Low back pain: Causes, Symptoms, Diagnosis, Treatment and Prevention

 

By: DatelinehealthAfrica (DLHA) Staff Writer

 

 

Introduction

Low back pain (LBP) is a very common bone and muscle (musculoskeletal) condition present worldwide in all races, gender and ages. It occurs broadly as pain or discomfort in the lower region of the back of spine closer to the buttocks.

Lower back pain is the most common form of back pain that many people experience in their day to day life. It is also called lumbago, and though it isn't a disease, it can have its repercussions on a person's life.

Globally, an individual will experience LBP at least once in his/her life span. If it continues for more than 3 months, it will be regarded as chronic back pain.

LBP is not life-threatening, but it is a leading cause of activity limitation and disability. It has substantial impact on the overall and financial well-being of an individual and society.

LBP results in significant losses in productivity at work and is associated with billions of dollars in medical expenditure annually, especially in middle and high income countries where medical cost data is available.

The prevalence of LBP worldwide is estimated to be between 30 and 80% among the general population and has been found to increase with age

In Africa, the average lifetime lower back pain prevalence (LBP) is 47% and this figure is believed to be rising. [1]

It is generally believed among researchers that a higher prevalence of LBP is associated with a lower  socioeconomic status and lower education levels. [1]

It is however unclear if there is a cause-effect relationship between economic status and prevalence of LBP. Therefore, the postulation that the burden of LBP would be greater in lower and middle income countries (LMICs) like those situated in Africa remains unproven. Indeed, studies have shown that, the prevalence of LBP in Africa was comparable to that of developed and high income nations [2]

 

Causes of low back pain

Back pain occurs if the person is experiencing some problems with one or many other parts of the lower back such as:

• Strained muscles or ligaments - as may occur when lifting or pulling heavy weights or performing strenuous exercise.

• Nerves.

• Muscles tension.

• Bones of the vertebrae, as in spinal stenosis and spondylitis. 

• Kidneys. 

• Stress.

• Poor posture as in sitting or slouching in a chair for long.

• Damaged or ruptured discs between vertebral bones.

• Injuries, fracture, falls and other chronic conditions like fibromyalgia.

 

Who is at risk for low back pain?

The following will put you at high risk for low back pain:

An obese black man with a tape measure aroung the abdomen. Click on image to enlarge

 

• Being overweight

• Lifting heavy objects on the job

• Being inactive and sedentary.

• Suffering from other chronic systemic conditions.

• Suffering from cancers that spread to bones of the vertebra.

 

Major symptoms of low back pain

The major symptoms associated with back pain include:

• Shooting and stabbing pain in your back

• Muscle aches in your upper or lower back

• Pain that spreads down to your legs

• Pain that makes it hard to move, walk or stand upright

• Pain while bending, lifting, standing or walking.

 

Other symptoms that require urgent medical attention include:

• Severe pain following a fall

• Pain associated with bowel or urinary problems

• Pain associated with fever, weakness in the legs, or numbness in groin

• Shooting and stabbing pain in your back.

• Chronic muscle ache in your upper or lower back.

 

Diagnosing low back pain

To help your doctor make accurate diagnosis of the nature of your low back pain, be sure to provide the following specific information:

• When the pain started

• What you were doing when it started

• Where the pain is located and whether it spreads beyond the back

• The severity of the pain.
  • usually rated on a scale of 1 – 10;
  • 1 being very low and 10 being very severe.

• What makes the pain go away

• What makes the pain worse

• Whether anyone in your family has history of similar back pain

• The work that you do

• The medications you have taken

• Whether you have suffered any falls or back injuries recently

• What you want the doctor to do for you about the pain.

Following a good history, your doctor will examine you fully.

You may be asked to stand, walk and perform a range of motions while your doctor watches you for any limitations or disability and also asks for any pain arising from the movements performed.

You may also be asked to lie on a couch while your doctor attempts to raise your extended legs up and asks you if you have any back pains and if the pain radiates anywhere into your legs.

A full neurological exam may also be performed to test for muscle weakness in your lower limbs or loss of sensation to touch and pain over the skin of your lower limbs.

An X-ray or CT scan of the bones of the back may be ordered by your doctor to assess for fracture or any other problems that may affect the vertebral bones and associated muscles and ligaments.

 

 

How to prevent low back pain?

There are various preventive measures you can undertake to ensure you aren't troubled by back pain:

• Maintain your body weight: - The most common cause of back pain is obesity. Being overweight causes extra pressure on not only your internal organs but also on your skeleton and muscles. As a result of this pressure, you are prone to develop back pain in the future.

• Exercise regularly: - Keep your muscles toned and fit by doing yoga regularly. This will help in weight management as well as strengthening your muscle tension.

• Avoid sitting for a long time: - Sitting continuously at one place for a long time can be a significant factor in triggering your back pain. It is advised that you take frequent short walks to keep your muscles engaged and prevent back pain.

• Maintain a good posture: - Your body posture matters a lot if you have a desk job. Sitting in a bad posture can not only trigger back pain, but it can also lead to other long-term effects that you might not notice.

• Sleep for at least 8 hours: - The right amount of sleep is essential to maintain a proactive life and avoid problems. A quality 7-8 hours sleep in a comfortable position can help you prevent various issues related to your lower back.

• Use proper lifting techniques: - You must be careful while lifting weights, take proper care and precaution so that you do not stress or strain your muscles and especially your back muscles. 

 

Ways to treat low back pain

There are three broad approaches to treating low back pain; non-medication; medication, and surgical (see table 1).

 

Table 1 showing a listing action steps for the management of low back management. Click on image to enlarge.

 

Non medication therapy

• Home remedies: Application of various rubs and ointments (having ibuprofen and lidocaine) can be used for instant mild pain relief

• Exercise

• Physical therapy

• Mindfulness stress reduction

• Acupuncture

• Biofeedback

• Relaxation therapy

• Massage therapy

• Heat therapy (heating pad or infrared lamp)

• Yoga

• Spinal manipulation. Some low back pain sufferers may get relief from spinal manipulation performed by a well-trained chiropractor or bone doctors. This procedure may not be suitable for everyone.

 

Medication therapy

• Your doctor may advise you to take some nonsteroidal anti-inflammatory medications (NSAIDs), which include ibuprofen (Motrin) and naproxen (Aleve).

• Other pain relievers (analgesics) like acetaminophen (Tylenol) also can be advised, but they don’t have anti-inflammatory properties.

• Other medications like tramadol, or duloxetine have pain relieving properties through actions in the brain. They may be prescribed to you to relieve low back pain.

• Opioids like Hydrocodone or Oxycontin should only be used where all other stated medications have failed.

• In case simpler medications and physical therapies are not helping, your doctor may prescribe injections to the back. Such injections usually contain steroids with or without long acting nerve blocking agents.

X-ray guided lower vertebrae facet injectionf for the control of pain. Click on image to enlarge.

 

Surgery

• Your doctor may recommend spine surgery when every other methods have failed to provide lasting relief and quality of life is deteriorating. Worsening neurological complications, like weakness in muscle of the limbs may also be a good ground for surgery. Depending on the cause of your pain, the type of surgery may vary from removal of herniated disc, or widening of the space around the spinal cord or fusing two or more spinal vertebrae.

 

Conclusion

There's an old saying "Prevention is better than cure"; hence, you must identify the red flags of back pain on time to prevent any potential damages and take proper treatment to cure back pain before it worsens.

 

References:

1. Morris, L.D., Daniels, K.J., Ganguli, B., Louw, Q.A. An update on the prevalence of low back pain in Africa: a systematic review and meta-analyses. BMC Musculoskelet Disord. 2018; 19: 196. 

2. Louw Q.A., Morris LD, Grimmer-Somers K., The prevalence of low back pain in Africa: a systematic review. BMC Musculoskel Disord. 2007; 8:105.

 

Published: December 12, 2019

Last updated: January 30, 2024

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