Lower back pain: Who should be more careful? Attention and intensive care are needed for people with lumbago lasting more than a month and a half, as they risk their low back pain becoming a chronic condition.
A review of studies, published in the Canadian Medical Association Journal, found that people with acute and sub-acute low back pain experienced an improvement in pain and difficulty in daily life within the first 6 weeks.
However, there is a percentage of patients with sub-acute low back pain who recover very slowly. Because the symptoms of these are very likely to become chronic and do not significantly improve over time (as was also shown by the study), it is considered appropriate to identify and intensify their care in order to prevent such a development.
“Back pain is very common orthopedic problemas over 600 million people worldwide experience lower back pain each year. This pain can come from any structure in the area, such as bones, joints, muscles, tendons, ligaments and nerves.
Although does not discriminate by agelower back pain occurs more often in people between the ages of 30-50, especially those who do not exercise, since then the muscles are not strong enough to support the spine adequately.
The increased weightthe repeated weight lifting, h poor posture and the smoking (due to the reduction of blood flow to the spinal discs) are the most common causes of it. Genetics also plays an important role, as it is responsible for the occurrence of certain diseases, such as ankylosing spondylitis”, explains the Spine Surgeon, Director of the Spine & Scoliosis Department at the Athens Medical Center and Scientific Director and Head of the Spine Department of Osteon Orthopedic & Spine Clinic, Dr. Konstantinos Starantzis.
Sometimes, the pain is caused by a specific reason, such as from injury or illness (herniated disc, stenosis, osteoporosis, etc.), but in most cases the pain is non-specific, i.e. the cause of it has not been clarified. It is often the result of simple strain.
The onset of low back pain varies from person to person and from case to case in the same patient. It can appear suddenly, after a poor movement or incorrect posture or weight lifting, or gradually. Sometimes it is mild and tolerable and other times unbearable.
Its regression also has a large time variation, from a few days to weeks, or much longer. According to the American Academy of Orthopedic Surgeons, most patients recover in a few weeks. In about 90% of cases the pain is temporary. But 50% of people who experience low back pain will have a recurrence within a year.
Understanding the clinical course of low back pain is essential to identify patients at risk of persistent low back pain so that they receive the correct treatment and advice.
In their review the Australian researchers included 95 studies, which included people with non-specific acute (< 6 weeks), sub-acute (6 to 12 weeks) or persistent (12 to less than 52 weeks).
Participants in the third category were found to have high levels of pain and disability with little improvement over time. Most people in the other two categories started to get better within the first 6 weeks, but a significant number in the sub-acute low back pain group had ongoing pain and physical difficulties. Identifying these and receiving increased care is the endpoint of the study, in order to speed up their slow recovery and avoid their back pain becoming chronic.
“Management of non-specific low back pain includes medications such as oral non-steroidal anti-inflammatory drugs and muscle relaxants and/or topical analgesics, non-drug options such as rest (not immobility but limited activity) and heat. Physical therapy is valuable for both recovery from an episode and prevention of recurrence by strengthening back and abdominal muscles, increasing flexibility, and training the patient to stand and sit with proper body alignment so that they do not his waist is straining.
To treat pain in patients that does not improve with conservative methods, there are invasive techniques. We have at our disposal medicines, which are granted through spinal injection (intraforaminal – perineural – epidural injections), which aim to reduce the swelling and inflammation of the spinal nerves. They are performed on non-hospitalized patients, without anesthesia, under radiological guidance. The duration of the procedure does not exceed 10 minutes in total. Repeating these injections is allowed for people who cannot have surgery, regardless of the reason, but there is a limit to the number per year.
Patients with specific pain, i.e. those whose cause is known, the therapeutic course is the same, except that they have another final option: surgery, which provides a definitive solution to the pain and the daily self-care difficulties due to it. The type of operation depends on the condition.
However, the most important thing to keep in mind for those who experience low back pain is that they should refer to a specialist spine surgeon when the pain lasts more than two to three weeks, in order for him to evaluate and perform clinical and imaging tests to determine its cause and recommend appropriate treatment.
Early diagnosis can speed up definitive treatment and free them from repeated incidents that inevitably have an impact on their quality of life,” concludes Dr. Starantzis.