Low Back Pain

Article submitted by Naples Day Surgery. They can be reached at 239-436-6711

Who among us has not at one time or another experienced low back pain? Initially we tend to treat this pain with modifying our activities, perhaps even resorting to bed rest and taking over the counter pain medications. What is the right thing to do if pain persists and one is not getting any better?
Studies have shown that low back pain is only behind the common cold in visits to primary care physicians. It is a widespread problem, but the good news is that most low back pain tends to improve over a six week period, regardless of what is done. There are a couple of red flags that everyone should be aware of.

If you have back pain and have lost control of your bowels or bladder, do not delay and go to the nearest emergency room. This is a potential neurosurgical emergency and if not evaluated emergency may progress to permanent paralysis in a matter of hours. Other important signs are pain associated with fever, new onset numbness and tingling and of course, intractable pain. These symptoms require evaluation by your primary care doctor.

There are over 80 different causes of low back pain, only a few of which will be touched upon in this article. As we get older our bodies tend to undergo degenerative changes of our bony structures and joints, which are a normal part of the aging process and is otherwise known as arthritis. When you look at the spine, it is a series of bones which are like building blocks. Each individual level is known as a vertebra and has a hole through its center for the spinal canal and cord to run through along with holes on either side for the spinal nerves to exit. In between the vertebrae is a disc which contains a gelatin like substance and functions as a shock absorber. In the rear of each vertebra are the joints which attach one level to another. All of these areas are potential sources of pain.

The disc is often the subject of much attention, as people will complain of having a "ruptured disc." The disc can protrude or even herniate and compress the spinal nerves causing pain in one or both legs. Just by the disc bulging, it releases inflammatory substances which often lead to pain. Because it is a gelatinous substance, with aging the disc can lose water content which causes a loss of disc height and support that can also cause back pain.

Sometimes the arthritic changes can affect the size of the hole that the spinal canal runs through. This is called spinal stenosis, meaning small hole. Often this can be the source of debilitating pain which is often relieved by bending forward, such as pushing a shopping cart. Stenosis can also occur at the holes in the vertebra where the spinal nerves exit the spinal cord. Another potential cause of low back pain is the facets, which are the joints in the rear of the vertebrae. The joint between the lower 5 fused vertebrae, known as the sacrum, and the hip bone is known as the sacroiliac joint and is a potential pain generator. Certainly scoliosis, which is curvature of the spine can cause back pain as well. A leg length discrepancy can cause lower back pain. Forty percent of the population has a leg length discrepancy, but not all of these have back pain, however if someone has had trauma to one or both legs, this can certainly be a reason for low back pain. Sometimes, one vertebra can "slip" over another in a condition called spondylolisthesis which can be another potential cause of low back pain. Trauma can play a huge part in a patient's pain. Often the elderly tend to fall, and because of the loss of bone mass, known as osteoporosis, they can experience a compression fracture of one or more of the bones in the lower back. This can cause severe pain, especially with any type of movement.

These are but a few, although more common causes of low back pain. If you suffer from low back pain, seek the counsel of your primary care physician who can assist you in the initial evaluation of your signs and symptoms. Should you need the care of a pain physician, be sure to check the physician's credentials to ensure they have the proper training and board certification to practice pain medicine. There are a variety of potential treatments which may help the patient in avoiding surgery; however that may be the best option depending on the diagnosis.