Low Back Pain – A Common Problem, often Mistreated

July 31, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain is a very common issue – 85% of the population will experience back pain at some point in their lives. However, back pain is often treated improperly and as a result, it has become a costly problem in American society. A lack of understanding of back pain, its causes, and usual treatment, leads to costly management.

Acute Low Back Pain

Acute low back pain is pain that has been present less than 3 months. Most back pain can be treated conservatively. Only rarely is back pain a serious medical emergency. There are many structures in the back that cause pain, including:

Vertebral discs
Bones
Joints
Nerves
Muscles

All of these can cause pain. Fortunately, most pain is caused by muscle strains and irritation of joints, discs or nerves. Initially all of these are treated the same, with ice and heat, minimal rest, stretching, and then muscle strengthening of the core.

Medications should be kept simple – use Tylenol or anti-inflammatories like naproxen to manage the pain. If pain is more severe, see a primary care physician for referral to a Physical therapist. Very short-term use of narcotic pain medicine is useful if other medications cannot be taken but these are not advised for more than several weeks.

If Back Pain Persists

If back pain persists for more than a month, despite basic management, you should seek out an expert in low back pain. The best medical doctors to evaluate and treat this type of pain are board certified physicians in Physical Medicine and Rehabilitation. These physicians are experts in the musculoskeletal and nervous system. They can guide a person through a detailed exam and diagnosis and more advanced treatments.

Surgery, MRIs, & CT Scans

Back pain is rarely a medical emergency. If a patient has had cancer and has new onset of back pain, aggressive evaluation is necessary to determine if cancer is affecting the region. Low back pain with loss of control of the bowels, or loss of muscle function in the legs is the other case when aggressive evaluation is necessary.

Back pain is usually relatively benign. Most pain will resolve within weeks with conservative treatment. Only in rare cases (such as cancer) should MRI or CT scans be obtained.

Surgery should only be considered if nerves are compromised, or bowel or bladder control is lost due to the spine being injured.

Sciatica & Low Back Pain: Diagnosis and Treatment

June 24, 2013September 27, 2016 / Thomas Cohn, MD

Sciatica is a term used to describe low back pain that usually radiates into one or both legs. If the pain is radiating down the leg, it is likely being generated from a structure associated with the lumbar spine.

Radicular low back pain is pain usually generated from the lumbar spine. Rarely, it can be from surrounding structures, muscles and pelvic or lower abdomen organs. Radicular pain can be caused by any of the following:

Lumbar Discs
Lumbar Facet Joints
Lumbar Vertebra
Lumbar Nerves
Sacroiliac Joints

All the above structures are linked to the lumbar spinal nerves, and when irritated, send signals to the brain that are perceived as pain in the low back that radiates into the buttock or leg. Pain can be felt on one or both sides of the body with this condition.

How to Identify Sciatica

There are several common symptoms that could indicate sciatica, including:

Lower back or leg pain (either sharp or chronic)
A tingling sensation or numbness in one or both legs, that may extend down to the toes
Pain in the buttocks

Generally, sciatica only results in pain on one side of the body rather than both. People who suffer from sciatica can have widely varying symptoms. Some people experience intense shooting pain that makes it difficult to stand or walk. Others feel a subtler and less frequent pain.

Sciatica Treatment Options

Most radicular low back pain is not serious. The condition can generally be resolved by using conservative treatment methods, such as:

Ice and heat
Keep rest to a minimum – movement actually helps most structures to heal, allowing blood to flow to the region that carries the body’s own healing tools
Use over the counter medication to reduce pain

If the pain does not resolve within a week of trying these methods, then help from a primary care provider may be beneficial to obtain stronger medications and physical therapy. No matter what you do, most sciatica pain will resolve within a month.

If radicular low back pain does not resolving in a month, the patient should consult with a Physical Medicine specialist, especially one board certified in Pain Medicine. These physicians can listen to your symptoms, examine the muscles, spine and nervous system, determine what more testing is necessary and design an appropriate individualized treatment program for you.

Low Back Pain: Causes & Treatment

June 12, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain can be the result of a number of medical problems in a variety of areas, including:

Muscles
Bones
Ligaments
Joints
Nerves
Spinal Discs
Other Internal Pelvic Structures

Any of these can cause pain that may be interpreted as low back pain. Fortunately, 95% of the time, the cause will heal quickly and the pain will go away no matter what treatment is performed.

Back Muscle Strains

The most common cause of back pain most people suffer is a muscle strain. Pain from a strain is localized in the muscles along the low back and in the buttock and they feel like tight bands. Usually this is from over stressing the muscles by lifting too much, twisting, and bending.

With mild to moderate strains, one is usually just sore and stiff when moving. In more severe strains, one may feel like they can hardly move due to the pain. If the pain is more severe, start with simple treatments such as:

Heat and ice
Stretching to loosen up the back muscles.
Over the counter medications like acetaminophen, aspirin, and ibuprofen

Joint Irritation in the Low Back

The next most common cause of pain is irritation of the joints in the low back or pelvis region. The facet joints in the back occur on both sides of the spine at every level. They are the same size and structure as the joints in the fingers but carry the weight of the whole body. The sacroiliac joints connect the bottom of the spine to the pelvis. Both of these joints cause deep pain in the low back region, but it does not usually radiate beyond the area, and may be worse with certain movements. Again, simple treatment with ice and heat, and over the counter medications will help.

When to See a Pain Doctor

The more complex the pain, the longer lasting the pain, the more benefit there is in seeing a doctor. If the pain does not go away within a week, start by seeing a primary care doctor. Sometimes resolving the problem can be accomplished through physical therapy and stronger medications. Rest is not recommended more than a day or two. The more active you are, the more likely you can solve the problem.

If the back pain continues for more than 4-6 weeks, then it is time to find a Physical Medicine doctor who specializes in Pain Medicine. These are highly trained doctors who really understand the complex elements of the low back that can cause pain. They can determine which structures are causing the pain and guide a person through successful long-term treatment. A good pain doctor will diagnosis what is wrong, and work with you to find the best solution for your specific needs.