Don't shrug off low back pain

Pain in the lower back in particular is both a common reason for seeing the doctor and one of the main causes of work absenteeism. 

Often it resolves itself or is relieved with the help of simple medication, but in some cases it can require specific treatment, or even emergency surgery. So it’s important to quickly assess the severity to prevent possibly serious complications. 

The ache emanates from the spine in the lumbosacral area, in the lower third of the back. The spinal discs between each set of vertebrae serve as shock absorbers and allow flexibility of the spinal column. These discs have two layers of cartilage, the outer one stronger. Nerves extend from the spinal cord next to the discs and many ligaments and muscles are attached to the backbone.

Back pain can result from several underlying causes, but in most cases no definite cause is ever found. Acute non-specific back pain lasting for less than six weeks could be related to muscle sprain, over-stretched ligaments, or a minor disc problem. In about 90 per cent of cases, the pain requires no investigation because it disappears or significantly lessens within a few weeks, although some recurrence may occur later. 

Medication – painkillers and anti-inflammatory agents – and physiotherapy are often effective in treating the pain, whereas spinal manipulation using chiropractic or osteopathic techniques and acupuncture give conflicting results. When the ache continues for more than six weeks, it’s called chronic non-specific back pain. It could be due to illness within the abdomen or the backbone and demands further investigation. 

     In some cases the back pain is linked to a nerve root syndrome or sciatica. A damaged spinal disc compresses the nerve emerging from the spinal cord and an MRI or CT scan might be required. 

The pain, which can be acute or chronic, might be felt all the way from the buttocks to the foot. The damaged disc could be due to a simple “bulging” of the outer cartilage or to the herniation of the disc, resulting from a crack in the outer layer, allowing the inner soft cartilage to “stick out”. 

Most sciatica can effectively be controlled with medical treatment and physiotherapy. In a few cases, however, the persistence of intense pain and/or signs of progressive nerve damage, such as numbness of the affected area, might require surgery – which must be performed by experienced spine orthopaedists or neurosurgeons. 

In rare cases, low back pain is accompanied by numbness in the groin, weakness in one or both legs and inability to control bowel movements or urination. Such signs are induced by compression of the lowest part of the spinal cord, a condition called cauda equina syndrome. If you have such symptoms, see a doctor immediately. 

This is a medical emergency – the compression of the nerves must be relieved before they’re permanently damaged. 

You can prevent low back pain by doing exercise that strengthens the muscles and flexes the spine, by improving your posture, and by maintaining a normal body weight.

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande @ceo-health.com.