อาการ สาเหตุ การตรวจวินิจฉัยและการรักษาอาการปวดหลังส่วนล่างในผู้ใหญ่ (Low back pain in adults) Low back pain in adults - Cause, Symptoms, Diagnosis and Treatment

Low back pain in adults

Pain in the lower back can be nagging and disturbing your daily life. Over 80% of people experience low back pain at least once in their lifetime. However, low back pain generally does not portend

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Low back pain in adults

Pain in the lower back can be nagging and disturbing your daily life. Over 80% of people experience low back pain at least once in their lifetime. However, low back pain generally does not portend a severe medical condition and can resolve over time.

Physical and emotional factors increasing the risk of developing lower back pain are gender, older age, physical exertion, sedentary lifestyle, smoking, obesity, depression, anxiety, stress, and job dissatisfaction.

Causes

Nonspecific back pain

More than 85% of people have low back pain with an unidentifiable cause, meaning it does not stem from a specific disease or spine injury. Low back pain can arise from muscle strain due to bending or heavy lifting. Nonspecific low back pain can resolve by itself within a couple of weeks. Meanwhile, a warm compress can relieve the pain. Avoid bed rest. According to studies, staying active is a better way to speed up recovery.

Serious underlying causes

Tumors, spine infections, lumbosacral nerve root compression, cauda equina syndrome, and vertebral compression fracture can cause low back pain, but these are not common. People with these conditions usually have other symptoms as well. For example, lumbosacral nerve root compression or cauda equina syndrome can cause bladder dysfunction and leg weakness.

Less serious underlying causes

  • Degenerative disc disease
    The spinal disc degenerates with age. Small cracks, tears, or fluid leakage from the disc may develop, causing back pain. However, some elderly with degenerated discs do not experience any symptoms.
  • Herniated disc with nerve root compression
    Weakened annulus fibrosus leads to a protruded disc. The protruded disc in itself does not always lead to back pain, but it can cause sciatica if the bulging disc presses on a nerve root which can cause weakness or leg pain. The nerve compression can resolve when the degenerated annulus naturally disintegrates and is resorbed.
  • Osteoarthritis
    Bone spur due to facet joint arthropathy caused by osteoarthritis may cause low back pain. Facet joint arthropathy is age-related. 
  • Spondylolisthesis
    The stress on the low back joints can cause a vertebra to slip forward, leading to spondylolisthesis. This condition is related to facet joint arthropathy. People with spondylolisthesis may develop low back pain and sciatica.
  • Lumbar spinal stenosis
    A bone spur is the common cause of lumbar spinal stenosis. Some may have leg pain while walking (neurogenic claudication), but some may not have any symptoms at all.
  • Ankylosing spondylitis
    Back pain in adolescents and young adults may be related to ankylosing spondylitis. The symptoms include back stiffness and pain, which improves with activity. However, if left untreated, the range of motion can become limited due to spinal bone fusion.

Occupational back pain

The condition can develop when your job requires prolonged sitting or standing, improper or frequent heavy lifting, and long-distance driving.

Treatment

Acute low back pain treatment

Acute low back pain, which is not a result of a severe medical condition, can resolve on its own, even in the case of a bulging herniated disc. However, the pain can interfere with daily activities. Here are what you can do to relieve it.

  • Warm compress: Applying a warm compress is beneficial and can temporarily relieve pain during the first few weeks after pain onset.
  • Stay active: When you experience severe, acute pain in your lower back, resting for a day or two is helpful. Adjust your resting posture to find a more comfortable position. Put a pillow under your knees and elevate your head and shoulder when lying supine. During sleep, lie on your side, bend your top knee, and insert a pillow between your knees to provide support. Once better, move around; it is best to stay active. Muscle tightness relaxes with movement. Light exercise or walking can help maintain muscle strength. Avoid strenuous physical activities causing discomfort.
  • Exercise:  Starting a new exercise program can improve symptoms of chronic back pain, but it is not beneficial for people with acute back pain.
  • Work Posture: If your job requires a long period of standing, try to stand with one foot on a wooden block and alternate the foot periodically. Avoid lifting heavy objects, sitting, or standing for long hours without shifting posture.
  • Pain medications:  It is more effective to use pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) for 3-5 consecutive days rather than taking them only when you experience pain. Muscle relaxants can also help relieve pain, but they can cause drowsiness. People who are driving or operating machinery should avoid it. Consult your doctor before taking any medications.
  • Massage and acupuncture: You may feel relaxed after a massage or acupuncture, but there is no clinical proof that they can treat acute low back pain.
  • Spinal manipulation: It can help relieve the pain and improve the function of the spine. However, a specialist such as a chiropractor, physical therapist, or osteopath should perform the maneuver. Consult your doctor if you would like to try this method.
  • Psychological therapy: Stress or mental problems may be the root cause of the pain in some cases. This approach can be helpful to those with both chronic and acute low back pain.

Other treatments

Some are not proven to relieve the pain. Some may be effective in a specific situation. 

  • Change your mattress: Some believe a firmer mattress can help relieve or prevent low back pain. However, this is unproven. Some studies even suggest that a less firm mattress is a better choice. 
  • Corsets and braces: Supportive orthotics is usually ineffective in relieving or preventing low back pain. 
  • Traction: According to studies, traction cannot relieve or prevent acute back pain. 
  • Injection of medications: The injection of local anesthesia into a trigger point may be helpful in people with chronic pain; but is not suitable for acute back pain. Injecting steroids into the epidural space in those with chronic low back pain due to sciatica or radiculopathy improves low back pain in the first 2-6 weeks after the injection. The effect wanes 3, 6, or 12 months after the injection. The epidural steroid injections are not helpful for back pain without sciatica.
  • Application of energy or electricity: There is no clinical support that applying energy or electricity through the skin via the use of ultrasound, shortwave diathermy, interferential therapy, transcutaneous electrical nerve stimulation, or other low-level laser therapies is effective for acute low back pain treatment during the first 4-6 weeks. 

Chronic low back pain treatment

Back pains lasting more than three months are chronic, while pain between 2-3 months is known as sub-acute low back pain. Treatments of sub-acute pain focus on preventing progression to chronic pain.

Short-term methods

These methods are helpful in the early phase of chronic pain, particularly if they can temporarily make you feel strong enough to participate in the more effective solutions such as exercise and mind-body or psychological therapies which can improve your symptoms in the long run.

  • Pain medications
  • Spinal manipulation
  • Acupuncture
  • Massage


Self-care

Rest when your condition is severe or the pain is unbearable. After your condition improves, try to stay active, as it is a proven method to improve your pain. Be mindful that sedentary activities or bed rest can worsen the pain. Do gentle stretching or relaxation exercises instead.

Psychological and mind-body therapies

Your mental health can affect your physical well-being. Managing psychological problems can improve the physical condition.

  • Cognitive behavioral therapy (CBT) administered by a physical therapist or psychologist is appropriate for people with anxiety or depression, problems dealing with back pain, fear of moving due to the pain, and a sense of hopelessness that low pain will not improve. CBT allows you to overcome your fears, learn to be more optimistic, and set and achieve your goal to improve your condition.
  • Mindfulness-based stress reduction approach with a trained professional can help you to learn meditation techniques and how to relax in a group setting.

Movement-based therapy

If the pain persists for more than 4-6 weeks, consult a physical therapist to create a personalized exercise regimen, including stretching, strengthening, and aerobic activities. You can then follow the regimen yourself at home. Exercises such as swimming, walking, low-impact aerobics, yoga, and Tai Chi increase the strength and flexibility of muscles supporting your back and decrease stress and anxiety.

Surgery

Usually, surgery is not necessary for people with low back pain. It is appropriate for those with cauda equina syndrome, tumors, infections, or spinal stenosis, but this is rare.

Persistent radiculopathy due to herniated disc or symptomatic spinal stenosis not responsive to conservative measures may benefit from surgery.

Consult an orthopedic surgeon if you experience:

  • Numbness
  • Bladder or bowel problems
  • Increasing weakness or other neurologic problems

Persistent back pain with no improvement after 4-6 weeks of nonsurgical treatments, accompanied by severe sciatica and nerve root problems.

When to see a doctor

Most of the time, low back pain can resolve without specific treatment. However, consult a doctor if you have the following symptoms:

  • Persistent pain which does not go away within one month. Pain when lying down or sleeping
  • Leg weakness, bowel, bladder, or sexual problems, can be signs of cauda equina syndrome
  • Radiating pain to the lower leg with leg weakness.
  • Back pain with unexplained weight loss or fever.
  • Back pain with a history of weakened immunity, osteoporosis, cancer, or overuse of corticosteroids.
  • Back pain due to injury, especially if you are over 50 years old.
  • New back pain in the over 70


Prevention

  • Regular exercise or being active is the best way to prevent a recurrence. Improve your cardiovascular fitness and augment your core and hip strength. Strong abdominal muscles can help support lower back muscles.
  • Learn the correct way to lift heavy objects. To avoid back strain, tighten your abdomen and squat down to lift heavy objects using leg muscles without stressing back muscles.
  • Change your posture often if you have to sit or stand for a long duration. Shift position and take a walk whenever possible.

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        Published: 12 Sep 2022

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