The Basics Of Low Back Pain

By Jatinder Narula, MD

Virginia Interventional Spine Associates

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The Basics Of Low Back Pain

If you suffer from low back pain, take heart, because you're not alone. In fact, 80 percent of people will experience low back pain, or lumbago, at some point in their lives. While this common musculoskeletal condition is generally self-limited, it can be debilitating, leading to loss of productivity at work and difficulty with day-to-day activities.

The lower back, otherwise known as the lumbar region, is an intricate structure comprised of multiple elements, including five vertebrae (L1-L5), spinal discs, joints, nerves, and other soft tissues. It is designed to provide support for the upper body and protect the spinal nerves that supply the pelvis and lower extremities, while simultaneously allowing for movement.

The symptoms of low back pain can be quite variable, ranging from muscle aches to shooting or stabbing pain. There is often associated stiffness or spasms and possibly radiating pain into one or both of the lower extremities. The pain can arise from something as simple as a soft tissue strain, but it can also involve the more complex structures of the back in cases of disc herniation or degeneration, osteoarthritis of the joints, nerve compression, and vertebral fracture.

Pain that is accompanied by significant leg weakness or loss of bowel and/or bladder control requires immediate attention. These may be signs of a more serious condition that needs to be investigated.

The initial step to determine the cause of the pain is a comprehensive history and physical examination. This will frequently provide sufficient information to establish the diagnosis and begin a treatment plan. When appropriate, further imaging studies may be ordered, such as an x-ray, CT scan, MRI, or myelogram. Your physician may also recommend electrodiagnostic testing.

The goal of treatment should not only be to address the pain but to restore function and prevent the recurrence of symptoms as well. Some first-line treatment options include activity modification, medications, exercise, and physical therapy. For persistent pain, more advanced interventional techniques can be considered. These often involve an injection of medication (epidural injection), nerve blocks, and even spinal cord stimulation. In more severe cases where the pain does not improve or there is neurologic compromise, surgery may be necessary.

The majority of people with low back pain will recover fully within several weeks. When pain becomes chronic, lasting more than three months, it can be more challenging to diagnose and treat. However, with the options that are now available, you do not have to suffer. Speak with a board-certified physician to find out what treatments are available for you.