All You Want To Know About Acute Low Back Pain
Acute low back pain is defined as low back pain present for up to, but less than, six weeks. Low back pain may begin following a strenuous activity or trauma, but often is seemingly unrelated to a specific activity. The pain may begin suddenly or develop gradually. It may be experienced as aching, burning, stabbing, sharp or dull, well-defined, or vague. The intensity may range from mild to severe and may fluctuate. The pain may radiate into one or both buttocks or even into the thigh/hip area.
Who can get acute low back pain?
Anyone can experience low back pain. At least 85% of individuals will experience a significant episode of low back pain at some point in their lives. In a general survey at any point in time, 15% of individuals report that they are experiencing low back pain.
What causes low back pain?
The exact source of acute low back pain is often difficult to identify. In fact, there are numerous possible structures that can produce pain. These include muscles, connective/soft tissue, ligaments, joint capsules and cartilage and blood vessels. These tissues may be pulled, strained, stretched or sprained. Additionally, annular tears (small tears that occur in the outer layer of the discs that are between each vertebra) can initiate severe pain. Even if the actual tissue damage is minor, and likely to repair quickly, the pain experienced may be quite severe.
Numerous chemical substances are released in response to tissue irritation. Some of these chemicals trigger the process of inflammation, or swelling, which also contributes to pain. This inflammation may persist for days to weeks. As a result of injury, muscle spasm in the surrounding tissues may occur. This can result in a decrease of the usual blood supply to the affected area, which reduces delivery of nutrients and oxygen and impairs removal of irritating byproducts of inflammation.
How long will acute low back pain last?
The good news is that 50% of episodes of acute low back pain nearly, completely resolve within two weeks, and 80% by six weeks. Unfortunately, the duration and severity of a single episode cannot be predicted based on the onset, location of pain, or even the initial severity. Excruciating initial pain may resolve within several days, while moderate or mild symptoms may persist for weeks.
Is this pain serious?
The seriousness of low back pain varies. The symptoms of acute low back pain are usually benign and self-limited. Even a ruptured disc has a chance of improving without surgery. However rare, low back pain could be caused by a more serious process such as a fracture, infection or cancer. This is more common in individuals over the age of 50, those with a history of cancer, those with severe pain at rest, pain associated with fever, and in persons with underlying medical problems such as diabetes, heavy alcohol or drug use, long time corticosteroid use, or osteoporosis. Pain in the legs, weakness, or difficulty with bowel or bladder control warrant prompt medical evaluation, as this may indicate a severe problem.
How should acute low back pain be managed?
Some of the best advice for treatment for acute low back pain is to continue to remain active "as tolerated". Most individual's natural inclination would be to stay in bed and avoid activity. Actually, activity keeps blood and nutrients flowing to the affected area, which inhibits inflammation and reduces muscular tension, so continuing to perform everyday activities is generally encouraged. Many individuals with low back pain find that they can perform controlled cardiovascular activities, such as walking, in spite of the pain and often feel better after the activity. More vigorous or uncontrolled activities such as weight lifting or competitive or contact sports are inadvisable while pain is severe.
Stretching exercises for the back and legs may be done during an acute episode of low back pain, but stretching should not cause more severe pain. If pain is aggravated by a particular exercise or stretch, avoid that particular activity. Local application of heat or ice can temporarily reduce pain and heat may facilitate stretching, but does not necessarily speed long term recovery.
Medication: Both acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are analgesics (pain relievers) which are known to provide effective reduction of acute low back pain. NSAIDs also inhibit the inflammatory process described earlier. These are usually the medications used initially for management of acute low back pain. They are available "over the counter" in lower dosages, or a higher dose may be prescribed.
"Muscle relaxants" are medications that do not actually relax skeletal muscle. However, they work by sedating the central nervous system and can be useful to facilitate sleep and secondarily reduce contributing muscular tension in the setting of severe pain.
Narcotics (also called opioids) are strong pain relievers and do reduce the symptoms of acute low back pain. Because narcotics are sedating, they can be useful to facilitate sleep during the first few nights of symptoms. Long term use of narcotics is associated with undesirable side effects including physical dependency, sedation, depression, constipation. Narcotics should only be used for a very short duration for severe low back pain.
Other treatments: Physical therapy modalities such as ultrasound, electrical stimulation, traction, mobilization and chiropractic manipulation can provide temporary relief, but are not proven to improve long term recovery. Acute low back pain usually resolves spontaneously on its own and in most cases, as long as activity can he maintained formal therapy may not be required. If the pain is severe, if participation in activities is impaired, or if motion is significantly restricted, a physical therapist can provide additional education and advice regarding strategies for restoring motion, resuming activities, preventing deconditioning and achieving a position of comfort during sleep.
For those with persistent or recurrent low back pain, a medical evaluation is indicated. The goal should always be towards developing and transitioning to a fully independent home or health club exercise regimen. Emphasis should be placed on optimizing trunk or "core" strength and improving general flexibility and cardiovascular endurance.
Spinal, injections: Spinal injections are generally not considered an appropriate treatment for acute, self- limited low back pain. There are several injection options for persistent or recurrent pain, including epidural steroid, facet joint and trigger point injections. The appropriateness of injections is determined following a comprehensive medical evaluation by a pain management specialist. These procedures should be performed under fluoroscopy or x-ray guidance.
Surgery: The need for surgery is extremely rare in episodes a acute low back pain. Instances where surgery would be indicated include significant nerve damage, weakness of legs which is progressively getting worse, bladder or bowel dysfunction due to compression of the spinal cord and from trauma when a fracture is, unstable.
Do I need any type of tests done?
The majority of cases of acute low back pain do not require any type of testing. Diagnostic imaging tests may be advised, n cases of pain associated with severe trauma, history of cancer, fever, diabetes, other medical problems, illicit IV drug use, age
over 50, bowel or bladder dysfunction; nocturnal pain or osteoporosis. These tests include regular X-ray studies, .bone scan, computed tomography (CT) scan and Magnetic
resonance imaging (MRI). The choice of test depends on what real condition your physician suspecting. It is important to that the “final” diagnosis is based upon a combination of history, physical examination and diagnostic testing, not imaging tests alone.
Acute low back pain can be a very painful experience, but fortunately it usually resolves fairly quickly. In situations when the pain does not improve satisfactorily, prompt comprehensive medical attention should be sought. The primary goal is to resolve the acute episode as quickly as possible and secondarily to prevent future episodes through proper education, exercise and conditioning.
Anil Sharma, MD
Spine and Pain Centers
Jersey Sporting News January 2012