Lower Back Pain: Causes, Risk Factors, and Treatment

Article Topics :

• Overview
• Lower Back Pain (LBP) Facts and Figures
• Symptoms of Lower Back Pain
• Quick Lower Back Pain Solutions
• Causes of Lower Back Pain
• Risk Factors for Lower Back Pain
• Medications for Treating Lower Back Pain
• Treating Lower Back Pain Without Medications
• Other Pain Relief Options
• Final Thoughts

Overview

Lower back pain is a common problem that has been reported as the leading cause of disability and absenteeism from work in all parts of the globe, and affecting approximately 32 million people in the U.S. About 80 percent of adults experience low back pain at some point in their lifetimes.
The prevalence of lower back pain has led to a continually growing collection of treatment strategies comprised of prescription drugs, chiropractic care, surgery of various types, psychotherapy, and lifestyle adaptations that include exercises and other natural techniques.

To understand LBP’s overarching cause, we have to take a look at the structure of the back and spine. The spine’s main function is to act as a strong shield that protects the sensitive vertebral column with its array of nerve endings that, together with the brain, constitute the heart of our central nervous system. The spine also needs to be malleable enough to permit bending and flexibility.

The problems begin right there, for the spine itself is an intense hub for nerve endings and can thus harbors a complex assortment of areas that can develop non-kidney related pain. For example, there can be strains to the large back muscles, injuries to the ligaments that protect the spine, disc or individual vertebra dislocations, and many more possibilities for joint or nerve damage.

The good news is that much of the non-kidney related pain that we often experience will simply go away on its own after a few days or weeks. In fact, the relevant and much documented statistic is that half of the back pain we experience will dissipate on its own within two weeks, and 90% within three months. The leftover pain, i.e. the pain that will not go away either on its own or as a result of some treatment, becomes known as chronic pain, i.e. pain that lingers for at least 12 weeks.

Lower Back Pain (LBP) Facts and Figures

According to the Global Burden of Disease, low back pain is the single leading cause of disability worldwide. Here are some facts relating to low back pain in the U.S.:

• It is thought that some 32 million Americans experience lower back pain at any given time.
• Half of the American workforce reveals they’ve had low back pain in the past year.
• Americans spend over $50 billion a year on non-kidney related lower back pain.
• Nearly one third of female adults suffer from lower back pain compared to a quarter for men, yet men claim their pain affects work 33% more so than women.
• 54% of U.S. citizens who have non-kidney related low back pain conduct their work while sitting.
• Most causes of back pain are not associated with serious conditions like cancer, arthritis, or broken bones.
• Back pain is one of the top reasons why people visit the doctor every year.

Symptoms of Low Back Pain

Back pain can develop quickly, gradually, or in episodes, with certain movements exacerbating it, while walking or resting may alleviate it. In general though, the symptoms that are associated with lower back pain (LBP) include:

• Shooting pain down one or both lower extremities (aka sciatica)
• Sensation of pins and needles
• Pain as the spine bends or twists
• Sharp pain
• Pulsating pain
• Numbness
• Muscle spasms
• Dull ache
• Tingling
• Tenderness
• Incontinence of bladder and/or bowel

Quick Low Back Pain Solutions

Many cases of non-kidney related lower back pain will disappear after 2 weeks. This can happen when, once we feel the pain, we:

• Rest for a period of time
• Get good sleep over a few nights
• Get a deep tissue massage
• Go to physical therapy
• Do some stretching exercises
• Do some low back pain exercises
• Use cold or heat treatment
• Use prescription or over the counter medications
• Or indulge in some stress-relief techniques like yoga or meditation

If none of the above responses resolve the problem, then it is time to go to the doctor for testing.

There are two non-kidney related conditions that could be possibilities if you’ve experienced a few days of pain that may need emergency attention. These are:

• Sharp abdominal pain, often accompanied by vomiting diarrhea or constipation, watery stools, spasms, bloating, gas, or rectal bleeding, all of which produced by a condition known as bladder and bowel dysfunction (problems with urinating and passing stools)
• Primary neurologic disease known as Myelopathy, or damage to the spinal cord. Its symptoms consist of progressive weakness in the legs and hands associated with clawing of the feet, numbness of hands and feet, and foot pain

Fortunately, these two conditions are rare.

Causes of Low Back Pain (LBP)

Studies have revealed that 90% of people with non-kidney related lower back pain in America never find out what caused their pain. Only 10% of Americans can attribute their lower back pain to an identifiable cause. In addition, the vast majority of (non-kidney related) cases of low back pain are chronic, meaning that the pain persists and recurs regularly, or that it lasts for longer than 12 weeks.

There are dozens of potential causes for lower back pain. Here is a short list of those with the highest incidence in the U.S.:

Lumbar herniated (slipped) disc

This can occur at any level in your spine when the soft center of a lumbar disc tears through the harder outer layer and pressures the closest nerve root.

Degenerative disc disease

Part of the aging process is that vertebral discs lose their jelly-like mass and wear down, restricting their ability to resist pressures. They can thus transfer pressure to the disc wall that may tear and become painful or weak (and may lead to herniation).

Spinal Osteoarthritis

This is also referred to as spondylosis or degenerative arthritis of the spine, and it is associated with aging and obesity. It is slowly progressive, and it may cause stiffness in the back and neck. Younger people may develop it as well, mostly through injury or heredity.

Lumbar spinal stenosis

This is a medical condition in which the spinal canal where the nerve roots are located narrows, compressing the spinal cord and nerves, and causing pain.

Facet joint dysfunction

This is also known as osteoarthritis. The facet joints have cartilage around the discs and are surrounded by capsular ligaments that enhance your back’s flexibility and enable you to bend and twist.

Spondylolisthesis

This condition of the back occurs when one vertebra slips over the adjacent one. The pain ensues when the affected nerves are compressed.

Sciatica

The sciatic nerve is your body’s longest nerve and one of the most important. It begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg. Sciatica is caused by a variety of low back conditions, including lumbar degenerative disc disease.

Compression fracture

This is mostly due to weak or brittle bones such as from osteoporosis that cause a fracture in the cylindrical vertebra.

Deformity

This is the forward curvature of the upper body, known as thoracic Kyphosis. This combination of forward and reverse curves in the spine allows people to sit and stand upright. This deformity can cause lower back pain if it leads to the breakdown of the discs, facet joints, sacroiliac joints, or stenosis.

Risk Factors for Low Back Pain

There are many risk factors for non-kidney related pain in general and lower back pain in particular. Among those, the most prominent risk factors include:

• Tumors
• Autoimmune disease
• PMS (Premenstrual Syndrome)
• Pelvic inflammatory disease (PID)
• Infection
• Prostatitis
• Kidney stones
• Endometriosis
• Cervical dysplasia
• Fibromyalgia
• And other conditions

Kidney-Related Lower Back Pain

The kidneys are vital organs that are located in the upper abdominal area against the back muscles on both sides of the body. The kidneys serve to continually rid the body of excess fluids and waste material. Kidney-related pain is caused primarily either by urinary tract infections or kidney stones, this latter usually producing symptoms of extreme and relentless pain, until the stones are either removed or made to dissolve.

The trouble with the pain that can emanate from the kidneys is that it can so readily be confused with other causes of low back pain. It is therefore essential to look out for typical kidney related issues through the typical symptoms that urinary tract infections or kidney stones produce. These include:

• Flank pain
• Fever
• Nausea
• Vomiting
• And very painful urination

Kidney pain can be on the left, right, or both sides of the lower back area.

When the diagnosis points to an infection, antibiotics are used for kidney treatment, often together with ibuprofen (Tylenol) or acetaminophen (Motrin). On the other hand, kidney stones can pass naturally or, when needed, can be taken out surgically.

Females at Greater Risk for LBP

When comparing men and women’s lifestyles, women live overall healthier lives with more healthy behaviors and less obesity. Yet women are more likely than men to report lower back pain. Nearly a third of female adults suffer from lower back pain compared with only a quarter for men. Here is a short list of reasons:

Osteoporosis

This is the most common cause of vertebral compression fractures, especially in women over the age of 50. Women are almost twice as likely as men to have a compression fracture.

Spondylolisthesis

This is a degenerative disease that generates muscle pain, stiffness, pain in the low back and legs, and fatigue, and women are 3 times more likely to develop it than men.

Spinal Osteoarthritis

This is a degenerative joint disease that constitutes the most common type of arthritis. It produces pain in the knees, hips and lower back. It is prevalent in both men and women up to age 45, but beyond that, it is more prevalent in women.

Coccydynia (tailbone pain)

This makes sitting painful, and women are 5 times more likely than men to develop it. It affects women at an average age of 40 and can become chronic.

Sacroiliac Joint Dysfunction

The sacroiliac joint serves as a shock absorber between the upper body and pelvis commonly producing low back and leg pain. It produces chronic pain that is more prevalent and frequently more severe in women.

Fibromyalgia

This is a disorder that produces widespread pain and fatigue and that is difficult to diagnose and treat. Over 80% of those who develop fibromyalgia are women.

Medications for Treating Lower Back Pain

Here is a brief listing of drugs commonly prescribed for patients reporting lower back pain:

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in pain management to alleviate the symptoms of pain. These are pain suppressant drugs that work by blocking the effects enzymes in the body and reducing inflammation. Examples of NSAIDs are Celebrex, Motrin, Advil (ibuprofen), Indocin and several other medications.

Antidepressants

Antidepressants, though intended for depression, have been found to be effective treatments for certain kinds of pain, one of which is lower back pain. It is thought that they increase neurotransmitters in the spinal cord that decrease pain signals. Most antidepressants don’t work right away – they may take a few weeks to provide some relief. Of different classes of anti-depressants, tricyclic antidepressants are most commonly prescribed for pain. Examples include Amitriptyline, Imipramine (Tofranil), Clomipramine (Anafranil), Doxepin, Nortriptyline (Pamelor), and Desipramine (Norpramin).

SSRIs

Selective Serotonin Reuptake Inhibitors (SSRIs), are a relatively new class of anti-depressant and anti-anxiety medication, usually prescribed in non-kidney related pain management techniques together with psychotherapy.

SSRIs are commonly used drugs for the treatment of Generalized Anxiety Disorder (GAD) as well as various other anxiety and phobia disorders. Such drugs include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Escitalopram oxalate (Lexapro)
• Citalopram (Celexa)

Anti-Seizure Medications

The Food and Drug Administration (FDA) has approved a few anti-seizure, or anti-convulsant, drugs for the treatment of chronic pain. These include:

• Carbamazepine (Tegretol) for trigeminal neuralgia, diabetic neuropathy pain and postherpic neuralgia
• Gabapentin (Neurontin) for postherpetic neuralgia, or shingles pain, and also diabetic neuropathy
• Pregabalin (Lyrica) specifically for postherpic neuralgia and diabetic neuropathy.
• And various other anti-seizure medications.

Muscle Relaxers

Muscle relaxers are a group of drugs that have a sedative or calming effect on the body. They work through the brain, as opposed to directly on the muscles. Muscle relaxants are widely prescribed for acute back pain, often in addition to an over-the-counter or prescription pain medication. Usually, doctors will prescribe them for a short time to relieve lower back pain caused by muscle spasms. Muscle relaxants are generally used for a few days (up to two weeks), but they can sometimes be prescribed for chronic back pain. One side effect of these medications is drowsiness so use caution if taking them during the day.

Corticosteroids

Corticosteroid drugs reduce spontaneous discharge in an injured nerve, which in turn reduces inflammation and neuropathic pain. They may be given orally, intravenously or via injections directly into joints. Commonly prescribed corticosteroids for pain include Prednisone, or prednisolone, and Dexamethasone.

Prescription Opioids

Opiods are high strength pain killers, and they represent the most widely prescribed class of medications in the U.S., despite their addictive and potentially harmful nature. Over the last decade, the number of prescriptions for the strongest opioid drugs has increased nearly fourfold, with only limited evidence of their long-term effectiveness or risks.

The rising use of legal prescription opioids, primarily painkillers such as Oxycodone and Hydrocodone (Oxycontin and Vicodin), has become a growing problem leading some patients from pain care to addiction. Deaths and other negative health outcomes from these prescription drugs and heroin have spiked, and surveys suggest that hundreds of thousands of patients nationwide may be on potentially dangerous dosages. However, sometimes opioids may be necessary to relieve severe pain for a temporary period of time. Discuss with your doctor whether the benefits outweigh the risks for your particular situation.

Treating Lower Back Pain Without Medication

There’s no commonly accepted pain relief program for those with lower back pain. However, people with low back or other chronic pain might seek relief through a variety of treatments that may include the following:

Physical Therapy

Physical therapy is usually prescribed as an initial attempt at mitigating pain before pursuing more aggressive treatment options. Physical therapists can provide possible treatments and techniques such as electrical stimulation, muscle-release techniques, heat, or ultrasound, to aid your back muscles and soft tissues for pain relief. Physical therapy will typically focus on decreasing back pain, increasing function, and teaching the patient exercises to do at home to prevent future back problems.

Cognitive-Behavioral Therapy (CBT)

Contingency Management and Cognitive Behavioral Therapy (CBT) focus on modifying the patient’s expectations and behaviors related to pain, building coping skills, and improving overall health. Psychotherapy treatments like cognitive-behavioral therapy (CBT) have shown benefits for those experiencing pain, especially when applied in tandem with pharmacotherapies.

Other Pain-Relief Options

You may also want to pursue some of these other alternative treatment options:

• Surgery
• Cortisone injections
• Stretching
• Chiropractic care
• Massage and manipulation
• Losing weight (for overweight people)
• Acupuncture
• Yoga, meditation and other relaxing techniques
• Cold and hot therapy

Low Back Pain Exercises and Stretching

If you have back or joint pain, there will be times when all you want to do is lie in bed all day. Lying in bed used to be what doctors prescribed the most, although it has been shown in many studies that it is stretching, exercise and staying flexible that does your back pain, and overall health, the most good.

There are many simple stretches and exercises that can be performed in 20 to 30 minutes as part of your daily routine. If you are just starting out, even a simple act of sitting upright on an exercise ball for 30 minutes a day will engage your core muscles.

The muscles in your abs and back play a critical role in supporting your lower spine. These muscles don’t get a good workout during the course of a normal day—they need to be specifically targeted through stretches and exercise.

Stretching

Specific stretches are often prescribed by physical therapists, and it is important to follow their instructions before you commit yourself to a wrong type of movements that may do more harm than good. Appropriate stretching of the muscles along with practice exercise workouts will help improve range of motion and generate stress relief and relief for less than optimally used muscles.

Generally speaking, people with LBP should concentrate on stretching the lower back muscles, abdominal muscles, hips, and legs.

Core strengthening exercises

Core exercises build abs and other core muscles. If you have back problems, osteoporosis or other health concerns, this type of exercises can be important, although the exercises should only be undertaken after consultation with a licensed physical therapist or doctor. These exercises include:

• Abdominal crunch
• Bridge
• Single-leg abdominal press
• Single-leg abdominal press variations
• Double-leg abdominal press

Dynamic stabilization exercises

These exercises comprise the use of various types of exercises to stabilize your core muscles and may include use of exercise balls, balancing machines or specific stabilizing exercises. By keeping your trunk steady as you move one or more of your extremities, you can begin to develop your dynamic stabilization.

Final Thoughts

Though back pain can be uncomfortable and debilitating, it is typically temporary and will resolve on its own or with treatment within a few weeks or months. If pain medications are not providing relief, ask your doctor about alternative treatments like acupuncture. Remember – 80% of adults have back pain sometime in their lives, so you are not alone. Fortunately there are many options for treatment and relief, so there is a good chance that one of these methods will work for you.

References

• https://www.spine-health.com/treatment/physical-therapy/physical-therapy-low-back-pain-relief
• https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011133/
• https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
• https://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment

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