The following is the opinion of an independent third party, not ERRX LLC
Who
Suffers from Chronic Low Back Pain?
Chronic low back pain is among the most common chronic pain
syndromes, affecting men and women equally. If left untreated,
it can cause unnecessary suffering and upset a person's life
at home and on the job. The good news is that a wide range
of treatment options are readily available to successfully
reduce or manage this type of pain.
Chronic low back pain frequently affects people in their prime
working years and, as a result, it is the single largest cause
of lost work days and lost income. It also accounts for more
than 25 percent of all workers' compensation claims, with
a great cost to society. Additionally, while studies show
that many sufferers do not seek medical attention, chronic
low back pain remains a primary reason for hospital and physician
office visits.
What Are the Symptoms?
The symptoms of chronic low back pain are varied, making a
precise diagnosis often difficult. Low back pain is considered
chronic if it persists for more than three months. Many people
have a limited range of motion or tender areas. In addition
to the actual back pain, some people may experience fever
or weight loss, which can indicate illness or infection. Psychological
symptoms also may occur.
Depression has been shown to be three to four times as prevalent
in patients with chronic back pain as in the general population.
Chronic low back pain can be shooting, stabbing, localized
in nature, or referred from another part of the body. In some
cases, people with chronic low back pain are found to have
distinct pain syndromes, including arthritis, myofascial pain
with muscle spasm, degenerative joint disease and radiculopathic
pain (pinched nerve). They may experience this pain only when
walking, sitting or standing, each action suggesting a specific
root cause. Whatever its degree and nature, chronic low back
pain should always be evaluated by a physician to rule out
any serious problems.
The Causes of Chronic Low Back Pain
and How It Can Be Diagnosed
The Causes of Back Pain
There are many pain-sensitive structures in the back. Injuries,
infection or inflammation affecting these structures are often
the origin of chronic low back pain. Most cases result from
simple sprains or strains of the muscles and ligaments. Others
may be related to bruises and disk herniations.
How Is Chronic Low Back Pain Diagnosed?
Diagnosis of chronic low back pain, as well as of its many
related syndromes,
relies heavily on a thorough physical examination and blood
work-up, a complete medical and psychosocial history, and
a description of the pain, including its location and how
it started. While a good physical exam focuses on obvious
deformities, tender areas, range of motion and neurologic
function, it also can shed light on problems not easily diagnosed
that involve the muscles, connective tissue, nerves and spine.
There are special maneuvers that should be performed so that
the physician can correctly assess and distinguish the many
possible causes of chronic low back pain.
Imaging techniques may be necessary if there is tenderness
over the spine or the patient's history indicates the possibility
of a tumor or infection. Magnetic resonance imaging (MRI)
is used to evaluate tissue, bone, muscles and nerves; computed
tomography (CT) provides three-dimensional images of internal
structures such as organs; and myelography and electromyelography
inject contrast dyes into the spine to produce pictures of
the spinal cord. Simple X-rays can be very useful in determining
such conditions as osteoporosis and spondylolisthesis.
Other more advanced diagnostics -- thermography, diskography
and electrophysiologic studies among them -- also are sometimes
necessary.
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Thermography
converts measurements of body heat, increased by inflammation
or infection, into visual signals that can be photographically
recorded. |
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Diskography
takes pictures of vertebrae in the spine following the
injection of radiopaque chemicals that can withstand radiation
and X-rays to identify areas producing pain. |
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Electrophysiologic
studies examine the electrical aspects of body functions. |
When
no physical reason for the pain can be identified, treatment
can be difficult to determine, necessitating a multidisciplinary
approach to care. In addition, depression, stress or other
psychological dysfunction should be treated at the same time.
Treatments
for Chronic Low Back Pain
Treatment for chronic low back pain may last from a few
weeks to several months, and usually takes a multimodality
approach, in which several different therapies (drug, physical,
interventional, complementary, psychological) are used in
combination with one another.
Drug Therapy. Medications
may include nonsteroidal anti-inflammatory drugs (NSAIDs),
adjuvant analgesics (like antidepressants and anticonvulsants),
and opioids. Long-term opioid therapy may be appropriate for
carefully selected patients who can be monitored by their
physicians and who can appropriately manage their medication.
Physical Therapy. Walking,
swimming or cycling on a stationary bike can provide
general conditioning and help strengthen weakened muscles
while minimizing the stress on the spine. Therapy is tailored
to the patient, with gradual increases in duration.
Interventional Therapy. One
way to alleviate chronic low back pain is to block or numb
pain pathways. This is accomplished through a variety of invasive
treatments, including epidural steroids, injections, joint
and nerve blocks and analgesic pump devices.
Complementary Therapy.
Used in combination with analgesic treatments, complementary
therapy incorporates a wide range of practices that are thought
to prompt the body's release of pain-relieving substances.
They include acupuncture, massage, meditation, herbal remedies,
chiropractics and hot and cold packs.
Psychological Therapy.
Some patients can benefit from counseling (single or group).
Employee assistance programs, located at the job site, and
often free of charge, can also help.
Some
patients with chronic lower back pain may require surgery
as a final alternative. And, for some patients who are particularly
disabled, a formal program administered by a multidisciplinary
pain center may be best.
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