Low back pain

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Low back pain
Synonyms	Lumbago
Pronounce	N/A
Specialty	N/A
Symptoms	Muscle pain, stiffness, numbness
Complications	Chronic pain, sciatica, depression
Onset	Sudden or gradual
Duration	Days to weeks (acute), more than 12 weeks (chronic)
Types	N/A
Causes	Muscle strain, herniated disc, degenerative disc disease, spinal stenosis
Risks	Obesity, sedentary lifestyle, smoking, occupational hazards
Diagnosis	Physical examination, medical imaging
Differential diagnosis	Kidney stones, abdominal aortic aneurysm, pancreatitis
Prevention	N/A
Treatment	Pain management, physical therapy, exercise, surgery
Medication	NSAIDs, muscle relaxants, opioids
Prognosis	N/A
Frequency	Affects about 80% of people at some point in their lives
Deaths	Rarely directly fatal

Lagehernia

Vertebral column illustration

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ACDF oblique annotated

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Straight-leg test

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L4-L5 disc herniation

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Harvey Cushing, Doris Ulmann 1920s

Low Back Pain (LBP), also known as lumbago, is a prevalent health issue affecting the muscles, nerves, and bones of the back. This condition can manifest in various ways, from a dull, continuous ache to a sudden, sharp sensation.

Classification

LBP is typically categorized based on the duration and underlying cause of the pain.

By Duration

• Acute LBP: This type lasts less than six weeks. It is often due to strain or minor injury.
• Sub-chronic LBP: This type persists for six to twelve weeks. It can be a continuation of acute LBP or a new issue.
• Chronic LBP: This type lasts more than twelve weeks and may be due to ongoing conditions such as arthritis, spinal stenosis, or degenerative disc disease.

By Cause

• Mechanical LBP: This type is the most common and is due to physical problems with the structures of the lower back, including the spine, intervertebral discs, or supporting muscles and ligaments.
• Non-Mechanical LBP: This type is less common and can be caused by conditions such as kidney stones, endometriosis, or fibromyalgia.
• Referred Pain: This type originates in a different part of the body but is felt in the lower back.

Prognosis

Most individuals with LBP see improvement in their symptoms within a few weeks of onset. Between 40-90% of patients recover within six weeks. However, recurrence is common, and the condition can become chronic in some cases.

Treatment

Treatment for LBP often includes a combination of self-care measures, physical therapy, medication, and in some cases, surgery. Patient education is also vital, as understanding the cause and mechanisms of LBP can help manage the condition.

References

• Mehling, W. E., Gopisetty, V., Bartmess, E., Acree, M., Pressman, A., Goldberg, H., ... & Avins, A. L. (2012). The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study. Spine, 37(8), 678-684.
• Delitto, A., George, S. Z., Van Dillen, L. R., Whitman, J. M., Sowa, G., Shekelle, P., ... & Godges, J. J. (2012). Low back pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1-A57.