BACK PAIN

 

INTRODUCTION: Most low back pain is caused by one of many musculoskeletal problems, including acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles, osteoarthritis of the spine, spinal stenosis, intervertebral disk problems, and unequal leg length. Obesity, postural problems, structural problems, stress, overstretching of the spinal supports, and occasionally depression may also result in back pain. Back pain due to musculoskeletal disorders usually is aggravated by activity, whereas pain due to other conditions is not. Older patients may experience back pain associated with osteoporotic vertebral fractures, osteoarthritis of the spine, spinal stenosis, and spondylolisthesis, among other conditions.

CLINICAL MANIFESTATIONS: Acute or chronic back pain (lasting more than 3 months without improvement) and fatigue. Pain that radiates down the leg (radiculopathy, sciatica); presence of this symptom suggests nerve root involvement. Gait, spinal mobility, reflexes, leg length, leg motor strength, and sensory perception may be affected. Paravertebral muscle spasm (greatly increased muscle tone of back postural muscles) occurs with loss of normal lumbar curve and possible spinal deformity.

ASSESSMENT AND DIAGNOSTIC METHODS: Health history and physical examination (back examination, neurologic testing). Spinal x-ray. Bone scan and blood studies. Computed tomography (CT) scan. Magnetic resonance imaging (MRI). Electromyogram and nerve conduction studies. Myelogram, Ultrasound.

MEDICAL MANAGEMENT: Most back pain is self-limited and resolves within 4 weeks with analgesics, rest, and relaxation. Management focuses on relief of pain and discomfort, activity modification, and patient education. Bed rest is recommended for 1 to 2 days, for a maximum of 4 days and only if pain is severe. Other effective nonpharmacologic interventions include the application of superficial heat and spinal manipulation. Cognitive-behavioral therapy (eg, biofeedback), exercise regimens, spinal manipulation, physical therapy, acupuncture, massage, and yoga are all effective nonpharmacologic interventions for treating chronic low back pain but not acute low back pain. Most patients need to alter their activity patterns to avoid aggravating the pain. They should avoid twisting, bending, lifting, and reaching, all of which stress the back. A gradual return to activities and a program of low-stress aerobic exercise are recommended.

PHARMACOLOGIC THERAPY: Acute low back pain: nonprescription analgesics (eg, acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), and prescription muscle relaxants (eg, cyclobenzaprine). Chronic low back pain: tricyclic antidepressants (eg, amitriptyline). Others: opioids (eg, morphine), tramadol (Ultram), benzodiazepines (eg, diazepam [Valium]), and gabapentin (Neurontin).

RELATED;

1. CHRONIC PAIN  

2. INFLAMMATION  

3. OSTEOPOROSIS

4.  MEDICAL CONDITIONS

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