This is one of the top 5 pain complaints when going to see a provider. It is defined as pain, muscle tension or stiffness below the ribs and above the lower part of your buttocks. It is common: 4 out every 5 people will have low back pain at least once in their lifetime. There are multiple potential causes but we will focus on mechanical low back pain. Most causes of acute low back pain will resolve in 2 weeks but more than 80% of cases will recur within the first year.
It is important to recognize “red flags” when low back pain is concerned. Usually this involves a history of trauma, cancer, infection and/or changes in your bowel/bladder function since the onset of your back pain that is not related to medication use ie constipation from pain medications. If you do not have any history of these and/or it has been ruled out as a potential cause of your low back pain, in the majority of cases, your pain is likely not in need of any surgical intervention at this time.
The most common cause of low back pain is related to disc issues. This is followed closely by joint inflammation (lumbar facet syndrome). Other potential causes of low back pain include: sacroiliitis, muscle spasms (myofascial pain) and spinal stenosis.
Like with any pain condition, the earlier you address the condition with the appropriate treatment, the likelihood of this not becoming a chronic problem improves dramatically. One of the worst things you can do is do nothing. Bed rest has been found to potentially worsen the condition. Therefore the goal of any treatment is to decrease/eliminate your pain as quickly as possible to allow you to return back to your normal daily activities without delay. In addition lifestyle changes can help to prevent any recurrence of your low back pain which can involve dietary changes as well as strengthening the muscles around your spine.
Acutely, low back pain can improve with oral medications typically anti-inflammatories and possibly muscle relaxants if you have a significant component of muscle spasms as well. If you have leg pain associated with your low back pain (sciatica/lumbar radiculopathy), then an anti-seizure medication or antidepressant may be added to help control your pain. The majority of “pain” medications have the side effect of sleepiness so they can also help you rest. Opioids ie “narcotics” are not recommended for the first line treatment of acute low back pain.
If your pain continues after several weeks or becomes too debilitating despite oral medications, being evaluated by a spine specialist as soon as possible should be your next step. Physical therapy may be recommended but can be difficult if your pain is still not under control. As we now realize that a significant amount of cases of acute low back pain is not treated by surgery initially, a referral to see a spine surgeon is likely unnecessary and at times, may delay appropriate treatment as it may take several weeks to months to be seen and evaluated. In the meantime, you may be given medications to help control your pain that are not indicated and/or may give you intolerable side effects. These may mask your pain and can have addictive properties that may make you dependent on them. If you decide to wait to see a spine surgeon, more often than not, you will likely be referred to see another spine specialist for further treatment before surgery is even considered. Even if your low back pain is causing significant leg pain to the point that it may be numb, tingle or even be weak, surgery is still unlikely to be an option at this time.
If you have factors such as a history of trauma, cancer or osteoporosis an x-ray may be warranted to rule out any type of fracture. If not, x-rays are typically not needed. In addition, if you have leg pain associated with your low back pain, an MRI is likely not needed prior to treating your condition (see lumbar epidural and lumbar transforaminal epidural steroid injections). However, if treatment based upon your clinical picture does not improve your symptoms, further studies including an MRI of your lower back may be the next step in your care. Only after conservative therapies fail, and appropriate treatment and diagnostic studies have been performed, should you need to see a spine surgeon. Your pain relief should not be delayed waiting to see a specialist nor should you be treated with medications that only mask your pain. Time is pain…..be seen at VIPSC today!
See Lumbar Epidural Steroid Injections – Transforaminal