain after six months account for more than 90% of all money spent on treatment of and compensation for low back pain.

Conditions and Treatment

Most low back pain is caused by one or more of the following:

Acute lumbar muscular strain

Acute lumbar muscular strain is a common cause of low back pain and is usually self-limited. Prolonged bed rest is no longer recommended; recent studies have proven two days of bed rest is as effective as seven days. Increased endurance and overall physical fitness have been shown as positively influencing the recurrence rate and natural history of low back pain. Therefore activity should be increased and exercises be started as soon as possible. Physical therapy and use of non-steroidal anti-inflammatory drugs (NSAIDS) are commonly used for the treatment of acute lumbar strain.

Lumbar disc degeneration

Lumbar disc degeneration can be the cause of chronic, disabling low back pain. Treatment has ranged from physical therapy, electrical stimulation, acupuncture, trigger point injections, epidural steroid injections, as well as surgical intervention with lumbar fusion. Unfortunately, no one treatment has been found to be uniformly successful, and therefore, conservative treatment is most commonly used.

Lumbar disc herniation

Lumbar disc herniation can cause low back pain as well as symptoms of sciatica, or pain in the distribution of the sciatic nerve. Disc herniation can occur without known injury or can be the result of a lifting injury, fall, or motor vehicle accident. The majority of patients can be treated with brief bed rest, use of NSAIDS, and physical therapy. The use of epidural steroid injections may reduce inflammation of the nerve root and may provide short-term pain relief. Only five to ten percent of patients with persistent sciatica will ultimately require surgical intervention. The ideal diagnostic procedure for evaluation of a suspected disc herniation is magnetic resonance imaging.

Lumbar spinal stenosis

Lumbar spinal stenosis can be the cause of low back pain in men and women over the age of fifty. Symptoms are usually aggravated by prolonged standing or walking, and usually relieved by sitting or bending forward. Pain often radiates into both lower extremities in the areas of the buttocks, thighs, and lower legs. Mild or early symptoms can be treated with physical therapy, NSAIDS, or epidural steroid injections. Lumbar surgery in the form of a decompression can be of great benefit in restoring the ability to stand and ambulate in patients with refractory symptoms.

In summary, lower back pain is a common disorder that affects most of us at one time or another. Low back pain can often be treated effectively with short-term bed rest, medications, and a short course of physical therapy. Surgical intervention is sometimes needed to improve one's symptoms after conservative treatment has failed. Your physician is your best source of information about how to relieve your discomfort and enjoy life more.

This material is not intended to substitute medical advice. The information contained in this website is for informational purposes only. Please consult a physician for specific treatment and recommendations.