Low back pain

Encyclopedia of Alternative Medicine, Apr 06, 2001 by Kathleen D. Wright

Low back pain is a common musculoskeletal symptom that may be either acute or chronic. It may be caused by a variety of diseases and disorders that affect the lumbar spine. Low back pain is often accompanied by sciatica, which is pain that involves the sciatic nerve and is felt in the lower back, the buttocks, the backs and sides of the thighs, and possibly the calves.

Low back pain is a symptom that affects 80% of the general United States population at some point in life with sufficient severity to cause absence from work. It is the second most common reason for visits to primary care doctors, and is estimated to cost the American economy $75 billion every year.

Low back pain may be experienced in several different ways:

• Localized. In localized pain the patient will feel soreness or discomfort when the doctor palpates, or presses on, a specific surface area of the lower back.
• Diffuse. Diffuse pain is spread over a larger area and comes from deep tissue layers.
• Radicular. The pain is caused by irritation of a nerve root and radiates from the area. Sciatica is an example of radicular pain.
• Referred. The pain is perceived in the lower back, but actually is caused by inflammation elsewhere--often in the kidneys or lower abdomen.

Acute pain in the lower back that does not extend to the leg is most commonly caused by a sprain or muscle tear, usually occurring within 24 hours of heavy lifting or overuse of the back muscles. The pain is usually localized, and there may be muscle spasms or soreness when the doctor touches the area. The patient usually feels better when resting.

Chronic low back pain has several different possible causes.

Chronic strain on the muscles of the lower back may be caused by obesity, pregnancy, or job-related stooping, bending, or other stressful postures.

Low back pain at night that is not relieved by lying down may be caused by a tumor in the cauda equina, which are the roots of the spinal nerves controlling sensation in and movement of the legs, or cancer that has spread to the spine from the prostate, breasts, or lungs. The risk factors for the spread of cancer to the lower back include a history of smoking, sudden weight loss, and age over 50.

Ankylosing spondylitis is a form of arthritis that causes chronic pain in the back. The pain is made worse by sitting or lying down, and improves when the patient gets up. It is most commonly seen in males between the ages of 16 and 35. Ankylosing spondylitis is often confused with mechanical back pain in its early stages.

Herniated spinal disk

Disk herniation is a disorder in which a spinal disk begins to bulge outward between the vertebrae. Herniated or ruptured disks are a common cause of chronic low back pain in adults.

Back pain that is out of proportion to a minor injury, or that is unusually prolonged, may be associated with a somatoform disorder or other emotional disturbance.

Low back pain that radiates down the leg usually indicates involvement of the sciatic nerve. The nerve can be pinched or irritated herniated disks, tumors of the cauda equina, abscesses in the space between the spinal cord and its covering, spinal stenosis, and compression fractures. Some patients experience numbness or weakness of the legs, as well as pain.

The diagnosis of low back pain can be complicated. Most cases are initially evaluated by primary care physicians or other health practitioners, rather than by specialists.

The doctor will ask the patient specific questions about the location of the pain, its characteristics, its onset, and the body positions or activities that make it better or worse. If the doctor suspects that the pain is referred from other organs, he or she will ask about a history of diabetes, peptic ulcers, kidney stones , urinary tract infections, heart murmurs, or other health issues.

The doctor will examine the patient's back and hips to check for conditions that require surgery or emergency treatment. The examination includes several tests that involve moving the patient's legs in specific positions to test for nerve root irritation or disk herniation. The flexibility of the lumbar vertebrae may be measured to rule out ankylosing spondylitis.

A thorough differential diagnosis is important before any treatment is considered. There are times when alternative therapies are the most beneficial, and other times when more invasive treatments are needed.

Chiropractic treats patients by manipulating or adjusting sections of the spine. It is one of the most popular forms of alternative treatment in the United States for relief of back pain caused by straining or lifting injuries. Some osteopathic physicians, physical therapists, and naturopathic physicians also use spinal manipulation to treat patients with low back pain, along with work on soft tissue around the bones.

Practitioners of traditional Chinese medicine treat low back pain with acupuncture, acupressure, massage, and the application of herbal poultices.

Herbal medicine can utilize a variety of antispasmodic herbs in combination to help relieve low back pain due to spasm. Lobelia (Lobelia inflata) and myrrh (Commiphora molmol) are two examples of antispasmodic herbs. Intake of fresh grape juice, preferably made from from dark grapes, on a daily basis at a time other than mealtime has also been found to be helpful.