Apta Treatment Base Classification for Low Back Pain Update 2015

Peer Reviewed

The Universal Guide to Lower Back Pain: Everything you ever wanted to know, straight from the experts.

In This Article: Lower Back Anatomy   |    How Long Does Lower Back Pain Usually Last?   |    Common Causes   |    Other Causes   |    Home Remedies   |    Nonsurgical Treatments   |    Complementary, Alternative, and Emerging Treatments   |    Surgery    |    When Is Lower Back Pain an Emergency?   |    Lower Back Pain Prevention   |    Sources

If you've ever had lower back pain stop you from doing what you want, you're not alone. Lower back pain is one of the most common medical problems in the world. It is a leading reason why people visit a doctor, affecting more than 80% of adults at some point in their lives.  According to the Global Burden of Disease—a significant study published in the Lancet medical journal—lower back pain is also a leading cause of disability.

While severe lower back pain can cause worry, pain severity is not always an indication something is seriously wrong. Photo Source: Shutterstock.

You may not be able to prevent lower back pain, especially as you age and your back loses some strength and resilience. Fortunately, there are many ways you can get relief, no matter the cause of your back pain.

What Exactly Is the Lower Back, Anyway?

Your lower back is known as the lumbar region of the spine. It has a lot of heavy lifting to do: The lumbar spine carries the weight of your entire upper body, plus biomechanical stresses that occur with movement.

The lumbar spine has five vertebrae—backbones. Each vertebra has a large disc – cushiony gel wrapped in a tough membrane – on its front side that acts as a shock absorber. Each vertebra also has two cartilage-lined facet joints on its back side. Working together, discs and facet joints allow the spine to safely bend and twist.

Your lower back also includes ligaments, tendons, and muscles. Ligaments are strong bands that hold the vertebrae and discs together. Tendons attach muscles to the vertebrae. These structures help limit excessive movement that could harm the spinal cord.

How Long Does Lower Back Pain Usually Last?

Lower back pain can be categorized as acute, subacute or chronic. Acute episodes of lower back pain usually last from a few days to 4 weeks and subacute lower back pain lasts between 4 to 12 weeks. However, according to the National Institutes of Health, about 20 percent of people with acute back pain go on to develop chronic back pain—defined as pain that lasts 12 weeks or longer. Even in these cases, there are many different treatment options to help relieve lower back pain symptoms.

When your back is really killing you, you might worry something is seriously wrong. The same goes for back pain that seems unending. The good news is that while back pain is a major inconvenience, it is rarely an urgent medical issue. In fact, most of the time you don't have to treat it. Back pain usually resolves on its own – unless you have a major underlying issue.

What Are Some Common Lower Back Pain Causes?

The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital (at birth) or acquired meaning the disorder develops later in life.

• Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies (vertebrae), ligaments, muscles or soft tissues.
• Organic lower back pain is attributed to disease, such as spinal cancer.
• Idiopathic refers to an unknown cause.

These are some of the things your doctor might look for – or rule out – when you schedule a visit for back pain.

The common symptoms of lower back pain.

Sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. They're often related to overuse.

Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear (see below).

Herniated disc . The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves

Sciatica. Pain that results from a pinched or irritated sciatic nerve. This nerve runs down your lower back through your hips and buttocks and down each leg. Sciatica is how laypeople refer to pain that travels down the leg from the lower back, although your doctor may use the term lumbar radiculopathy.

Spondylolisthesis. A vertebra slides forward out of position, disrupting your spine's alignment and sometimes compressing nerve roots. It is most common in the lumbar region, but can happen anywhere along the spine. This slippage is often caused by either disc degeneration or a fractured vertebra (spondylolysis).

Spinal stenosis . A narrowing of the inside spaces of your spine, most often from a herniated disc but sometimes from bone spurs caused by spinal osteoarthritis. This can result in painful pressure on your spinal nerves. Spinal stenosis can occur in both the upper (cervical) spine and the lumbar spine, but lumbar spinal stenosis is more common.

What Are Some Other Causes of Lower Back Pain?

The shape of your spine, and well as spinal diseases, are other culprits in lower back pain. Depending on a range of factors, your doctor may look for:

Abnormal spinal curvature. A normal spine resembles a gently curved letter S when seen from the side. Abnormal curves include:

• Lordosis, in which the spine curves too far inward at the lower back
• Kyphosis, in which the spine is abnormally rounded in the upper back
• Scoliosis, in which the spine curves from side to side, often in a C shape

Normal and abnormal curves of the spine Arthritis. There are more than 100 types of arthritis, many of which can cause lower back pain. The most common types include osteoarthritis (the most common by far; in the back it's known as spondylosis), rheumatoid arthritis, and ankylosing spondylitis.

Cauda equina syndrome (CES) . Compression of the bundle of nerves that forms below the spinal cord in the lumbar spine. It is a rare but serious disorder that requires immediate medical attention and possibly emergency surgery. CES got its name from the fact that the fanned-out bundle of nerves resembles the base of a horse's tail.

Discitis or osteomyelitis .Both infections of discs (discitis) and bone (osteomyelitis) can cause severe pain and require prompt medical attention.

Osteoporosis . Your bones lose mass faster than it can be replaced, making them brittle. They can even fracture with little or no warning. These fractures are especially common in the spine, where they're called vertebral compression fractures. Both men and women lose bone mass as they age, but postmenopausal women lose it much faster and so are more at risk for osteoporosis.

Spinal tumors . When cells divide and multiply unchecked, the result is a tumor. Both benign and malignant tumors can cause lower back pain. They can either originate in the spine or metastasize there, meaning they've spread from somewhere else in the body.

What Home Remedies for Lower Back Pain Actually Work?

Unless you've had a major injury, such as a fall or car accident, you probably don't need to rush to the doctor for back pain. You may want to try these simple self-care strategies first.

Avoid bed rest. When lower back pain strikes, people often think complete rest will relieve back pain. However, a review of many clinical studies found that patients who retreated to bed actually experienced more pain – and recovered more slowly ­– than patients who stayed fairly active

Use ice and/or heat. Many people find that using ice or cold packs for periods of up to 20 minutes at a time helps reduce pain and swelling. Always wrap ice or a cold pack in a thin towel before putting it on your body so you don't injure your skin. You may also find that heat, such as a heating pad or warm bath, eases pain. Ice is recommended in the first 48 hours after injury; then you can try a combo of ice and heat.

Try over-the-counter (OTC) remedies. Short-term use of OTC pain relievers, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen, may ease your lower back pain. Also consider OTC creams, gels, patches, or sprays applied to the skin. They stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain.

What Are Some Less Invasive or Noninvasive Back Pain Treatments?

Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.

Medications. When over-the-counter pills and topicals don't do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:

• Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
• Muscle relaxants, such as baclofen or carisoprodol

• Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
• Opioids, such as oxycodone or hydrocodone, on a short-term basis. (For a variety of reasons, opioids aren't good long-term options for lower back pain.)

Physical therapy (PT). PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:

• Exercise
• Ice/heat
• Massage
• Transcutaneous electrical nerve stimulation (TENS)
• Ultrasound

Injections. An epidural steroid injection or a selective nerve block may provide short-term pain relief when lower back pain causes sciatica symptoms, such as leg pain.

What Are Some Complementary, Alternative, and Emerging Treatments for Lower Back Pain?

In some cases, doctors suggest therapies that are not considered "standard of care." They probably won't be covered by insurance, but they may be worth considering. Examples include:

Platelet-rich plasma (PRP). PRP treatments use a small sample of your own blood that has concentrated amounts of blood building blocks known as platelets. Your doctor then injects the PRP directly into a damaged disc. The theory is that PRP injections use your own healing system to accelerate improvement of injured tendons, ligaments, muscles, and joints. PRP treatment has a longer track record in knee osteoarthritis, but a recent review article in the Journal of Spine Surgery suggests it may have a useful role for back pain, too. PRP needs a lot more research before it can be considered a proven technique.

Stem cells. In this emerging treatment, your doctor injects stem cells harvested from your hip into the intervertebral disc or discs causing your pain. Doing so may lessen pain and the degenerative effects of aging, though, like PRP, more research is needed before stem cells for lower back pain could eventually become the standard of care.

Acupuncture. Your doctor probably doesn't perform acupuncture (some do), but may support you trying it as a complementary therapy. Acupuncture involves careful insertion of fine, sterile needles into specific points on your body. This may stimulate the release of your natural pain-killing chemicals.

Chiropractic care. More than 50 percent of people with acute lower back pain see a chiropractor, a healthcare provider who specializes in spinal manipulation. Look for one that uses evidence-based techniques.

What Are the Most Common Lower Back Surgery Procedures?

Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:

Spinal Fusion. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spine's stability in severe cases of spinal osteoarthritis or herniated discs.

Laminectomy and laminotomy . Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.

Discectomy and microdiscectomy . When a herniated disc in the lower back is causing severe symptoms like pain or loss of sensation, your surgeon might operate to remove a portion of the damaged disc. When the surgeon operates through standard incisions in your back, the surgery is known as a discectomy. When the surgeon uses a minimally invasive technique and small incisions, the surgery is called a microdiscectomy. Discectomies are rarely performed anymore due to the safety, effectiveness, ease and low rate of complications that microdiscectomy brings to the table.

When Is Lower Back Pain an Emergency?

Most episodes of lower back pain eventually resolve on their own, but there are times when you should seek urgent medical attention. Some of these situations include:

• Patient is a child
• Accident, injury, other trauma
• Fever or nausea
• Weakness, numbness and/or tingling sensations develop in the legs and/or feet
• Loss of bladder or bowel control
• Pain is severe, constant, suddenly or progressively worsens, and/or doesn't go away
• Pain interrupts sleep

While some situations may warrant immediate intervention, most cases are not urgent and can be scheduled at a time convenient for the patient.

How Can You Prevent Lower Back Pain?

While you can't stop aging or change your genetic makeup, lifestyle changes can help manage and prevent lower back pain. Having a healthy lifestyle may make you less likely to suffer an accidental injury, too.

Improve your physical fitness. People who are not physically fit are more likely to develop lower back pain because strong core muscles help support the lower back.

Stay active. People who lead sedentary lives may be more likely to injure themselves when they do exert themselves. As far as back health is concerned, it's better to do a smaller amount of physical activity most days of the week than to sit all week and over-exert yourself on the weekends.

Lose weight if necessary. The more you weigh, the more pressure you have on your lumbar vertebrae. Being overweight or obese can put stress on the back and lead to lower back pain.

Lift heavy objects the right way. Be sure to squat while lifting so that your hips and knees do much of the work. Keep the load close to your chest while you lift.

Your legs, not your lower back, should be the main driver when you're lifting something heavy. Make your workspace as ergonomic as possible. If you sit at a desk, make sure your chair has plenty of low-back support and your hips are at a right angle to the floor.

Manage your mental health. People who have anxiety and depression, or face excessive stress, may be more likely to experience back pain over time. And, let's face it, living with lower back pain can be difficult, too. Making your mental health a priority can help reduce your risk of lower back pain.

Don't use tobacco products. In addition to all the other health problems tobacco use causes, it can restrict blood flow and oxygen to the discs, causing them to degenerate faster.

Make common-sense choices to reduce injury. Wear your seatbelt at all times while in a moving vehicle. Don't carry (or allow your child to carry) very heavy backpacks. And, while it should go without saying, don't spend a weekend doing heavy gardening or in a tennis match if you've been sedentary for a few months.

Continue Reading ... Lumbar Spinal Stenosis

Sources

Prevalence: National Library of Medicine. MedlinePlus. (Updated April 30, 2020.) "Back Pain." https://medlineplus.gov/backpain.html

Anatomy: Johns Hopkins Medicine. (n.d.) "Lower Back Pain: What Could It Be?" https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/lower-back-pain-what-could-it-be

Duration: National Institute of Neurological Disorders and Stroke. (April 27, 2020). "Low Back Pain Fact Sheet." https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Common causes: Cedars-Sinai.org. (n.d.) "Degenerative Disc Disease." https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/degenerative-disc-disease.html

American Association of Neurological Surgeons. (n.d.) "Low Back Strain and Sprain." https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Strain-and-Sprain

Mayo Clinic. (August 1, 2020.) "Sciatica." https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

American Academy of Orthopaedic Surgeons. (n.d.) "Adult Spondylolisthesis in the Low Back." https://orthoinfo.aaos.org/en/diseases--conditions/adult-spondylolisthesis-in-the-low-back/

Mayo Clinic. (n.d.) "Spinal stenosis." https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961

Arthritis Foundation. (n.d.) "When Back Pain May Mean Arthritis." https://www.arthritis.org/health-wellness/about-arthritis/where-it-hurts/when-back-pain-may-mean-arthritis

Arthritis Foundation. (n.d.) "Osteoporosis." https://www.arthritis.org/diseases/osteoporosis

American Association of Neurological Surgeons (n.d.) "Spinal Tumors." https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Tumors

Treatments: Cochrane Database of Systematic Reviews. (2010.) "Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica." https://pubmed.ncbi.nlm.nih.gov/20556780/

National Center for Complementary and Integrative Health. (2016.) "Acupuncture: In Depth." https://www.nccih.nih.gov/health/acupuncture-in-depth

Journal of the American Medical Association. (2018.) "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial." https://jamanetwork.com/journals/jama/fullarticle/2673971

Spine Journal. (2015.) "Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?" https://pubmed.ncbi.nlm.nih.gov/26096484/

Hospital for Special Surgery. (n.d.) "Platelet-Rich Plasma (PRP) Injections." https://www.hss.edu/condition-list_prp-injections.asp#:~:text=Platelet%2Drich%20plasma%20(PRP)%20therapy%20uses%20injections%20of%20a,system%20to%20improve%20musculoskeletal%20problems

Journal of Spine Surgery. (2018.) "Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5911760/#:~:text=The%20clinical%20studies%20that%20used,not%20cause%20any%20major%20complications.

Current Pain and Headache Report. (July 29, 2019.) Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review. https://pubmed.ncbi.nlm.nih.gov/31359164/

Prevention: National Institute of Neurological Disorders and Stroke. (April 27, 2020). "Low Back Pain Fact Sheet." https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2.

Chou R. Subacute and chronic low back pain. Nonpharmacologic and pharmacologic treatment. UpToDate. June 9, 2019. https://www.uptodate.com/contents/subacute-and-chronic-low-back-pain-nonpharmacologic-and-pharmacologic-treatment?search=low%20back%20pain&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4. Accessed July 24, 2019.

Low Back Pain Sheet. National Institute of Neurological Disorders and Stroke (NINDS). National Institutes of Health (NIH). Last modified: May 14, 2019. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Accessed July 24, 2019.

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low back pain and sciatica. Cochrane Library. Cochrane Database Sys Rev. 2010.

Turner JA, Comstock BA, Standaert CJ, et al. Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms? Spine J. 2015;15(11):2319-31.

National Center for Complementary and Integrative Health (NCCIH). Acupuncture: In depth. January 2016. https://nccih.nih.gov/health/acupuncture/introduction. Accessed July 24, 2019.

Updated on: 03/30/21

Apta Treatment Base Classification for Low Back Pain Update 2015

Source: https://www.spineuniverse.com/conditions/low-back-pain

Share this post