The term low back pain defines any low back pain, that is, in the anatomical space between the first lumbar vertebra (L1) and the sacrum (S1) and that can affect from the vertebral midline to the lumbar flanks. It is the condition most frequently seen in both primary care and pain management practices. It is also the most frequent and prevalent pain condition among the general population, as well as the major cause of absenteeism from work.
The causes may be varied and should be evaluated and studied by a specialist. Disc pathology (rupture of disc ring fibers, disc protrusions or herniated discs) and degenerative arthropathy of facet joints are the most frequent cause, but other causes should be ruled out, such as tumor or metastatic causes, pain radiating from abdominal organs, vascular or rheumatologic pathology or muscle overload. The correct study should include a clinical history and physical examination of the patient and, if necessary, the performance of complementary imaging tests (MRI, CT or scintigraphy), analytical tests, etc.
In some cases the specialist in the Pain Unit can perform “test blocks” on certain structures, techniques with very little or minimal risk, to locate the exact origin of the pain.
How can we relieve low back pain?
In the early stages, pain relief in low back pain is based on systemic analgesics, associated with coadjuvant drugs such as muscle relaxants or anti-inflammatory drugs, as well as orthopedic measures (sacrolumbar support braces, local heat or TENS). Physical measures and physiotherapy are sometimes helpful. The most important thing is a correct diagnosis in order to direct and focus the treatment.
In later phases or with very high levels of pain, different types of blocks (epidural, facet, etc.) or special techniques of ozone therapy, collagen infiltration or radiofrequency are used.
Platelet-rich plasma concentrates and other biological medicine techniques (stem cells, etc.) are also being used in certain cases with good results, especially due to their safety, as they are practically free of adverse effects.
What exercises can we do to improve?
The most recent studies show that inactivity is not necessary and may even be harmful. The degree of physical activity should be directed by a specialist, but in general, if the pain allows it, it is recommended to maintain moderate physical activity (walking, swimming, etc.) and exercises aimed at maintaining joint mobility, avoiding the appearance of thromboembolic phenomena due to circulatory remansamiento and minimizing the loss of muscle mass. Yoga or pilates sessions can be carried out under the guidance of an appropriate professional.
In what way can it disable the patient’s life?
The degree of disability depends on the intensity and duration of the pain, the prescribed medication, and the time of evolution of the pathology. If there is compression of the sciatic nerve roots, this may suffer an irreversible lesion if action is not taken promptly. Neurological claudication manifests as pain when walking short distances, requiring the patient to sit down or stop, whereupon the pain subsides momentarily. Usually the distance at which the pain appears is gradually shorter.
Likewise, facet lesions may prevent standing without moving for intervals of time, requiring the patient to walk or continually change support or position.
Can it become chronic low back pain?
Low back pain is considered chronic when the pain lasts for more than 6 months. In these cases, treatment is more complicated and generally less effective. Ideally, low back pain should be treated appropriately (almost always by means of blocks) if the pain persists beyond two months, in order to avoid reaching the sixth month and chronification, which is much more difficult to treat.
Together with chronic low back pain of long evolution, there are often psychological symptoms of depression, anxiety, dependence, etc., associated with work or family problems.
It is considered that with early and effective treatment only 15% of low back pain would become chronic, while in chronic low back pain treatment decreases its effectiveness to resolve only 50% of the cases.