Lower back pain is the second most common reason why patients seek medical visits. It is one of the most common causes of disability in younger patients. The annual cost of diagnosis and treatment of low back back pain is an outstanding 20 to 50 billion dollars. Patients in the past may have received care that was sub-optimal but with numerous research in the field the physicians are now well prepared to help patients overcome their pain and disability.
The natural history of back pain is encouraging. Over 90% of patients with low back pain will have complete resolution of their symptoms within 4-6 weeks and the other 5% by 12 weeks. Only 5% will develop chronic pain condition who would eventually consume 60% of the resources. Therefore, the patients and their physicians should aggressively help each other to ensure that the problem does not become chronic which would make it much more difficult to evaluate and treat. However, it is rather important for a physician to look for red flags which are signs that may indicate the back pain is associated with a significant neurological or other serious conditions such as cancer, vascular abnormalities, spinal cord injury, infection, or fracture.
Most patients present with simple back pain which would resolve within days and does not need any specific treatment. This is usually the most common reason in the schools and sports activities when students report a back pain to their coach and teachers. However, it is important to emphasize that 50% of patients with low back pain may have a recurrence of their pain within one year. Therefore, home stretching exercises, activity modification, and correct lifting techniques are of particular importance in preventing the back pain. Sciatica refers to back pain with pain that travels below the knee. Only 1% of patients with lower back pain will have sciatic type pain. In that case the treatment is somewhat more involved and may require obtaining more diagnostic and radiological study such as a MRI or bone scan to delineate the cause of the back pain. The majority of patients with sciatic do not need surgery. However, those patients with unstable neurological signs such as progressive weakness, bowel and bladder incontinence, and foot drop may benefit from surgical consultation. EMG/Nerve conduction study is a valuable test to obtain objective and useful information on patients with suspect radiculopathy (pinched nerve) and to evaluate for nerve or muscle damage. Combination of EMG, X-rays, or MRI maybe required to help your doctor appropriately diagnose your back pain if it continues past 4-6 weeks.
For the majority of patients, bed rest is not encouraged past the initial 2-3 days. Activity modification such as limited lifting and gradual return to activities are more beneficial than the bed rest. There are several types of pain medications and analgesic creams that maybe prescribed by your doctor. The preference is to use the medications with the least side-effects profile. There are newer anti-inflammatory medications available for reducing pain that do not have as much side-effects as the older medications.
In summary the low back pain is the second most common reason why people seek medical care. For the most part the lower back pain should resolve within 2-6 weeks without any intervention. It is important to seek medical care immediately if there are red flags such as unexplained weight loss, sever back pain, or bowl and bladder incontinence.
The good news is that the majority of back pain are preventable and curable without the need of surgery. For more information please contact your physician or call 593-9300.
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Manouchehr Refaiean, MD
Board Certified Physical Medicine & Rehabilitation
Board Certified Pain Management