Lower back pain can be traced back to the earliest humans. Walking upright proved crucial in human evolution, but at what cost? The spine, specifically the lumbar region (or lower back), suddenly had to support all of the upper body weight. The arms and hands -- now free to reach, throw, lift and pull -- put the lower back in constant danger of strain, sprain and over-exertion.
Documented treatments for lower back pain go as far back as the ancient Egyptians. Early treatments included localized bee stings; repeated shocks using an electric eel; application of snake or lizard oil; and the once very popular medieval remedy of bloodletting. Thankfully, these strange and exotic schemes for alleviating pain are no longer in use.
So after all this time, what have we learned about lower back pain? We do know that other ancient methods of back pain treatments, such as acupuncture and opiate use, endured the test of time and science and are still used to today in successful treatment regimens. But to best understand lower back pain, we first need to define exactly what it is.
Definition and Cause
The most common definition of lower back pain is a sudden, sharp, persistent or dull pain felt below the waistline. Either localized or general, the pain often radiates from the low back into the buttocks or legs and can be accompanied by numbness, tingling or weakness. Lower back pain can either be acute – sudden or intense pain lasting three months or less; or chronic – persistent long-term pain, often lasting a lifetime.
The most common diagnosed cause relates to heavy lifting or overstretching, resulting in injury to the muscles or bone trauma. Other frequent causes for lower back pain include a ruptured disc that puts pressure on nerves; obesity; stress; pregnancy; poor posture or sleeping position; arthritis; osteoporosis or other degenerative conditions.
A thorough exam and complete medical history can help rule out less common, but more serious medical conditions that present lower back pain as a symptom, such as cancer or, vascular disease. If you have lower back pain accompanied by bowel or bladder dysfunction, severe back pain while in bed, groin or leg weakness or numbness or any other severe unrelenting symptoms, seek the advice of a medical professional immediately.
Diagnosis & Treatment
Approximately 90 percent of lower back pain issues resolve on their own without invasive therapies or treatment. Often all that is needed – or prescribed – is bed rest for a day combined with medication to reduce inflammation and pain. Over-the-counter acetaminophen (Tylenol) and over-the counter nonsteroidal anti-inflammatory drugs (NSAIDs) are a common medication choice and include naproxen, aspirin or ibuprofen. For those with chronic pain or for those that do not respond to standard medication or therapy, there exists a full range of state-of-the-art diagnostic and treatment options.
Diagnostic techniques to help determine the source of the pain range from standard X-rays, CTs and MRIs, bone scans and discography. Discography, also called provocative discography or discogram is an outpatient diagnostic procedure utilizing both X-ray and Cat (CT) scans. X-ray is used to guide a needle into the disc so that radiopaque dye can be injected. The CT is used to examine the dye distribution and locate problems within discs that often appear normal on MRI films. The discography can confirm the diagnosis of discogenic pain.
Nucleoplasty is a minimally invasive outpatient procedure. A catheter is inserted into the abnormal disc through a small puncture in the skin. It reduces the volume of the center of the disc and allows the disc protrusion or herniation to decompress. Similarly, Intradiscal Electrothermal Therapy (IDET) uses thermal energy to treat pain resulting from a cracked or bulging spinal disc. These procedures are very helpful for a selected group of patients who are suffering from incredible lower back pain. It can be an alternative to major back surgery.
Last year, the FDA approved the use of artificial discs to replace a diseased or damaged disc. An artificial disc, usually made of metal or biopolymer materials, is a device implanted into the spine to imitate the functions of a normal disc (carry load and allow motion). This procedure is currently performed at only a few centers across the United States and is still under investigation.
Recovery & Prevention
While much about lower back pain remains a mystery, what we do know can mean the difference between a healthy, mobile existence -- and life-long, debilitating pain. Exercise is the single most important element in maintaining a healthy back. Activities that involve stretching, walking and swimming can help build muscle strength, increase flexibility, and improve coordination, mobility and overall relaxation.
It is also important to maintain good posture. Try not to lift objects too heavy for you. When you do have to pick up a heavy object, lift with your knees; not with your back. Eat well -- losing extra pounds will reduce stress on your spine. Try sleeping on your side to reduce the curve in your spine. Wear comfortable, low-heeled shoes. Don’t smoke – smoking reduces blood flow to the lower spine and causes the degeneration of spinal discs.
For those who suffer from lower back pain, The Alaska Spine Institute is fully equipped with the doctors, physical therapists and informational support to get patients through diagnosis, treatment, rehabilitation and on the road to recovery. Obtain more information at www.alaskaspineinstitute.com, or www.spineuniverse.com