Low back pain is a very common and sometimes debilitating condition that affects up to 80 % of the population. Most patients that develop the acute onset of low back pain will able to return to normal activities of daily living and become a functional member of society within 6 weeks of onset. Yet, a small percentage of the population can go on to suffer with chronic disabling lumbar pain.
Despite many scientific advances in medicine over the decades, improvement in the quality of healthcare and the proliferation of various new pharmaceuticals, controlling chronic low back pain can be difficult but not impossible. Surgical solutions for treating low back pain is difficult and often met with mixed results and should be the very last option.
Causes of Chronic Low Back Pain
The causes of chronic lumbar pain are many and can include one or a few of the problems listed below in combination, and the causes are not limited to this list:
Degenerative Arthritis: This is the most common cause in adults, and is consistent with the normal wear and tear process to the lumbar spine.
Other types of arthropathies: There are a number of conditions which fall under this section such as Lupus, Rheumatoid Arthritis, Diffuse Idiopathic skeletal Hyperostosis(DISH), Lupus, Ankylosing Spondylosis or other HLA-B27 conditions.
Fibromyalgia: Disease of disuse and muscle deconditioning.
Stress: This could be either emotional or social stressors which can lead to lumbar pain via muscle spasm.
Fractures: This can be as a result of any significant trauma such as a motor vehicle accident.
Muscle Strains: The most common cause as a result of work-related injuries lifting injuries or other types of other trauma.
Herniated Disc: Disruption of the disc that separates two vertebra that results in nerve root compression.
Spinal Stenosis: Compression of the spinal nerves secondary to naturally progressive age related arthritis.
Infection: Bacterial or fungal infection of the spine.
Intra-abdominal or pelvic organ pathology: Kidney, pancreas, and aorta problems as well as others can mimic symptoms consistent with traditional lower back pain.
It is because the majority of lower back pain in our society is caused by muscle strain or arthritis, and the frequency is so common, that a delay or missed diagnosis of underlying rare conditions, such as but not limited to fractures, cancer, infection, renal stones, and aortic aneurysms, can occur.
What are the Predisposing Factors for Chronic Lower Back Pain?
There are a number of predisposing factors that can increase a patient's chances of having back issues. Problems such as smoking, alcoholism, obesity, low physical activity, psychosocial issues, sedentary jobs, prior failed back surgery, secondary gain, and deconditioning can all increase a patient's chances of developing or maintaining chronic lower back pain.
As it relates to treatment for lower back pain, it is fortunate that the vast majority of patients will have complete resolution of their pain within six to eight weeks of acute onset. The prevalence of lower back issues in our society persisting longer than two weeks is approximately 14%, with a point prevalence of approximately 7% (Deyo, R. A. 1990).
The active treatment of lower back pain has two main focuses, the first of which should always be non-operative care. This should include physical therapy, chiropractic, anti-inflammatories, muscle relaxants, limited use of narcotics, various injections (both diagnostic and therapeutic), weight loss, smoking cessation, muscle reconditioning, and the tincture of time.
As it relates specifically to aerobic exercise, fitness creates an overall protective effect on the spine by increasing muscle strength, endurance, and increasing endorphin levels. This can lead to avoiding conditions such as fibromyalgia, which is a disease of disuse.
The other generalized treatment algorithm may include surgery. It is known that surgical intervention for predominant low back pain typically does not result in excellent long-term results.
Surgical fusion has been met with mixed results for the treatment of predominant low back pain and decompression has a very limited role.
Artificial Disc Replacement (ADR) is showing some significant promise in the treatment of low back pain as well as artificial nucleus. Research is still ongoing as it relates to artificial nucleus replacement, yet artificial disk replacement is available and is no longer experimental as the Food and Drug Administration (FDA) has completed the initial research and approved ADR for human use since 2003. In Europe, artificial disk replacement has been an approved (CE mark) treatment for over 20 years.
Any patient that is considering treatment for chronic, disabling, low back pain should seek the advice of their primary care physician first and address many of the risk factors that have been outlined above.
Surgical intervention for chronic low back pain is not common, but evaluation by a spinal surgery specialist would be an important step to take if you, as a patient, have remained symptomatic, despite the conservative course, for longer than 6 to 8 weeks.