October
2007
Acute Low Back Pain
Acute Back Pain. Back pain in general is the #2 reason to visit the doctor. 84% adults have low back pain in their lifetimes. 1989-1990 US survey showed about 15 million doctor’s office visits for back pain (and about the same in 2002 survey). Estimate $100 billion per year for the total cost of back pain; 75% of this cost is due to only 5% of those with back pain. About ¾ who seek treatment for back pain give up sports or exercise, 60% cannot do some daily activities, and ½ give up sex due to back pain.
Risk factors for back pain: smoking, obesity, older age, women, physically strenuous work but also sedentary work, psychologically stressful work, low education, worker’s compensation, job dissatisfaction, depression, anxiety, and somatization. In England a study showed physical activity outside the workplace was not associated with back pain; instead poor physical health was associated with back pain, in particular in heavier weighing women.
Acute low back pain goes away about 80% of the time within 2 weeks, 90% of the time in 3 weeks. One study showed 90% of people with low back pain did not see their doctor after 3 months. Good prognosis for those without sciatica or systemic symptoms.
Cause of acute low back pain: 85% of the time the physiologic cause cannot be found. It is though 70% are due to a lumbar strain or sprain. Other cause include degenerative disc disease, arthritis of vertebrae, herniated disk, osteoporotic compression fracture, spinal stenosis, and spondylolisthesis (a vertebra slips forward).
Emergency acute low back pain means immediate medical attention is necessary to prevent nerve damage, such as due to abscess, tumor compression. Less than 5% of back pain seen in primary care will be something really bad like this. Cauda Equina Syndrome – bladder and/or bowel dysfunction occurs. This can be a sign of a tumor or a huge midline disk herniation and this requires immediate attention by a neurosurgeon or orthopedic specialist in back surgery. Numbness in the perineum (between the legs called Saddle Anesthesia) going down both legs also occurs. Weakness in the foot/ankle can occur as well. So systemic problems causing back pain include unexplained fever, weight loss, HIV/Immunusuppressed, cancer history, IV drug use, osteoporosis, history of prolonged steroid use, >70 years old, focal neurological deficit.
Sciatica means a lumbar nerve root is pinched. This causes parathesias (pins and needle pain or a numbness) down the buttock, back of the thigh or side of thigh to the foot. If sciatica is due to a disk herniation, increasing pressure will make the sciatica pain worse (like coughing or sneezing)
Most people with acute low back pain don’t need an X-ray or other imaging if there aren’t complicating factors. CT scan and MRI are good to show herniated disks, spinal stenosis, infection and cancer.
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drjohnhong 
Bones & Muscles, Pain 
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