What Causes Lower Back Pain?
Chronic lower back pain lasts more than three months or exceeds the predicted duration. Symptoms typically appear gradually but remain for a longer period. Chronic lower back pain can cause pain in the back and sciatic pain that reaches over the hips and down the legs. The most common causes include:
- Vertebral body fractures
- Arthritis
- Osteoporosis
- Spondylolisthesis
- Ankylosing spondylitis
- Neoplasms
- Infections
- Sacroiliac joint disease
- Disc extrusion
- Facet joint osteoarthritis
- Spinal stenosis
- Fibromyalgia
- Degenerative disc disease
- Disc protrusion
- Herniated disc
- Nerve root irritation or compression
- Central sensitization
- Biomechanical factors
- Poor posture
- Psychological and emotional factors
Causes of lower back pain also depend on the structure of the lower back affected by the medical condition. These include:
Bony Structures:
Vertebral body fractures can affect bony structures in the spine. They may also be affected by:
- Osteoporosis
- Spondylolisthesis
- Neoplasms (Primary vs. metastatic lesions)
- Infections
- Facet joint osteoarthritis
Intervertebral Disc:
The intervertebral discs in your spine are vulnerable to degeneration and injury over time. It can result in chronic lower back pain. Some disorders that affect all parts of intervertebral discs include:
- Facet joint osteoarthritis
- Nerve root irritation or compression (sciatica)
- Disc infection
- Degenerative disc disease
- Disc protrusion
- Herniated disc
- Disc extrusion
Spinal Ligaments And Muscles:
Chronic lower back pain can also be caused by stress, strain, and injury to the ligaments and muscles. These include:
- Muscle tear
- Ligamentous strain
- Ligamentous tear
- Myofascial pain syndrome
- Muscular strain
How is Lower Back Pain Diagnosed?
The doctor will examine your ability to sit, stand, walk, and lift your legs. If your doctor suspects that a particular condition is causing your lower back pain, he may recommend one or more tests:
X-Ray:
These images show your bone alignment and whether you have arthritis or fractured bones.
CT or MRI scans:
Images from these scans can identify herniated discs or abnormalities with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels.
Blood Tests:
These can assist in determining whether you have an infection or another disease that is causing your lower back pain.
Bone Scan:
A bone scan can diagnose bone cancers or compression fractures caused by osteoporosis.
Nerve Studies:
Electromyography (EMG) detects the electrical impulses generated by your nerves and the muscle responses. This test can diagnose nerve compression caused by herniated discs or spinal canal constriction.
Treatment Options for Lower Back Pain
Bed rest is not a good choice for treating lower back pain. Exercise might help you feel better by boosting your flexibility and range of motion. Exercise also causes the release of endorphins, which are your body’s natural pain relievers. Treatment options include:
1. Braces:
Back braces may be all you need for support when recovering from an injury. Back braces combined with good nutrition and light exercise keep you active and help you regain your flexibility and range of motion. Physical and occupational therapy can help to reduce or avoid functional limitations.
2. Medications:
NSAIDs (ibuprofen-type medicines), acetaminophen (like Tylenol), muscle relaxants, and membrane-stabilizing medications are frequently beneficial for lower back pain.
3. Epidural Steroid Injections:
Some common pain conditions can benefit from epidural steroid injections (e.g., degenerative disc disease). This approach includes injecting a steroid into the epidural space of the spinal cord, which contains the inflamed nerve roots.
4. Trigger Point Injections:
Muscle spasms can be effectively treated with trigger point injections. This approach involves injecting a local anesthetic and steroid into a trigger point, which is the source of the pain.
5. Minimally Invasive Lumbar Decompression (MILD):
Lumbar Spinal Stenosis can be treated with minimally invasive lumbar decompression. The MILD technique is a minimally invasive, FDA-approved treatment that removes extra tissue in the spinal canal, relieving pressure on the spinal nerves. It can be done as an outpatient procedure in less than an hour.
6. Spinal Cord Stimulation (SCS):
Spinal cord stimulation involves implanting an electrical device to disrupt the spinal cord and pain processing centers in the brain.
7. Peripheral Nerve Stimulation:
This procedure includes placing small electrodes near the damaged nerves. The electrodes generate a small electrical current, blocking pain transmission and may provide pain relief.
8. Vertebroplasty And Kyphoplasty:
Both of these techniques are minimally invasive and can cure osteoporotic fractures. The treatment involves injecting acrylic cement into the crushed vertebrae to fix them.
9. Intrathecal Pump Implants:
Pain pumps are also available and can be helpful for long-term pain control for lower back pain. Pain pumps are placed near the spine and release the medicine to the targeted area.
10. Peripheral Nerve Blocks And Ablation:
Peripheral nerves are nerves that extend from the spinal cord. These nerves are frequently painful and can be blocked with a local anesthetic. If pain relief is successful, ablation applies heat to destroy the nerve for long-term relief.
11. Back Surgery:
Surgical techniques are usually used when all conservative treatments have failed to relieve pain or when the spinal cord or peripheral nerves have been severely injured or compressed. Invasive surgical procedures include:
- Spinal fusion
- Spinal instrumentation
- Laminectomy
