Low Back Pain: Causes and Treatments

Do you suffer from low back pain? If so, you’ve got plenty of company. According to government statistics, nearly 4 out of every 5 adults experience significant back pain at least once in their lives, and the ailment is the number one cause of lost productivity for American workers. This article explains the underlying conditions of most back pain and the most promising treatment for those of us who suffer from it.

Conditions that may cause low back pain and require treatment by a physician or other health specialist include:

Bulging disc (also called protruding, herniated, or ruptured disc). The discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.

A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.

Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.

Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition.

Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

While these are the most common causes of low back pain, it is important to note that in approximately 80 percent of cases the ailment often occurs with no diagnosed underlying medical cause. In order to arrive at a diagnosis, your physician may order any or all of the following medical tests:

X-rays: An x-ray will show the bones of the spine and determine if there is significant wear and tear or disease of the bone. It will also show whether the bones are lined up properly.

Computed Tomography (CT): A CT (also known as a CAT scan) uses an x-ray and a computer to generate images of the spine in slices. The CT shows the anatomy of the spine in great detail. It also clarifies the relationship of the disc or bone spurs to the spinal cord and nerves.

Magnetic Resonance Imaging (MRI): The MRI uses a powerful magnetic field rather than x-rays to produce a detailed anatomical picture of the spine and the structures within. It is probably the best test to see herniated discs since they are soft tissue that are invisible to x-rays.

Myelogram: A myelogram is an x-ray picture taken with a special dye injected into the spinal sac to highlight the spinal cord and nerves. The dye is usually injected into the spine with a needle and then the x-rays are obtained. Myelograms have largely been replaced by CT and MRI scans.

Electromyogram and Nerve Conduction Studies (EMG/NCS): Unlike the other tests, which help reveal anatomy and structure, these tests primarily study how the nerve and muscles are actually working together. They test for the impulse coming from the brain and/or spinal cord. If the impulse is blocked somewhere, it may be delayed or diminished enroute to its final destination (i.e., muscle, skin, toe, finger-tips). This information can assist in determining which nerves or muscles are functioning abnormally.

Discography: This is a special x-ray test that may help identify which discs are damaged and if they are a source of pain. It uses a contrast dye injected into the disc space to image the disc.

Because of the difficulty of properly diagnosing the specific cause of low back pain, determining the best course of treatment for any particular patient can be a challenge. Research indicates that 90 percent of back pain sufferers get better without aggressive medical treatment. For most, rest, over-the-counter anti-inflammatory medications, massage, and heat (or cold) treatments are sufficient.

For the small percentage for whom surgery is the best option, recent advances have made pain-relieving procedures far safer and effective than ever; however, the potential benefits must always be weighed against the inherent risks of surgery.

The use of narcotic pain killers like Vicodin (hydrocodone) and Percocet and OxyContin (oxycodone) to treat back pain has become a hotly-debated issue in the medical community. For pain sufferers for whom less aggressive treatments have failed, the drugs may provide their only relief from near-constant discomfort or agony. On the other hand, the use narcotics always entails the risk of dependence or addiction. With the development of more potent non-steroidal anti-inflammatory drugs (NSAIDS), fewer and fewer doctors are treating chronic back-pain patients with narcotic medications.

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