Low back pain
what it is, symptoms and treatments
What is low back pain?
The LBP can be defined as a pain in the lumbar region, ie in the lower region of the spine near the basin. It is also known as "lumbago", " back pain ", "kidney pain" or "pain in the bedrooms".
The pain may extend to the buttocks, the back of the thighs but not far beyond the knee, without compromising a specific nerve path.
One percent of patients with acute low back pain have sciatica, which is defined as pain radiating to the territory of a lumbar nerve root, often accompanied by symptoms such as difficulty walking and tingling.
It is a very prevalent problem and can be a cause of disability. More than 90% of the world population suffers from low back pain at some point in life and low back pain is the second most frequent cause of seeking medical services.
Types
Low back pain can be classified as acute or chronic in duration.
Acute low back pain
Acute when they last four to six weeks. About 65-90% of adults will experience an episode of acute low back pain throughout life, with a peak incidence occurring between 35-55 years of age
Acute low back pain is not related to any definite factor and usually occurs after excessive physical effort leading the patient to feel a sensation of “locking the spine”.
Approximately 90% of patients with acute low back pain improve in 4 weeks and only 2-7% will progress to chronic form.
Chronic low back pain
Chronic pain occurs at any age and in approximately 75-85% of patients who leave work it becomes recurrent. Low back pain is classified as chronic when the duration is greater than 12 weeks. The difference between acute and chronic low back pain is the time of evolution and this can even influence the diagnosis of the cause of this pain.
Risk factors
The main risk factors that can trigger low back pain are, mainly, muscle twists, caused by excessive overload, when lifting more weight than the person can at the gym, for example, when carrying a lot of weight, pushing cabinets, in short, common activities that cause overload in the joints of the spine and vertebrae.
Causes
The problem is often postural, that is, caused by a poor position to sit, lie down, lower yourself to the floor or carry a heavy object. Other times, low back pain can be caused by inflammation, infection, herniated disc , slipping of the vertebra, arthrosis (degenerative process of a joint) and even emotional problems.
Low Back Symptoms
The symptoms of low back pain are pain located below the twelfth rib to the crease of the gluteus, defined as the lower back. Pains can also radiate to the middle of the thigh.
Back Pain Diagnosis
More than 90% of the time, the diagnosis and cause are established with a good conversation with the patient and a well-done physical examination.
Complementary imaging tests such as X-rays , ultrasound, computed tomography and magnetic resonance imaging are not usually ordered, but can only be ordered to confirm a suspicion for the diagnosis of low back pain
The initial physical examination should be able to identify a serious illness such as infection, fracture or nerve compression.
The X-ray should be restricted to suspected cases of severe low back disease, based on the warning signs. In some conduct guides, x-ray is suggested as an optional exam in cases of persistent low back pain for more than 4 to 6 weeks.
A recent systematic review of imaging studies concluded that for adults under 50 years of age, without systemic symptoms (fever, weight loss, coughing) imaging did not change the treatment of low back pain.
Low Back Treatment
Although acute low back pain improves spontaneously over time, a variety of therapeutic interventions are available, such as: pain relievers, anti-inflammatories, steroids and muscle relaxants. The main goal of treating acute low back pain is to relieve pain, improve functional ability and prevent recurrence and chronicity.
The summary recommendations for the treatment of acute low back pain according to the European guide of conduct are:
Passive activities such as massage, ultrasound, electrotherapy, thermotherapy, electromyography, transcutaneous electrical nerve stimulation (TENS), laser, traction, as well as multidisciplinary programs and cognitive behavioral therapy should be avoided for the treatment of acute low back pain, as they could increase the risk of indisposition of the patient and chronicity of the disease.
. Provide adequate information to the patient, reassuring him about his low back pain, explaining that it is generally not a serious disease and that rapid recovery occurs in most patients
. Prescribe medication, if necessary, for pain relief or to be used preferably at regular intervals
. paracetamol, as the first option and non-steroidal anti-inflammatory drug (NSAID), as the second option
. Consider adding muscle relaxants for a short time
Not all cases of herniated discs have to be operated on. Almost all regress with relative rest, physiotherapy, hydrotherapy, therapeutic academy, pilates, acupuncture and other non-medication measures without the need for surgery.
Thus, the hernia withers and stops compressing important structures, such as nerves. Surgical treatment is indicated only in 10% of cases in which the crisis does not last between three to six weeks, in patients who have repeated crises in a short period of time or when there are sphincter changes (loss of control to urinate and defecate).
While, in adults, most low back pains have simple causes and treatments, low back pain in adolescents is uncommon and with causes that must be carefully investigated by the rheumatologist to rule out secondary causes such as inflammatory diseases, such as ankylosing spondylitis.
Low Back Medicines
The most used drugs for the treatment of low back pain are: pain relievers, anti-inflammatories and muscle relaxants.
Corticosteroids and morphine can be used in more severe cases, but this is more rare. Everything depends on the patient's clinical condition, which must be evaluated by the doctor. Among the drugs used are:
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