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Fewer than 1% of people who suffer acute low back pain have a serious cause, such as cancer, infection, or cauda equina syndrome.
How is a diagnosis made?
A careful medical examination will help determine the type of back problem and its cause, and the best treatment options. Diagnosis requires evaluation that includes a medical history, physical exam, and sometimes, diagnostic tests (Table 1).
Table 1. Diagnostic tests used to evaluate back pain.
test |
structures seen |
what it detects |
example |
X-ray | bone | extent of wear, bone disease, misalignment | osteoarthritic changes, fracture, bone spurs, slippage |
CT | bone, soft tissue | relationship of bones, soft tissues, nerve roots | stenosis, bone spurs, spinal canal narrowing, disc herniation |
Discogram | disc | site of pain origin | disc herniation |
MRI | soft tissue | detail of soft tissues, discs, nerve roots, spinal cord | disc herniation, tumor |
Myelogram (x-ray fluoroscope), CT/myleogram |
spinal canal seen by dye injection | view of spinal cord and nerve roots in relation to bone | pinched nerve, bony overgrowth, spinal abcess, tumor |
EMG-NCS | nerve, muscle | assessment of muscle (EMG) and nerve (NCG) function | nerve damage |
What treatments are available?
In developing a treatment plan, your physician or healthcare provider will assess the type of disease or condition, and its impact. A team approach for treatment of back problems is often the most effective. Medical treatments include surgical or nonsurgical care and self-care strategies. The goal is to restore function and prevent re-injury.
Self care: Most back pain resolves with self-care measures such as rest, ice or heat, massage, over-the-counter pain relievers, or gentle stretches (see Self Care for Neck and Back Pain). Applying ice and then heat is helpful to relax the muscles and decrease muscle inflammation. We generally recommend that you apply an ice pack for 20 minutes several times a day during the first 48 hours. A warm shower or a heating pad on the low setting may help relax tight muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. A short period of bed rest is okay, but more than a couple of days does more harm than good. If home treatments aren't working within the first couple of days, see your doctor.
Medications: Your doctor may prescribe nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) to reduce inflammation and relieve pain. If you have spasms, a muscle relaxant may be prescribed for a short time (3-4 days). If the pain is severe, an analgesic that can be taken with the NSAID or muscle relaxant may be prescribed.
Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period or as an injection directly into the source of pain (see epidural steroid injections and facet injections). Steroids may provide almost immediate pain relief within 24-hours.
Physical therapy: For moderate to mild back pain, we recommend a near-normal schedule from the onset. The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Physical therapists can instruct you on proper lifting and walking techniques, and they’ll work with you to strengthen and stretch your lower back, leg, and stomach muscles. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long daily routine. Massage, ultrasound, diathermy, heat, and traction may also be recommended for short periods. Patients may also benefit from chiropractic manipulation and acupuncture.
Surgery: Surgery is rarely recommended unless you have muscle weakness, a proven disc herniation, severe stenosis, cauda equina syndrome, or if the pain is severe and not resolved after a reasonable course of nonsurgical treatment.
Most people with acute low back pain respond rapidly to treatment; 90% are symptom-free within 1 to 2 weeks. Many of the remaining 10% recover within 3 months. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of this recovery. If regular job duties cannot be performed initially, it is in the patient's best interest to return to some kind of modified (light or restricted) duty. Your health care provider can give prescriptions for such activity for limited periods of time.
Recurrences of back pain are common. The key to avoiding recurrence is prevention:
Healthy supporting muscles can help keep your spine in proper alignment, promote healing after injury, and relieve chronic symptoms. Strong, flexible muscles maintain good spine alignment, allow movement, and provide structural support. When back pain does occur, there are many options to aid in its diagnosis and treatment for each individual’s needs.
Sources & Links
If you have more questions, please contact the Mayfield Spine Institute at 800-325-7787 or 513-221-1100. Additional information is available on the web.
www.spine-health.com
www.neurosurgerytoday.org/what/patient_e/low.asp
www.allaboutbackandneckpain.com
www.spineuniverse.com
Glossary
acute: a condition of quick onset lasting a short time, opposite of chronic.
arthritis: joint inflammation caused by infection, immune deficiency (rheumatoid arthritis), or degeneration of the cartilage that causes pain, swelling, redness, warmth, and restricted movement.
chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.
disc (intervertebral disc): a fibrous cushion that separates spinal vertebrae. Has two parts, a soft gel-like center called the nucleus and a tough fibrous outer wall called the annulus.
osteoporosis: loss of bone or atrophy of skeletal tissue that causes bones to weaken and become brittle, and prone to fracture. Preventive measures include adequate calcium and regular exercise to stimulate bone metabolism.
radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg.
sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
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