Low Back Pain (Lumbar Spine Pain) Overview

Facts about low back pain

Structure support, movement, and protection of particular bodily tissues are all functions of the low back, or lumbar area.

The bony lumbar spine, intervertebral discs (discs between the vertebrae), ligaments surrounding the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area can all cause pain in the low back.

The best way to treat low back pain is to target a specific cause that has been identified or suspected. Using a home treatment for acute back pain caused by lumbar strain can be helpful at first.

Treatment for Low Back Pain

Steroid Injection in the Epidural Space

Radicular discomfort, which is a radiating pain conveyed away from the spine by an inflamed spinal nerve, is the most prevalent reason for epidural steroid injections. Lumbar radiculopathy is discomfort that travels down the leg caused by irritation of a spinal nerve in the low back. Epidural injections are also used to alleviate nerve compression in the neck (cervical spine), which produces discomfort and is known as cervical radiculopathy.

What is the low back's anatomy?

It's vital to understand the typical architecture (anatomy) of the tissues in this area of the body in order to comprehend the many causes of low back pain. The bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area are all important structures in the low back that can cause symptoms.

The lumbar spine is made up of bony vertebrae that are "stacked" together to give moveable support while also shielding the spinal cord from harm. The spinal cord is made up of nerve tissue that extends from the brain down the spinal column. Each vertebra has a spinous process, which is a bony protrusion behind the spinal cord that protects the neural tissue of the cord from impact stress. Vertebrae also have a strong bone "body" (vertebral body) in front of the spinal cord that serves as a platform for all tissues above the buttocks to bear weight. The lumbar vertebrae are stacked directly on top of the sacrum bone, which is found between the buttocks. The sacroiliac joints of the buttocks are formed when the sacrum joins the iliac bone of the pelvis on each side.

What is the low back's anatomy? (Continued)

The discs are pads between the various vertebral bodies that act as "cushions." They aid in reducing the impact of stress forces on the spine. Each disc has a center, softer component (nucleus pulposus) and a surrounding, firm outer ring, similar to a jelly donut (annulus fibrosus). The center component of the disc can rupture (herniate, as in a herniated disc) through the outer ring, causing nerve irritation and sciatica as detailed below. Ligaments are tough, fibrous soft structures that hold bones together. Ligaments connect the vertebrae to one another and surround each of the discs.

The nerves that supply sensation and activate the muscles of the low back, as well as the lower extremities (thighs, legs, feet, and toes), exit the lumbar spinal column through bone portals known as "foramen."

Tendon insertions connect many muscle groups involved for flexing, extending, and rotating the waist, as well as moving the lower extremities, to the lumbar spine.

The aorta and blood arteries that transport blood to and from the lower extremities flow through the abdomen and pelvis in front of the lumbar spine. Lymph nodes (lymph glands) and tissues of the involuntary nervous system surround these blood arteries, which are vital for bladder and bowel control.

In front of the pelvic area of women, the uterus and ovaries are key pelvic tissues. In men, the prostate gland is an important pelvic organ. The kidneys are located in front of the lumbar spine on either side of the rear of the lower abdomen.

Nerve roots exiting from the lumbar spine supply nerve roots that supply the skin over the lumbar area.

What role does the low back play?

The human body's low back, or lumbar region, performs a variety of critical activities. Structure support, movement, and protection of various body tissues are among these roles.

The lower back functions to support the weight of the upper body when we stand. The lower back is involved in movement when we bend, extend, or rotate at the waist. As a result, injury to weight-bearing systems such as the bony spine, muscles, tendons, and ligaments can frequently be observed when the body is standing erect or performing various actions.

The lumbar spine and neighboring muscles of the low back play an important role in protecting the soft tissues of the neurological system and spinal cord, as well as nearby organs of the pelvis and abdomen.

What are the most common causes of back pain in the lower back?

Lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and bone and joint problems are all common causes of low back pain (lumbar backache). Each of these is discussed in detail below. A lumbar strain (acute or chronic) is a stretch injury to the low back's ligaments, tendons, and/or muscles. The stretching incident causes microscopic rips in various tissues of varying degrees. One of the most common reasons of low back pain is lumbar strain. Overuse, incorrect use, or trauma can all lead to harm. If a soft-tissue injury has been present for days to weeks, it is usually classed as "acute." The strain is classified as "chronic" if it lasts more than three months. Lumbar strain is most common in persons in their forties, but it can strike anyone at any age. The syndrome is characterized by localized pain in the low back that appears after an event that stresses the lumbar tissues mechanically. The degree of strain and consequent spasm of the low back muscles determines the severity of the injury, which can range from minor to severe. The diagnosis of lumbar strain is made based on the injury's history, the pain's location, and the absence of nervous system injury. X-rays are usually only used to rule out bone abnormalities.

Resting the back (to minimize reinjury), drugs to ease pain and muscular spasm, local heat treatments, massage, and eventually (after the acute episode has passed) reconditioning exercises to strengthen the low back and abdominal muscles are all used to treat lumbar strain. Heat application, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and avoiding reinjury and hard lifting may be used as first-line treatments at home. Non-steroidal anti-inflammatory medicines, such as sulindac (Clinoril), and naproxen, are prescription medications that are sometimes used for acute low back pain (Naprosyn), Carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and metaxalone (Skelaxin) via injection or by mouth, muscle relaxants such as carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and metaxalone (Skelaxin), as well as analgesics such as (Ultram).

Long periods of idleness in bed are no longer suggested because they can impede recuperation. In some patients who do not show evidence of nerve irritation, spinal manipulation for up to one month has been proven to be beneficial. Back-protection strategies during activities and support devices when needed at home or at work are used to prevent future damage.

Lower back pain is caused by nerve inflammation and lumbar radiculopathy.

Nerve irritation: The nerves of the lumbar spine can be irritated anywhere along their courses, from their roots in the spinal cord to the skin surface, by mechanical pressure (impingement) by bone or other tissues, or by disease. Lumbar disc degeneration (radiculopathy), bony encroachment, and nerve inflammation caused by a viral infection are among these diseases (shingles). These conditions are described in detail below.

Lumbar radiculopathy is a type of nerve irritation caused by injury to the discs that separate the vertebrae. Degeneration ("wear and tear") of the outer ring of the disc, acute injury, or both can cause disc damage. As a result, the center softer section of the disc might burst (herniate) through the outer ring, abutting the spinal cord or its nerves as they exit the bony spinal column. This rupture is what generates the "sciatica" pain associated with a herniated disc, which radiates from the low back and buttocks down the leg. Sciatica can develop after a "popping" sensation that is accompanied by numbness and tingling, or it can develop after a "popping" sensation that is accompanied by numbness and tingling. Back pain is usually aggravated by waist movements and can also be aggravated by coughing or sneezing. Sciatica can be accompanied by bladder and/or bowel incontinence in more severe cases. The sciatica caused by lumbar radiculopathy usually affects only one side of the body, such as the left or right. Based on the symptoms listed above, lumbar radiculopathy is suspected. The diagnosis is supported by increased radiating back pain when the lower extremity is elevated. Nerve irritation can be detected via lower extremity nerve testing (EMG/electromyogram and NCV/nerve conduction velocity). Imaging studies, such as CAT or MRI scanning, can discover the actual disc herniation. Medical treatments to surgery are all options for lumbar radiculopathy treatment. Patient education, drugs to reduce pain and muscular spasms, cortisone injections around the spinal cord (epidural injections), and physical therapy (heat, massage by a therapist, etc.) are all part of medical management. Rest, ultrasound, workouts, and electrical stimulation) (not strict bed rest but avoiding reinjury). Surgery may be required if there is unrelenting pain, severe impairment of function, or incontinence (which can suggest spinal cord irritation). The type of procedure done is determined by the general condition of the spine, as well as the patient's age and health. Laminotomy (a small opening in the bone of the lumbar spine enclosing the spinal cord), laminectomy (removal of the bony wall), percutaneous discectomy (removal of the bony wall), disc-dissolving techniques (chemonucleolysis), and other operations are used to remove the herniated disc.

Lower back pain is caused by bony invasion

Encroachment of the adjacent spinal cord and nerves: Any disorder that causes movement or development of the vertebrae of the lumbar spine can cause encroachment of the adjacent spinal cord and nerves. Foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal, and into the body, commonly as a result of arthritis), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis are all causes of bony encroachment of the spinal nerves (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Sciatica pain that radiates down the lower extremities might result from spinal-nerve compression in certain circumstances. Lower-extremity pains caused by spinal stenosis can intensify with walking and be eased by resting (mimicking the pains of poor circulation). Depending on the severity of the condition, treatment options range from rest and exercises to epidural cortisone injections and surgical decompression, which involves removing the bone that is crushing the nerve tissue.

Lower back pain is caused by bone and joint problems

· Bone and joint problems: Low back pain can be caused by a variety of bone and joint disorders, including those that are present from birth (congenital), wear and tear (degenerative), injury, and inflammation of the joints (arthritis).

· Low back pain can be caused by congenital bone abnormalities such as scoliosis and spina bifida, which are present from birth. Scoliosis is a sideways (lateral) bending of the spine caused by one lower extremity being shorter than the other (functional scoliosis) or an aberrant spine design (structural scoliosis). Children with severe structural scoliosis may need to be treated with bracing and/or spine surgery. Adults are rarely surgically treated, however they frequently benefit from support bracing. A congenital defect in the bony vertebral arch that spans the spinal canal is known as spina bifida. The spinous process is frequently absent. The lowest lumbar vertebra and the top of the sacrum are most typically affected by this birth abnormality. On occasion, aberrant tufts of hair appear on the skin of the affected area. Spina bifida is a modest bone defect that can go unnoticed. However, significant neurological abnormalities of the lower extremities might accompany the illness.

· The water and protein composition of the body's cartilage changes as we age, resulting in degenerative bone and joint disorders. The cartilage becomes weaker, thinner, and more fragile as a result of this alteration. Because the discs and the facet joints that stack the vertebrae are partly made of cartilage, they are prone to wear and tear over time (degenerative changes). Spondylosis is the term for disc degeneration. On X-rays of the spine, spondylosis can be seen as a narrowing of the typical "disc space" between the vertebrae. In older patients, the disc tissue degradation predisposes the disc to herniation and localized lumbar pain ("lumbago"). Localized lumbar pain can also be caused by degenerative arthritis (osteoarthritis) of the facet joints, which can be identified with simple X-ray examination. To reduce pain, muscular spasm, and inflammation, these causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and pharmaceuticals.

· Fractures (bone breaks) of the lumbar spine and sacrum bone are the most prevalent injuries among elderly adults with osteoporosis, especially those who have used long-term corticosteroid therapy. Even little pressures on the spine (such as bending to tie shoes) might result in bone fractures in these people. The vertebrae may collapse in this situation (vertebral compression fracture). The fracture results in an early onset of significant regional pain that can radiate in a band-like pattern around the waist and is exacerbated by movement. The pain does not usually spread to the lower extremities. In younger patients, vertebral fractures only occur after severe trauma, such as a car accident or a convulsive seizure.

· Vertebral fractures require weeks to heal with rest and pain medicines in both younger and older people. Compression fractures of the vertebrae caused by osteoporosis can be corrected with a treatment known as vertebroplasty or kyphoplasty, which can help relieve pain. A balloon is inflated in the compressed vertebra, which often restores part of the lost height. Following that, a "cement" (methylmethacrylate) is injected into the balloon and remains there to maintain the structure and height of the vertebral body. As the height of the compressed vertebra is recovered, pain is eased.

· Spondyloarthropathies are inflammatory arthritis conditions that can affect the lower back and sacroiliac joints. Reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease arthritis are all examples of spondyloarthropathies. Low back pain and stiffness are common symptoms of each of these disorders, which are usually worst in the morning. In most cases, these diseases appear in the second and third decades of life. They're given anti-inflammatory drugs to help them feel better. Newer biological treatments have been extremely effective at both slowing and arresting the progression of the disease.

What are some of the additional reasons for lower back pain?

Kidney difficulties, pregnancy, ovary problems, and tumors are some of the other causes of low back pain.

Problems with the kidneys

Low back pain is usually linked to kidney infections, stones, and traumatic bleeding of the kidney (hematoma). Urine analysis, sound-wave testing (ultrasound), and other imaging investigations of the abdomen can all be used to make a diagnosis.

Pregnancy

Mechanically straining the lumbar spine (altering the normal lumbar curvature) and the location of the baby inside the abdomen are two prominent causes of low back pain during pregnancy. The effects of the female hormone estrogen and the ligament-loosening hormone relaxin may also contribute to back ligament and structural loosening. Pelvic tilt exercises and stretches are frequently prescribed for pain relief. According to their doctors' advice, women should maintain physical conditioning during pregnancy. Low back pain can also be caused by natural childbirth.

Problems with the ovaries

Low back pain can also be caused by ovarian cysts, uterine fibroids, and endometriosis. A gynecologic examination and testing may be required for a precise diagnosis.

Tumors

Tumors that develop in the bone of the spine, pelvis, or spinal cord (primary tumors), as well as tumors that start elsewhere and spread to these areas, can cause low back pain (metastatic tumors). Depending on whether the tumors impact the neurological tissue, symptoms range from localized pain to radiating acute pain and loss of nerve and muscle function (including incontinence of pee and stool). Imaging techniques, such as simple X-rays, nuclear bone scanning, and CAT and MRI scanning, are used to detect tumors in these locations.

What are some of the more unusual causes of low back pain?

Paget's disease of the bone, pelvic hemorrhage or infection, infection of the cartilage and/or bone of the spine, aneurysm of the aorta, and shingles are all uncommon causes of low back pain.

Paget's disease is a bone disease.

Paget's disease of the bone is a condition in which bone growth is out of sync with normal bone remodeling for unexplained reasons. This disorder causes unusually weaker bones and deformities, as well as localized bone pain, however it frequently goes unnoticed. People above the age of 50 are more likely to get Paget's disease. The causes have been suggested to be heredity (genetic background) and specific rare virus infections. Sciatica can be caused by a thickening of the implicated bone regions of the lumbar spine, which causes radiating lower extremities pain.

Plain X-rays can be used to diagnose Paget's disease. A bone biopsy, on the other hand, is sometimes required to establish the correctness of the diagnosis. Bone scanning is useful for determining the degree of the disease, which might affect multiple bone areas. Alkaline phosphatase is a blood test that can be used to diagnose and monitor treatment response. Aspirin, various anti-inflammatory medications, pain relievers, and medications that inhibit bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel), alendronate (Fosamax), risedronate (Actonel), and pamidronate, are all choices for treatment (Aredia).

Infection or bleeding in the pelvic

Without major trauma, bleeding in the pelvis is uncommon, and it mainly occurs in people who are using blood-thinning drugs like warfarin (Coumadin). Rapid-onset sciatica pain in these patients could indicate bleeding at the back of the pelvis and abdomen, which is squeezing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is uncommon, however it can occur as a result of diverticulosis, Crohn's disease, ulcerative colitis, pelvic inflammatory disease with infection of the Fallopian tubes or uterus, or even appendicitis. Pelvic infection is a significant complication of these illnesses that is often accompanied by fever, low blood pressure, and a life-threatening condition.

What are some alternative reasons of low back pain that are less common?

Infection of the spine's cartilage and/or bone

Septic discitis and osteomyelitis are exceedingly unusual infections of the discs and bones. These disorders cause localized pain that is accompanied by a temperature. When these tissues are analyzed using laboratory cultures, microorganisms including Staphylococcus aureus and Mycobacterium tuberculosis are discovered (TB bacteria). Pott's illness is a TB infection in the spine. Each of these illnesses is quite dangerous and necessitates a lengthy course of antibiotics. Bacterial infection of the sacroiliac joints is uncommon. Brucellosis is a bacterial infection that affects the sacroiliac joints and is spread through raw goat milk.

Aneurysm of the aorta

Atherosclerosis can weaken the wall of the big arterial blood vessel (aorta) in the belly in the elderly. The aorta wall can bulge (aneurysm) as a result of this weakening. While most aneurysms go undetected, some might produce pulsing low back pain. Aneurysms of a certain size, particularly those that become larger over time, may require surgical surgery with a grafting process to fix the aberrant component of the artery.

Shingles

Shingles (herpes zoster) is an acute infection of the nerves that transmit feeling to the skin. It usually affects one side of the body and occurs at one or more spinal levels (right or left). Patients with shingles have usually had chickenpox at some point in their lives. Long after the chickenpox has gone away, the herpes virus that causes chickenpox is thought to lay dormant within the spinal nerve roots. This virus reactivates in persons with shingles, causing infection along the sensory nerve, resulting in nerve pain and, in most cases, an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). Patients with lumbar shingles may have back pain days before the cutaneous rash appears. Several crops of tiny blisters can form over a period of days, then fade away with crusty irritation in one to two weeks. Patients may experience increased persistent nerve pain as a result of their treatment (postherpetic neuralgia). Symptomatic relief using lotions like calamine or pharmaceuticals like acyclovir (Zovirax) for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain are possible treatments.

What factors put you at risk for low back pain?

Athletic activity, hard lifting, throwing, moving luggage, traumatic injury, renal infection, pregnancy, osteoporosis, and aging are all risk factors for low back pain.

What are some of the additional symptoms and indicators of low back pain?

Low back pain can manifest itself in a variety of ways, depending on the specific source of the pain (as discussed above). Numbness and/or tingling of the lower extremities, incontinence of urine or stool, inability to walk without worsening pain, lower extremity weakness, atrophy (decreased size) of the lower extremity muscles, rash, fever, chills, weight loss, abdominal pains, burning when urinating, dizziness, joint pain, and fatigue are all symptoms that can be associated with low back pain.

How do doctors determine the cause of low back pain?

Low back pain is diagnosed through a study of the patient's medical history and underlying medical disorders, as well as a physical examination. Injury history, aggravating and alleviating factors, concomitant pain symptoms (fever, numbness, tingling, incontinence, etc.) as well as the length and course of symptoms must all be reviewed. Aside from normal examinations of the abdomen and extremities, rectal and pelvic examinations may be required in the future. Blood and urine tests, plain film X-ray testing, CAT scanning, MRI scanning, bone scanning, and nerve tests such as electromyograms (EMG) and nerve conduction velocities may be required for the diagnosis of low back pain (NCV).

What are the possibilities for treating low back pain?

So, how do you manage low back pain? As previously said, the treatment is very dependent on the exact reason of the back pain. Furthermore, each patient must be assessed and handled on an individual basis, taking into account their underlying health status and degree of activity.

As evidenced by research presented at the American College of Rheumatology's national meeting, The patient's personal understanding and assessment of their own condition is a critical component of the individual evaluation. Researchers in the United Kingdom discovered that those who believed their symptoms had major ramifications for their life and that they had little control over their symptoms, or that their treatments had little control over their symptoms, were more likely to have a worse outcome. This study emphasizes to doctors the necessity of addressing patients' worries and perceptions about their condition during initial evaluations.

Finally, keep in mind that the conditions given above are meant to be reviewed in general. There are numerous other reasons of back pain that have not been mentioned, including upper back pain.

Is there anything you can do at home to help with low back pain?

Cold pack and heat applications, topical analgesic balms, avoiding re-injury, avoiding heavy lifting, and using over-the-counter pain medicines such as acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen are all self-care therapies for pain relief (Advil, Motrin).

What are the chances of recovering from low back pain?

The prognosis for low back pain is entirely dependent on the reason. Acute strain injuries, for example, usually heal completely with minimum care. Bony anomalies that irritate the spinal cord, on the other hand, may necessitate extensive surgical treatment, and the prognosis is dependent on the surgical outcome. Exercise rehabilitation programs, which may include physical therapists, are frequently used to get long-term best results.

Is there a way to avoid low back pain?

Low back pain can be avoided by avoiding injury to the low back. Conditioning training regimens that strengthen the lumbar area and associated tissues can also help to reduce the incidence of low back injury. With the support of physical therapists and other treating health care professionals, specific regimens to relieve and prevent back pain can be established.

What medical specializations deal with low back pain?

Generalists and subspecialists are among the physicians who evaluate and treat low back pain. Emergency medicine, general medicine, family medicine, internal medicine, gynecology, spine surgeons (orthopaedics and neurosurgery), rheumatology, pain management, and physiatry are among these specializations. Physical therapists, chiropractors, massage therapists, psychiatrists, and acupuncturists are some of the other health care professionals who can help with low back pain.

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source : medicinenet

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