Low back pain
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225634517
2008-07-14T17:38:25Z
WLU
2118749
undo - source it ([[WP:PROVEIT]])
{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = |
ICD10 = {{ICD10|M|54|4|m|50}}-{{ICD10|M|54|5|m|50}} |
ICD9 = {{ICD9|724.2}} |
ICDO = |
OMIM = |
MedlinePlus = 003108|
eMedicineSubj = pmr|
eMedicineTopic = 73|
MeshID = D017116 |
}}
'''Low back pain''' is a common musculoskeletal disorder causing [[back pain]] in the [[lumbar vertebrae]]. It can be either [[Acute (medical)|acute]], subacute or [[Chronic (medicine)|chronic]] in its clinical presentation. Typically, the symptoms of low back pain do show significant improvement within two to three months from its onset. In a significant number of individuals, low back pain tends to be recurrent in nature with a waxing and waning quality to it. In a small proportion of sufferers this condition can become chronic. Population studies show that back pain affects most adults at some stage in their life and accounts for more sick leave and disability than any other single medical condition.<ref>{{cite web |url=http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm |title=Lower Back Pain Fact Sheet. nih.gov |accessdate=2008-06-16 |format= |work=}}</ref>
An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue like [[muscle]]s, [[ligament]]s and [[tendon]]s. With a serious accident or due to osteoporosis or other causes of weakened vertebral bones, vertebral fractures in the lumbar spine may also occur. At the lowest end of the spine, some patients may have tailbone pain (also called [[coccyx]] pain or [[coccydynia]]). Others may have pain from their sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint dysfunction (see [[sacroiliac joint]] for more information). Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include [[osteoarthritis]], [[rheumatoid arthritis]], [[degenerative disc disease|degeneration of the discs]] between the [[vertebrae]], or a [[spinal disc herniation]], a vertebral fracture (such as from [[osteoporosis]]), or rarely, a tumor (including [[cancer]]) or infection. The cause may also be psychological or emotional or due to other non-anatomical factors.<ref name="prevention">{{cite web |url=http://www.prevention.com/article/0,5778,s1-1-77-24-928-1,00.html |title=When Back Pain Starts in Your Head: Is repressed anger is causing your back pain? |accessdate=2007-09-12 |last=McGrath |first=Mike |date=2004-11-03 |work=Prevention.com |publisher=Rodale Inc.}}</ref>
==Causes==
Possible causes of low back pain:
* Mechanical:
** [[Apophyseal]] [[osteoarthritis]]betch
** [[Diffuse Idiopathic Skeletal Hyperostosis]]
** [[Degenerative disc disease|Degenerative Discs]]
** [[Scheuermann's disease|Scheuermann's kyphosis]]
** [[Spinal disc herniation]] (slipped disc)
** [[Spinal stenosis]]
** [[Spondylolisthesis]] and other congenital abnormalities
** Fractures
** Non-specific muscular or ligamentous strains or sprains
** Leg Length Difference
** Restricted hip motion
** Misaligned pelvis - pelvic obliquity, anteversion or retroversion
* Inflammatory:
** Seronegative spondylarthritides (e.g. [[ankylosing spondylitis]])
** [[Rheumatoid arthritis]]
** Infection - epidural abscess or osteomyelitis
* [[Neoplastic]]:
** [[Bone tumor]]s (primary or [[metastatic]])
** [[Intradural Spinal tumor]]s
* [[Metabolic]]:
** [[osteoporosis|Osteoporotic]] fractures
** [[Osteomalacia]]
** [[Ochronosis]]
** [[Chondrocalcinosis]]
* [[Psychosomatic]]
** [[Tension myositis syndrome]]
* [[Paget's disease of bone|Paget's disease]]
* [[Referred pain]]:
** Pelvic/abdominal disease
** Prostate Cancer
** [[Posture]]
* [[clinical depression|Depression]]
* [[oxygen deprivation]]
==Diagnosis==
Diagnosing the underlying cause of low back pain is usually done by a [[medical doctor]], osteopathic physician, physiotherapist (physical therapist) or by a [[chiropractor]]. Often, getting a diagnosis of the underlying cause of low back pain and/or related symptoms is quite complex. A complete diagnosis is usually made through a combination of a patient's medical history, physical examination, and, when necessary, diagnostic testing, such as an [[MRI scan]] or [[x-ray]]. There are a number of health care professionals who may specialize in diagnosing and treating low back pain, including chiropractors, osteopathic physicians, physical therapists (physiotherapists), physiatrists, anesthesiologists/pain medicine physicians, and orthopedic surgeons or neurosurgeons.
Research shows that the presence of a leg length difference does not mean you will have back pain. Diagnosis of leg length difference is quite easy; just stand in front of a mirror in your underwear on a flat, level floor (a bathroom is usually good). Look at your hips to see if they are level. If one seems higher, put a magazine under the shorter leg. Keep adding magazines until your hips look level. Measure the height of the magazines. This is the difference in the length of your two legs. 90% of the population has a leg length difference; the same percentage that experiences lower back pain during their lifetime. A difference of only 1% would be ⅓ inch or more.
Diagnosis of restricted internal hip rotation is also easy. Lie on your stomach with your legs together. Bend your knees 90 degrees so that the soles of your feet point up toward the ceiling. Keeping your knees together, move your feet apart. Your lower legs will form a V. Have someone measure the angle of each lower leg in relation to a vertical line. The angle should be the same for both legs. Each leg should be a minimum of 45 degrees; 60 degrees if you play golf or tennis. Vad, et al, found restricted internal hip rotation on the lead hip associated with lower back pain in professional golfers.
==Treatments==
The course of treatment for low back pain will usually be dictated by the clinical [[diagnosis]] of the underlying cause of the [[pain]].
===Conservative treatment===
For the vast majority of patients, low back pain can be treated with non-surgical care. For those with acute, short-term back pain, certain home remedies<ref>{{cite web |url=http://www.back.com/articles-back_pain_relief.html |title=Acute back pain. Causes and treatment options. |accessdate=2007-09-26 |format= |work=}}</ref> may be effective.{{Fact|date=September 2007}} [http://clinicalevidence.com/ ClinicalEvidence.com] has systematically reviewed [[randomized controlled trials]] published through April, 2004 and concluded:
====Treatments likely to be beneficial====
* [[Analgesic]]s (pain medications), such as [[NSAIDs]] or [[acetaminophen]].<ref name="pmid16973062"/><ref name="pmid16973063">{{cite journal |author=van Tulder M, Koes B |title=Low back pain (chronic) |journal=Clinical evidence |volume= |issue=15 |pages=1634–53 |year=2006 |pmid=16973063 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1116/1116.jsp}}</ref>
* [[Arch support]]
* [[Spinal manipulation]] for acute<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> pain. A [[clinical prediction rule]] can guide who is most likely to respond to manipulation.<ref name="pmid15611489">{{cite journal |author=Childs JD, Fritz JM, Flynn TW, ''et al'' |title=A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study |journal=Ann. Intern. Med. |volume=141 |issue=12 |pages=920–8 |year=2004 |pmid=15611489 |doi=}} [http://www.annals.org/cgi/content/full/141/12/920/T1 Summary of the rule]</ref>
* [[Muscle relaxant]]s for acute<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> pain.
* [[Antidepressant]]s for chronic low back pain.<ref name="pmid16973063"/>
* Stay physically active.<ref name="pmid16973062">{{cite journal |author=Koes B, van Tulder M |title=Low back pain (acute) |journal=Clinical evidence |volume= |issue=15 |pages=1619–33 |year=2006 |pmid=16973062 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1102/1102.jsp}}</ref>
* Exercise for chronic pain.<ref name="pmid16973063"/>
* Intensive multidisciplinary treatment programs may help subacute<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> low back pain.
* [[Behavioral therapy]]<ref name="pmid16973063"/>
* [[Acupuncture]] may help chronic pain<ref name="pmid16973063"/>; however, a more recent [[randomized controlled trial]] suggested insignificant difference between real and sham acupuncture.<ref name="pmid17893311">{{cite journal |author=Haake M, Müller HH, Schade-Brittinger C, ''et al'' |title=German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups |journal=Arch. Intern. Med. |volume=167 |issue=17 |pages=1892–8 |year=2007 |pmid=17893311 |doi=10.1001/archinte.167.17.1892}}</ref>
====Other treatments====
Additional treatments have been more recently reviewed by the [[Cochrane Collaboration]]:
* [[Massage]] therapy may benefit some patients.<ref name="pmid12076429">{{cite journal |author=Furlan AD, Brosseau L, Imamura M, Irvin E |title=Massage for low back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD001929 |year=2002 |pmid=12076429|doi=10.1002/14651858.CD001929}}</ref>
* Ice and/or heat application (or moist heat) has uncertain benefit.<ref name="pmid16437495">{{cite journal |author=French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ |title=Superficial heat or cold for low back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD004750 |year=2006 |pmid=16437495 |doi=10.1002/14651858.CD004750.pub2}}</ref>
Individual [[randomized controlled trials]], thus interpretation may be subject to [[publication bias]], also confounded by absence of [[double blinding]] have shown benefit for:
* Viniyoga,<ref name="pmid16365466">{{cite journal |author=Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA |title=Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial |journal=Ann. Intern. Med. |volume=143 |issue=12 |pages=849–56 |year=2005 |pmid=16365466 |doi=}}</ref> Iyengar,<ref name="pmid15836974">{{cite journal |author=Williams KA, Petronis J, Smith D, ''et al'' |title=Effect of Iyengar yoga therapy for chronic low back pain |journal=Pain |volume=115 |issue=1-2 |pages=107–17 |year=2005 |pmid=15836974 |doi=10.1016/j.pain.2005.02.016}}</ref> and Hatha [[yoga]] (small trial).<ref name="pmid15055095">{{cite journal |author=Galantino ML, Bzdewka TM, Eissler-Russo JL, ''et al'' |title=The impact of modified Hatha yoga on chronic low back pain: a pilot study |journal=Alternative therapies in health and medicine |volume=10 |issue=2 |pages=56–9 |year=2004 |pmid=15055095 |doi=}}</ref>
* Correcting leg length difference may help.<ref name="pmid16271551">{{cite journal |author=Defrin R, Ben Benyamin S, Aldubi RD, Pick CG |title=Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain |journal=Archives of physical medicine and rehabilitation |volume=86 |issue=11 |pages=2075–80 |year=2005 |pmid=16271551 |doi=10.1016/j.apmr.2005.06.012}}</ref> To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust.
* [[Muscle Energy Technique]] (MET) may help (small study).<ref name="pmid14524509">{{cite journal |author=Wilson E, Payton O, Donegan-Shoaf L, Dec K |title=Muscle energy technique in patients with acute low back pain: a pilot clinical trial |journal=The Journal of orthopaedic and sports physical therapy |volume=33 |issue=9 |pages=502–12 |year=2003 |pmid=14524509 |doi=}}</ref>
Other treatments that were not reviewed are
* Education and attitude adjustment (TMS)
* Increasing internal hip rotation
* Increase internal hip rotation with stretching or connective tissue massage
* [[Medical cannabis]]
Because of variations in clinical study methodology, a review of clinical studies in any one area is not necessarily conclusive.
For any one condition, it may be necessary to try a variety of treatments in order to find the best one (or combination) to best manage the pain. In almost all cases, [[physical therapy]] and/or a regular [[exercise]] program that includes stretching, strengthening and low impact cardio conditioning will be part of the treatment and rehabilitation program.
The role of [[narcotic]]s for ''chronic'' low back pain is uncertain.<ref name="pmid17636781">{{cite journal |author=Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D |title=Opioids for chronic low-back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004959 |year=2007 |pmid=17636781 |doi=10.1002/14651858.CD004959.pub3}}</ref>
===Surgery===
Lumbar surgery is indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence, which can be seen with severe [[lumbar disc herniation]], spinal abscess or cauda equina syndrome. Other possible indications for surgery include:
* Severe [[Degenerative disc disease]]
* [[Spinal stenosis]]
* [[Spondylolisthesis]]
* [[Scoliosis]]
* [[Compression fracture]]
* Spinal instability
* Spinal trauma
* Spinal malignancy(cancer)
* Spinal hematoma
* Spinal Disc replacement
The most common types of low back surgery include microdiscectomy, discectomy, laminectomy, foraminotomy, or spinal fusion. Another less invasive surgical technique consists of an implantation of a [[spinal cord stimulation|spinal cord stimulator]] and typically is used for symptoms of chronic radiculopathy ([[sciatica]]). Lumbar artificial disc replacement is a newer surgical technique for treatment of [[degenerative disc disease]], as are a variety of surgical procedures aimed at preserving motion in the spine.
==See also==
* [[Back pain]]
* [[Bertolotti's syndrome]]
* [[Coccydynia]]
* [[Degenerative disc disease]]
* [[Sciatica]]
* [[Tension myositis syndrome]]
* [[Upper back pain]]
==References==
{{Reflist|2}}
==External links==
* {{DMOZ|Health/Conditions_and_Diseases/Musculoskeletal_Disorders/Back_and_Spine/|Back and spine}}
{{Diseases of the musculoskeletal system and connective tissue}}
{{pain}}
[[Category:Disability]]
[[Category:Symptoms]]
[[de:Rückenschmerzen]]
[[es:Lumbalgia]]
[[fr:Lombalgie]]
[[ja:腰痛]]
[[nl:Lumbago]]
[[no:Lumbago]]
[[pl:Lumbago]]
[[pt:Lumbago]]
[[ru:Люмбаго]]
[[sv:Ryggskott]]
[[tr:Lumbago]]
[[zh:下背痛]]