Lower Back Pain (Lumbago)

Approximately $50 billion annually is spent on lower back pain in the United States alone, and it is one of the most frequent reasons for going to the emergency room or the doctor’s office. It is also one of the most common reasons for missed work, second only to the common cold, and is second-runner-up to the headache as the most common neurologic-based pain.

Most Americans will experience lower back pain at least once during their lives, and almost half of these will suffer from one or more repeated occurrences. This pain in itself is not a disease, but the symptomatic result of any number of causes.

Lower back pain is sometimes referred to as lumbosacral pain or lumbago because this area of the back includes the five lowest lumbar vertebrae as well as five of the uppermost sacral vertebrae.  The causes of this ailment are complicated, and can present some difficulty to diagnose.

While most often pain is related to strain, overuse or injury to the ligaments, muscles and/or discs, there are also times when lower back pain is associated with degenerative diseases, illnesses and even bacterial infection. Unfortunately, causes can build upon each other thereby compounding the problem and over time medical or surgical intervention may be unavoidable.

Types of Lower Back Pain

Axial pain is confined to the lower back, and does not radiate into other parts of the body such as the legs or feet, as does sciatica and other related conditions. The most common type is “mechanical” and is defined by lower back pain that worsens during particular physical activities, lower back pain that worsens during periods of time spent in particular positions, such as sitting or standing, and lower back pain that is ameliorated with rest.

Axial pain is the most common type of lower back pain, and its symptoms are usually self limited and resolve themselves over a period of time. However, axial or mechanical lower back pain can also be the result of a degenerated disc, joint issues, or damage to muscles, ligaments, and tendons, and it is often difficult to identify which of these is at the root of the problem.

Other types of lower back pain include:

• Low Back Pain with Referred Pain – This pain can vary in severity and area of distribution, but is usually dull and achy, and it comes and goes. It is often the result of an injury or issue that causes axial back pain and is often not serious.
• Referred Pain – This usually originates in the lumbar region and travels via interconnected nerve networks to the upper thigh, buttocks, and groin area. It often migrates from area to area, but rarely travels below the knee. This is not as common as axial pain or radicular pain (sciatica).
• Lumbar Radiculopathy – Also known as radicular pain and sciatica, this condition usually produces a deep and steady pain that is associated with certain positions and activities. The pain can be severe, and is usually confined along the leg’s sciatic nerve. Symptoms can also include muscle weakness, numbness and tingling, and loss of reflexes.

Common Causes of Lower Back Pain

Injuries, strain, and overuse during repetitive actions are some of the most common causes, but age, fractures, and an array of conditions and diseases can also produce symptoms of lower back pain.

Doctors classify lower back pain as either acute (temporary), or chronic (long-lasting), and both the type of pain and the area across which the pain is distributed can help a doctor diagnose and treat both conditions. Most doctors will perform a comprehensive physical exam, analyze the patient’s medical history and order any diagnostic tests to determine whether a patient is suffering from a muscle, tendon, or ligament problem, or by a more weighty underlying condition, such as a tumor, infection, or even a fracture.

Common causes of lower back pain include disease or injury to the muscles, bones, and/or nerves of the spine, and abnormalities of organs within the abdomen, pelvis, or chest. Other disorders within the abdomen, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders can often cause lower back pain. Even a normal pregnancy can cause back pain, along with sciatica, herniated discs, spinal disc degeneration, Cauda Equina syndrome and Spondylosis. Additional causes can be fibromyalgia, tumors, and herpes zoster virus (shingles). This list is by no means all-inclusive, and it is important to see a doctor to be medically evaluated for severe or long-lasting pain.

Ways to Treat Lower Back Pain

Strains and sprains occur when lifting heavy objects, or lifting improperly, from twisting, and from sudden movements or falls. This is most commonly axial pain, and may be accompanied by muscle spasms or soreness, with varying degrees of pain. Patients who are suffering from pain due to muscle strains are often advised to rest for a couple of days, and use such over-the-counter pain medications as acetaminophen and ibuprofen. Additionally, applying either heat or ice may also ease the pain. This type of back pain usually heals fairly quickly, anywhere from two days to two weeks. However, the patient’s muscles may begin to weaken if lower back pain persists for more than two weeks.

Injections may be given to treat the source of axial lower back pain that hasn’t resolved in six to eight weeks time. Some additional testing may also be done. Referred pain is treated with the same course of nonsurgical care as axial pain and should also be continued for six to eight weeks. If this treatment fails to alleviate the pain, a physician may recommend a laminectomy, a discectomy, or a microdiscectomy, or a combination of all three. These are types of decompressive surgeries that usually provide radicular and leg pain relief in 85%-90% of cases.

When to Seek Medical Attention

Overall, lower back pain should begin to improve after a couple of days of rest and home treatment, and does not require a visit to a doctor. However, if pain persists to the point that you are unable to perform your normal daily routine, you should see your doctor.

The following may be indications of a serious medical condition that requires immediate medical attention:

• Fever and chills.
• Unexplained weight loss, particularly with a history of cancer.
• Significant trauma, such as a fall from a ladder, car accident, or similar incident.
• Numbness or altered feelings in the upper inner thighs, groin area, buttocks or genital area.
• Weakness, numbness or tingling in the leg, foot, arm or hand.
• Difficulty passing urine or moving the bowels, or sudden loss of control of urination or bowel movements.
• Severe, continuous abdominal pain and back pain.
• The inability to walk or to raise or lower your foot at the ankle, raise the big toe upward, walk on your heels, or stand on your toes. These symptoms may indicate compression or acute nerve injury, and possibly a neurosurgical emergency.

Also, lower back pain combined with any of the following necessitates a visit to your doctor as soon as possible. If your primary care physician is unable to see you within 24 hours, go to an alternate physician, or to the nearest hospital ER.

• Mild trauma from a recent incident for those aged 50 or older: For example, household slips and other minor falls .
• Prolonged steroid use: Those with COPD, asthma, and rheumatic disorders may be taking this type of medication.
• History of osteoporosis: For example, an elderly person who has had a hip fracture would be considered high risk.
• Anyone 70 or older: Due to increased potential for cancer, infections, and abdominal-related causes.
• History of cancer.
• History of a recent infection.
• Temperature over 100 F.
• IV drug use: Increases risk of an infectious cause.
• Lower back pain that worsens during rest: Can be infection-related, but can also occur with Ankylosing Spondylitis.
• Pain not managed with the prescribed medicine. There may be a need for reevaluation, and should be handled by the doctor writing the prescription. However, if that doctor is not available, the patient should go to the ER.
• Pain so intense during the night that it awakens you, even from a deep sleep.

Almost everyone will experience lower back pain at some point in their lives, and many of these persons will also suffer from a reoccurring episode. Fortunately, most back pain issues will resolve themselves within 1-2 weeks with rest and care. However, if there is severe pain, or if pain persists longer than a couple of weeks, it’s a good idea to see a doctor.