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14-September-2008 18:02:36 - Low back pain Low back pain Classification and external resources ICD-10 M54.4-M54.5 ICD-9 724.2 MedlinePlus 003108 eMedicine pmr/73 MeSH D017116 Low back pain is a common musculoskeletal disorder causing back pain in the lumbar vertebrae. It can be either acute, subacute or chronic in its clinical presentation. Typically, the symptoms of low back pain do show significant improvement within two to three months from its onset. In a significant number of individuals, low back pain tends to be recurrent in nature with a waxing and waning quality to it. In a small proportion of sufferers this condition can become chronic. Population studies show that back pain affects most adults at some stage in their life and accounts for more sick leave and disability than any other single medical condition.1 An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue like muscles, ligaments and tendons. With a serious accident or due to osteoporosis or other causes of weakened vertebral bones, vertebral fractures in the lumbar spine may also occur. At the lowest end of the spine, some patients may have tailbone pain also called coccyx pain or coccydynia. Others may have pain from their sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint dysfunction see sacroiliac joint for more information. Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae, or a spinal disc herniation, a vertebral fracture such as from osteoporosis, or rarely, a tumor including cancer or infection. The cause may also be psychological or emotional or due to other non-anatomical factors.2 Contents 1 Causes 2 Diagnosis 3 Treatments 3.1 Conservative treatment 3.1.1 Treatments likely to be beneficial 3.1.2 Other treatments 3.2 Surgery 4 See also 5 References 6 External links Causes Possible causes of low back pain: Mechanical: Apophyseal osteoarthritis Diffuse Idiopathic Skeletal Hyperostosis Degenerative Discs Scheuermann's kyphosis Spinal disc herniation slipped disc Spinal stenosis Spondylolisthesis and other congenital abnormalities Fractures Non-specific muscular or ligamentous strains or sprains Leg Length Difference Restricted hip motion Misaligned pelvis - pelvic obliquity, anteversion or retroversion Inflammatory: Seronegative spondylarthritides e.g. ankylosing spondylitis Rheumatoid arthritis Infection - epidural abscess or osteomyelitis Neoplastic: Bone tumors primary or metastatic Intradural Spinal tumors Metabolic: Osteoporotic fractures Osteomalacia Ochronosis Chondrocalcinosis Psychosomatic Tension myositis syndrome Paget's disease Referred pain: Pelvic/abdominal disease Prostate Cancer Posture Depression oxygen deprivation Diagnosis Diagnosing the underlying cause of low back pain is usually done by a medical doctor, osteopathic physician, physiotherapist physical therapist or by a chiropractor. Often, getting a diagnosis of the underlying cause of low back pain and/or related symptoms is quite complex. A complete diagnosis is usually made through a combination of a patient's medical history, physical examination, and, when necessary, diagnostic testing, such as an MRI scan or x-ray. There are a number of health care professionals who may specialize in diagnosing and treating low back pain, including chiropractors, osteopathic physicians, physical therapists physiotherapists, physiatrists, anesthesiologists/pain medicine physicians, and orthopedic surgeons or neurosurgeons. Research shows that the presence of a leg length difference does not mean you will have back pain. Diagnosis of leg length difference is quite easy; just stand in front of a mirror in your underwear on a flat, level floor a bathroom is usually good. Look at your hips to see if they are level. If one seems higher, put a magazine under the shorter leg. Keep adding magazines until your hips look level. Measure the height of the magazines. This is the difference in the length of your two legs. 90% of the population has a leg length difference; the same percentage that experiences lower back pain during their lifetime. A difference of only 1% would be â…“ inch or more. Diagnosis of restricted internal hip rotation is also easy. Lie on your stomach with your legs together. Bend your knees 90 degrees so that the soles of your feet point up toward the ceiling. Keeping your knees together, move your feet apart. Your lower legs will form a V. Have someone measure the angle of each lower leg in relation to a vertical line. The angle should be the same for both legs. Each leg should be a minimum of 45 degrees; 60 degrees if you play golf or tennis. Vad, et al, found restricted internal hip rotation on the lead hip associated with lower back pain in professional golfers. Treatments The course of treatment for low back pain will usually be dictated by the clinical diagnosis of the underlying cause of the pain. Conservative treatment For the vast majority of patients, low back pain can be treated with non-surgical care. For those with acute, short-term back pain, certain home remedies3 may be effective.citation needed ClinicalEvidence.com has systematically reviewed randomized controlled trials published through April, 2004 and concluded: Treatments likely to be beneficial Analgesics pain medications, such as NSAIDs or acetaminophen.45 Arch support Spinal manipulation for acute4 or chronic5 pain. A clinical prediction rule can guide who is most likely to respond to manipulation.6 Muscle relaxants for acute4 or chronic5 pain. Antidepressants for chronic low back pain.5 Stay physically active.4 Exercise for chronic pain.5 Intensive multidisciplinary treatment programs may help subacute4 or chronic5 low back pain. Behavioral therapy5 Acupuncture may help chronic pain5; however, a more recent randomized controlled trial suggested insignificant difference between real and sham acupuncture.7 Other treatments Additional treatments have been more recently reviewed by the Cochrane Collaboration: Massage therapy may benefit some patients.8 Ice and/or heat application or moist heat has uncertain benefit.9 Individual randomized controlled trials, thus interpretation may be subject to publication bias, also confounded by absence of double blinding have shown benefit for: Viniyoga,10 Iyengar,11 and Hatha yoga small trial.12 Correcting leg length difference may help.13 To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust. Muscle Energy Technique MET may help small study.14 Other treatments that were not reviewed are Education and attitude adjustment TMS Increasing internal hip rotation Increase internal hip rotation with stretching or connective tissue massage Medical cannabis Because of variations in clinical study methodology, a review of clinical studies in any one area is not necessarily conclusive. For any one condition, it may be necessary to try a variety of treatments in order to find the best one or combination to best manage the pain. In almost all cases, physical therapy and/or a regular exercise program that includes stretching, strengthening and low impact cardio conditioning will be part of the treatment and rehabilitation program. The role of narcotics for chronic low back pain is uncertain.15 Surgery Lumbar surgery is indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence, which can be seen with severe lumbar disc herniation, spinal abscess or cauda equina syndrome. Other possible indications for surgery include: Severe Degenerative disc disease Spinal stenosis Spondylolisthesis Scoliosis Compression fracture Spinal instability Spinal trauma Spinal malignancycancer Spinal hematoma Spinal Disc replacement The most common types of low back surgery include microdiscectomy, discectomy, laminectomy, foraminotomy, or spinal fusion. Another less invasive surgical technique consists of an implantation of a spinal cord stimulator and typically is used for symptoms of chronic radiculopathy sciatica. Lumbar artificial disc replacement is a newer surgical technique for treatment of degenerative disc disease, as are a variety of surgical procedures aimed at preserving motion in the spine. See also Back pain Bertolotti's syndrome Coccydynia Degenerative disc disease Sciatica Tension myositis syndrome Upper back pain References ^ Lower Back Pain Fact Sheet. nih.gov. Retrieved on 2008-06-16. ^ McGrath, Mike 2004-11-03. When Back Pain Starts in Your Head: Is repressed anger is causing your back pain?. Prevention.com. Rodale Inc.. Retrieved on 2007-09-12. ^ Acute back pain. Causes and treatment options.. Retrieved on 2007-09-26. ^ a b c d e Koes B, van Tulder M 2006. Low back pain acute. Clinical evidence 15: 1619-33. PMID 16973062. ^ a b c d e f g h van Tulder M, Koes B 2006. Low back pain chronic. Clinical evidence 15: 1634-53. PMID 16973063. ^ Childs JD, Fritz JM, Flynn TW, et al 2004. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann. Intern. Med. 141 12: 920-8. PMID 15611489. Summary of the rule ^ Haake M, Müller HH, Schade-Brittinger C, et al 2007. German Acupuncture Trials GERAC for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups. Arch. Intern. Med. 167 17: 1892-8. doi:10.1001/archinte.167.17.1892. PMID 17893311. ^ Furlan AD, Brosseau L, Imamura M, Irvin E 2002. Massage for low back pain. Cochrane database of systematic reviews Online 2: CD001929. doi:10.1002/14651858.CD001929. PMID 12076429. ^ French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ 2006. Superficial heat or cold for low back pain. Cochrane database of systematic reviews Online 1: CD004750. doi:10.1002/14651858.CD004750.pub2. PMID 16437495. ^ Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA 2005. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann. Intern. Med. 143 12: 849-56. PMID 16365466. ^ Williams KA, Petronis J, Smith D, et al 2005. Effect of Iyengar yoga therapy for chronic low back pain. Pain 115 1-2: 107-17. doi:10.1016/j.pain.2005.02.016. PMID 15836974. ^ Galantino ML, Bzdewka TM, Eissler-Russo JL, et al 2004. The impact of modified Hatha yoga on chronic low back pain: a pilot study. Alternative therapies in health and medicine 10 2: 56-9. PMID 15055095. ^ Defrin R, Ben Benyamin S, Aldubi RD, Pick CG 2005. Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain. Archives of physical medicine and rehabilitation 86 11: 2075-80. doi:10.1016/j.apmr.2005.06.012. PMID 16271551. ^ Wilson E, Payton O, Donegan-Shoaf L, Dec K 2003. Muscle energy technique in patients with acute low back pain: a pilot clinical trial. The Journal of orthopaedic and sports physical therapy 33 9: 502-12. PMID 14524509. ^ Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D 2007. Opioids for chronic low-back pain. Cochrane database of systematic reviews Online 3: CD004959. doi:10.1002/14651858.CD004959.pub3. PMID 17636781. External links Back and spine at the Open Directory Project v d e Diseases of the musculoskeletal system and connective tissue M, 710-739 Arthropathies Arthritis Septic arthritis - Reactive arthritis - Rheumatoid arthritis - Psoriatic arthritis - Felty syndrome - Juvenile idiopathic arthritis - Still's disease - crystal Gout, Chondrocalcinosis - Osteoarthritis Heberden's node, Bouchard's nodes - Monoarthritis/Polyarthritis Specific joints shoulder Winged scapula, Adhesive capsulitis, Rotator cuff tear, Subacromial bursitis - elbow Cubitus valgus, Cubitus varus - hand Wrist drop, Boutonniere deformity, Swan neck deformity hip Protrusio acetabuli, Coxa valga, Coxa vara - leg Unequal leg length - patella Luxating patella, Chondromalacia patellae - foot Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe, Foot drop, Flat feet, Club foot general terms Valgus deformity, Varus deformity Synovium and tendon Synovitis/Tenosynovitis Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome - Irritable hip - Ganglion cyst Bursa Bursitis Olecranon, Prepatellar, Trochanteric, Subacromial - Baker's cyst Other Hemarthrosis - Arthralgia - Osteophyte - Hypermobility Dorsopathies spinal curvature Kyphosis, Lordosis, Scoliosis - Scheuermann's disease - Spondylolysis - Torticollis - Spondylolisthesis Spondylopathies Ankylosing spondylitis, Spondylosis, Spinal stenosis - Schmorl's nodes - Degenerative disc disease - Coccydynia - Back pain Radiculopathy, Neck pain, Sciatica, Low back pain see also congenital v d e Pain and nociception Head and neck Jaw and mouth pain Odynophagia , temporal arteritis Ear pain otalgia, otitis media, otitis externa Eye pain glaucoma Head pain headache, migraine, tension headache, cluster headache, cerebral aneurysm, sinusitis, meningitis Neck pain atypical myocardial infarction Thorax Back pain upper back pain, lower back pain, spinal disc herniation, degenerative disc disease, coccydynia Breast pain perimenstrual, breast cancer Chest pain myocardial infarction, gastroesophageal reflux disease, pancreatitis, hiatus hernia, aortic dissection, asymptomatic pulmonary embolism, Tietze's syndrome Shoulder pain right side - cholecystitis Abdominal pain Left and right upper quadrant peptic ulcer disease, gastroenteritis, hepatitis, pancreatitis, cholecystitis, atypical myocardial infarction, abdominal aortic aneurysm, asymptomatic gastric cancer Left and right lower quadrant appendicitis, ulcerative colitis, Crohn's disease, ectopic pregnancy, endometriosis, pelvic inflammatory disease, diverticulitis, urolithiasis, pyelonephritis, colorectal cancer Limbs Arms myocardial infarction, left arm Legs deep vein thrombosis, peripheral artery occlusive disease, claudication, spinal disc herniation, sciatica Joints arthralgia Small joints osteoarthritis, rheumatoid arthritis, systemic lupus erythematosis, gout, pseudogout Large joints septic arthritis, hemarthrosis, osteonecrosis Back joints ankylosing spondylitis, inflammatory bowel disease Other psoriatic arthritis, Reiter's syndrome Musculoskeletal Delayed onset muscle soreness, Myalgia, Physical trauma Other/unspecified pain Allodynia, breakthrough pain, chronic pain, congenital insensitivity to pain, congenital insensitivity to pain with anhidrosis, hyperalgesia, hyperpathia, neuralgia, pain asymbolia, pain disorder, paroxysmal extreme pain disorder, phantom pain, referred pain Related concepts Anterolateral system, gate control theory of pain, pain management anesthesia, cordotomy, pain scale, pain threshold, posteromarginal nucleus, substance P, OPQRST Retrieved from http://en..org/wiki/Low_back_pain Categories: Pain | Nociception | Sensory system | Disability | SymptomsHidden categories: All articles with statements | Articles with statements since September 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français עברית Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Suomi Svenska Türkçe ä¸æ–‡ This page was last modified on 12 September 2008, at 16:4
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