How To Deal With Back Pain
"Low back pain (LBP) is one of the most common reasons patients seek out care, and they appreciate being told what is causing their back pain. This is why doctors gather a careful and complete history from new patients and perform a physical examination. Once the “pain generator” is determined, a doctor can discuss various treatment options and develop a plan for managing the patient. Let’s review some causes of LBP!
If we divide the various conditions into three categories, it significantly improves diagnostic accuracy. These include 1) Mechanical LBP; 2) Nerve root pain, and 3) “Red Flags” (serious conditions). The most common conditions are those belonging to the first group. The following is a partial list of conditions that belong to each category:
1. Mechanical LBP:
Causes of mechanical LBP include Lumbar and sacroiliac (SI) sprains, lumbar muscle strains, facet syndrome, degenerative disk disease (DDD) and/or injury to the disk without nerve pinch, osteoarthritis (this can affect different parts of the spine), spinal instability, spondylolysis and/or spondylolisthesis, and more. The pain pattern is usually localized to the low back and may spread into the buttocks, hips, thighs, but rarely extends past the knee. Usually, there is NO numbness or weakness in the leg or foot because that symptom suggests a spinal nerve pinch.
2. Nerve root pain
This can result from a herniated disk (from either direct nerve pinching and chemical irritation inflaming the nerve), central or lateral spinal stenosis (usually caused by a combination of things including DDD), arthritis, and calcification of ligaments near the nerve. These can be managed very successfully without surgery, but the careful monitoring of numbness, muscle weakness, and treatment satisfaction is important!
3. Red Flags:
These are the potentially dangerous conditions such as cancer, fracture, infections, cauda equina syndrome (spinal cord pinch creating bowel and bladder weakness). Referred pain from organs may be included here as well. As you can see, these carry potentially lethal consequences and require immediate referral and specialty management.
The majority of patients suffering from LBP fall into the first two categories, and the HISTORY can tell us a lot! If the patient complains of pain that stays mostly in the low back but may spread into the buttocks or thigh without numbness/weakness in the leg and feels better with leaning forwards or curling up in a ball, it probably is a Group 1 (mechanical) diagnosis. If there is numbness, tingling, and weakness in the leg to the foot and bending over hurts, it’s most likely disk derangement (bulge, herniated, etc.) with a nerve pinch. If there is unexplained weight loss, a history of cancer, non-responding LBP to treatment, sleep interruptions, and age >50 years old, we may now be in category three, and further tests are needed!”