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"Living with Low Back Pain"
By: Risa Caldoza-De Leon MD, FPAPSHPIBack to Back

Meet Ron, a family driver; Geraldine, a supermarket cashier; Bobby, a computer programmer; Jessica, a factory worker and Junjun, a badminton coach. All are in their 30’s and all share the same complaint - low back pain (LBP). Around the world, this malady ranks high, often first, as the cause of disability and inability to work as well as the reason for seeking medical consults. Eight of 10 adults, men, and women alike, will experience LBP at some point.

This malady is not a disease. In fact, only a few cases exist with a direct association to a defined disease. Acute or short term LBP often presents pain lasting up to three months and it’s normal to have repeated bouts. Sometimes, the pain is felt down to one or both legs. The sensation ranges from a dull ache to a sudden sharp pain. In most cases, back pain resolves on its own within a few weeks. Geraldine recalls that all through her 20s, she kept having lower back pains, not severe enough for her to seek consult, but it had led to absences, which made her employers fire her. “Pang siyam ko na pong trabaho ito kasi lagi akong absent dahil sa likod ko. Ang hirap po kasing magtrabaho ng may nararamdaman,” she said.

The acutest LBP stems from a disruption in how the parts of the back, from the spine, muscle, round rubber pads called intervertebral discs, and nerves, fit together and move. Your spine is made up of small bones, called vertebrae, which are piled on top of one another. The lower back where most back pain occurs includes the five vertebrae (referred to as L1-L5), which supports much of the weight of the upper body. Thirty-one pairs of nerves are rooted to the spinal cord and control body movements and send signals from the body to the brain.

Two of 10 people affected by acute LBP develop chronic LBP with persistent symptoms for one year. Chronic back pain usually lasts for 12 weeks or longer, even after an initial injury or the underlying cause of acute LBP has been treated. According to Junjun, he had been having physical therapy because his back pain is troubling him, enough to interfere with his coaching. “It’s a good thing that I only coach part time and I have a full-time managerial position, or else, I would be out on the streets. My treatments are expensive but worth it since when I have spasms, I can’t function properly.”

Causes of LBP:

  • sprains and strains
  • Intervertebral disc degeneration (the usually rubbery discs lose integrity as a normal process of aging)
  • Herniated or ruptured discs (intervertebral discs become compressed and bulge outward or rupture)
  • Radiculopathy (compression, inflammation and/or injury to a spinal nerve root)
  • Sciatica (form of radiculopathy caused by compression of the sciatic nerve)
  • Spondylolisthesis (vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column)
  • traumatic injury
  • Spinal stenosis (narrowing of the spinal column)
  • Skeletal irregularities, including scoliosis (curvature of the spine) and lordosis (abnormal arch in the lower back)
  • Infections 
  • Tumors
  • Cauda equina syndrome  (serious, but rare complication of a ruptured disc)
  • Abdominal aortic aneurysms 
  • Kidney stones 
  • Inflammatory diseases of the joints such as arthritis, including osteoarthritis and rheumatoid arthritis
  • Osteoporosis (metabolic bone disease)
  • Endometriosis (buildup of uterine tissue in places outside the uterus)
  • Fibromyalgia (chronic pain syndrome)

Check out if you are you at risk?

  • Age: 30-50 years old
  • Fitness level: Unfit physically, inactive
  • Pregnant
  • Weight gain: Overweight, obese
  • Genetics: Do your parents suffer from LBP?
  • Occupational risk factors: Jobs that require heavy lifting, pushing, or pulling. An inactive job or a desk job that requires you to sit all day.
  • Mental health factors: anxiety and depression, stress
  • Backpack overloads in children. The American Academy of Orthopaedic Surgeons recommends that a child’s backpack should weigh no more than 15 to 20 percent of the child’s body weight.

How is back pain treated?

In general, treatment for LBP falls into one of three categories: medications, physical medicine, and surgery.

Physical

  • Hot or cold packs have never been proven to quickly resolve LBP but it may ease pain and reduce inflammation
  • Activity: Limit bed rest and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain.
  • Strengthening exercises are not advised for acute LBP but may speed recovery from chronic LBP.
  • Physical therapy programs

Medications

  • Analgesic medications range from over the counter (OTC) acetaminophen and aspirin, as well as prescription opioids (addicting) such as codeine, oxycodone, hydrocodone, and morphine. Tramadol is a good example of an opioid analgesic. It works by changing the way the brain and nervous system respond to pain. Tramadol is used to relieve moderate to moderately severe pain, including pain after surgery. The extended-release or long-acting tablets are used for chronic ongoing pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS) include OTC ibuprofen, ketoprofen, and naproxen sodium. Prescription NSAIDS include COX-2 inhibitors. Long-term use of NSAIDS has been linked to stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and rarely, kidney and heart problems. Anticonvulsants, which treat seizures, may help people with radiculopathy and radicular pain.
  • Antidepressants such as tricyclics and serotonin and norepinephrine reuptake inhibitors have been commonly prescribed for chronic LBP.
  • Counter-irritants such as creams or sprays applied on the skin, stimulate the nerves in the skin to dull pain. Topical analgesics reduce inflammation and stimulate blood flow.
  • Steroids, taken either orally or injected into the spine, deliver a high dose of anti-inflammatory medicine.

Regardless of your age or symptoms, if your back pain does not get better within a few weeks, or you have a fever, chills, or unexpected weight loss, you should visit your doctor.

Surgery

When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.

Can back pain be prevented?

  • Avoid movements that jolt or strain the back
  • Maintain correct posture. Don’t slouch! Mom is right when she says sit up straight.
  • Lift objects properly. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. Keep objects close to the body.
  • Use ergonomically designed furniture and equipment to protect the body from injury at work and home. Make sure work surfaces are at a comfortable height.
  • Exercise - Speed walking, swimming, or stationary bike riding 30 minutes daily can boost muscle strength and flexibility. Yoga also can help stretch and strengthen muscles and improve posture. Remember to always stretch before exercise or other strenuous physical activity.
  • Wear comfortable, low-heeled shoes.
  • Sleep on one side with the knees drawn up in a fetal position to aid in opening the joints in the spine and relieve pressure. Always sleep on a firm surface.
  • Maintain a proper diet to control weight. A diet with enough of calcium, phosphorus, and vitamin D helps promote new bone growth.
  • Quit smoking. Smoking reduces blood flow to the lower spine, which can add to spinal disc degeneration. Smoking also ups the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.
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