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Low back pain (LBP) affects at least 80% of us some time in our lives, perhaps 20-30% of us at any given time. It is usually recurrent, and subsequent episodes tend to increase in severity. It is common in individuals who lead sedentary lives and in those who engage in manual labor. It can occur at any age but is most prevalent during the third to sixth decades of life.

COSTS

A team of Duke Medical Center researchers has found that patients suffering from back pain consume more than $90 billion annually in health-care expenses, with approximately $26 billion of that amount directly attributable to treating the back pain. Tremendous costs are associated with LBP, including lost productivity and income from work, the expense of medical, rehabilitation, and surgical interventions, and the costs of disabling pain and limited daily function.

Back pain is second only to upper respiratory conditions as the stated cause of work loss. The costs for treatment and compensation for LBP in industry may be greater than the total amount spent on all other industrial injuries combined. However, most of the costs, perhaps 80%, are incurred by about 20% of the LBP patients who then become disabled.

COMMON MISCONCEPTION

A common misconception often cited is that 90% of back pain will go away on its own without treatment. However, a recent review published in the European Spine Journal in 2003, showed that the reported proportion of patients who still experienced pain after 12 months was 62% (range, 42-75%), dispelling the popular notion that up to 90% of low back pain episodes resolve spontaneously within 1 month.

1. What would cause you to suffer low back pain?

Not all back pain originate in the lower back. In 65% of cases the pain comes from the lower back, 25% from the hip and sacroiliac joint and in 10% the cause is unknown even after extensive investigation.

A. Mechanical Causes - due to anatomical or functional abnormalities of the spine

Muscle & Ligament Strain

Osteoarthritis

Spinal Stenosis

Degenerative Disc Disease

Spondylolisthesis

Vertebral Fracture

B.Nonmechanical Physical Causes - diseases affecting the body as a whole

Ankylosing Spondylitis

Neoplasms

Infections

Abdominal aortic aneurysm

C. Diseases of other organs, such as uterine or pelvic infections in women, kidney infections, and gastrointestinal disease such as pancreatitis and cholecystitis,

D.Neurological Disorders

E.Biomechanical Causes- Poor posture and movement patterns

F.Psychological Causes

2. How do you diagnose the cause of low back pain?

Finding the cause of low back pain begins with a detailed history, physical examination and the use of several diagnostic tests. These tests are used to find out the cause of your pain and not to make your pain better. X-rays of the lower back are usually a first step and will help determine if more tests are needed. The MRI is commonly used to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. It is done to find tumors, herniated discs, or other soft-tissue disorders. The CT scan is most useful when a condition that only affects the bones of the spine is suspected. A bone scan is used to help locate the affected area of the spine. Blood tests are done to look for infection or arthritis.

3. When should you seek treatment?

Progressive leg weakness.

Loss of bowel or bladder control.

Severe uncontrolled pain.

Unexplained weight loss accompanied by pain and neurological impairment.

Fever with increased pain which does not respond to common fever reducers.

Recent significant trauma such as a fall from a height, motor vehicle accident, or similar incident.

Recent mild trauma in those older than 50 years of age.

Anyone with a history of osteoporosis: An elderly woman with a history of a hip fracture

Any person older than 70 years of age: There is an increased incidence of cancer, infections, and abdominal causes of the pain.

Prior history of cancer.

IV drug use: Such behavior markedly increases risk of an infectious cause.

Low back pain worse at rest can be associated with an infectious or malignant cause of pain.

4. What are treatments for low back pain?

A. Nonsurgical Treatment

Medications.

Aspirin or acetaminophen can relieve pain with few side effects.

Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen reduce pain and swelling.

Narcotic pain medications, such as codeine or morphine

Steroids, taken either orally or injected into your spine.

Physical therapy include passive modalities such as heat, ice, massage, ultrasound, and electrical stimulation. Active therapy

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