Diagnosis and Management of Low Back Pain

1. Introduction:

Low back pain is a common symptom, affecting about 80% of the population in their lifetime. Low back pain can be caused by a variety of factors, ranging from simple causes like sprains to more serious conditions like herniated discs and metastatic cancer. This article will provide information about the diagnosis and management of low back pain, helping you better understand your condition and receive appropriate treatment.

2. Causes of Low Back Pain:

The causes of low back pain are divided into two main groups:

a. Mechanical Causes:

• Lumbar herniated disc: This is the most common cause, accounting for about 90% of sciatica cases. Herniated discs often occur at the L4-L5 and L5-S1 levels, mainly in younger individuals due to the flexibility of the intervertebral discs. In older adults, the intervertebral discs are more prone to fibrosis and are less likely to experience herniation.

• Facet joint arthritis: This occurs when the joints between the vertebrae degenerate, causing pain and limited mobility.

• Spinal slip (Spondylolisthesis): This is a condition where a vertebra slips out of its normal position on the vertebra below, causing pain and nerve compression.

• Spinal stenosis: The spinal canal is the bony channel that contains the spinal cord and nerve roots. When the spinal canal narrows, it can compress the spinal cord and nerve roots, causing pain and numbness in the limbs.

• Osteoporosis: Bones become brittle and prone to fractures, leading to pain and spinal deformities.

• Scoliosis: Abnormal curvature of the spine, causing pain and affecting mobility.

• Hypertrophy of transverse processes, bifid L5, S1: The bony projections on the vertebrae L5 and S1 grow excessively, compressing nerve roots, leading to pain.

• Calcification of articular cartilage: The accumulation of calcium in articular cartilage causes pain and limits mobility.

b. Other Causes:

• Ankylosing spondylitis: An autoimmune disease that causes inflammation and stiffness of the spine.

• Infectious spondylitis: Due to bacterial infection in the spine, causing pain and high fever.

• Metastatic cancer of the spine: Cancer that spreads to the spine, causing pain and potential paralysis.

• Osteomalacia: A disease that affects the bones, causing pain and fractures.

• Psychological: Low back pain can arise from psychological stress and anxiety.

• Aortic aneurysm: An aortic disease that can cause back pain and be life-threatening.

Note:

• Low back pain can be a symptom of many different medical conditions, so it’s important to be diagnosed and treated by a qualified medical professional.

• Do not self-medicate or attempt any treatments without a doctor’s recommendation.

3. Diagnosis:

Diagnosing low back pain involves taking a medical history, performing a physical examination, and conducting diagnostic tests:

• Medical history: The doctor will ask about your symptoms, when they started, risk factors, medical history, current medications, etc.

• Physical examination: The doctor will check your physical condition, examine your lower back, assess your movement and sensation, check reflexes, and perform a neurological examination.

• Diagnostic Tests:

• X-ray of the lumbar spine: Helps detect structural abnormalities, such as degeneration, slippage, osteoporosis.

• Magnetic resonance imaging (MRI): Provides detailed images of the intervertebral discs, spinal cord, nerve roots, helping to detect herniated discs, spinal stenosis, etc.

• Computed tomography (CT) scan: Helps detect abnormalities in bones, soft tissues, and can assess the extent of spinal cord and nerve root compression.

• Blood tests: Helps diagnose ankylosing spondylitis, infectious spondylitis, and blood-related conditions.

• Urine tests: Helps rule out kidney disease as a cause.

• Electrodiagnostic studies: Helps determine the extent of nerve root compression.

Note:

• X-ray of the lumbar spine is a basic test for diagnosing low back pain, but it’s not always necessary.

• MRI is an effective test for diagnosing herniated discs, spinal stenosis, but it’s more expensive.

• CT scans may be performed when MRI is not feasible or when a more detailed assessment is needed.

• Other tests are only performed when recommended by the doctor.

4. Treatment:

Treating low back pain depends on the cause, severity, and the patient’s overall health.

a. Medical treatment:

• Pain relievers: Paracetamol, Ibuprofen, Diclofenac, Meloxicam, Celecoxib.

• Muscle relaxants: Baclofen, Tizanidine.

• Corticosteroids: Indicated in cases of nerve root or spinal cord pain, acute sciatica.

• Osteoporosis medication: If low back pain is due to osteoporosis.

b. Physical therapy:

• Hot or cold packs: Help reduce pain and inflammation.

• Massage: Helps relax muscles, reduce pain.

• Exercises: Strengthen muscles, improve posture, and reduce pain.

c. Surgery:

Surgery is indicated when conservative treatments are ineffective, or if there are serious complications such as paralysis, cauda equina syndrome, etc. Common surgical techniques include:

• Disc surgery: Removes the herniated disc, reducing pressure on the nerve root.

• Spinal stenosis surgery: Widens the spinal canal, reducing pressure on the spinal cord and nerve roots.

• Spondylolisthesis surgery: Fuses the vertebrae, preventing further slippage and reducing pain.

Note:

• Surgery should only be performed when conservative treatment is ineffective or when there are serious complications.

• Consult with a specialist about the risks and benefits of surgery before making a decision.

5. Prevention:

• Maintain a healthy lifestyle: Exercise regularly, eat a balanced diet, manage your weight.

• Avoid prolonged sitting or standing in one position.

• Lift heavy objects correctly, avoiding bending over.

• Choose comfortable shoes, avoid high heels regularly.

• Avoid smoking and excessive alcohol consumption.

• Get regular health checkups to detect medical conditions early.

Conclusion:

Low back pain is a common symptom that can be caused by various factors. Diagnosis and treatment of low back pain should be conducted by a medical professional to determine the cause and choose the appropriate treatment method.

Note:

This article is for informational purposes only and does not replace the advice of a doctor. Consult with a medical professional for accurate diagnosis and treatment.