Finding Relief from Low Back Pain
If you are suffering from low back pain, you are not alone. Below are a few facts regarding low back pain from a systematic review recently published in The Lancet Rheumatology 2023:
Low back pain is the single leading cause of disability worldwide
Low back pain can be experienced at any age
Almost everyone will experience back pain at some point in their lifetime
Prevalence increases with age up to 80 years
The highest number of low back pain cases occur between the ages of 50 and 55
Low back pain is more prevalent in women
Non-specific low back pain is the most common cause in about 90% of cases
GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29.
What is causing my low back pain?
While low back pain is one of the most common reasons people seek medical care, its cause is often unclear. Approximately 90% of low back pain occurs without an obvious structural or pathological cause seen on imaging and is classified as non-specific low back pain. Proper diagnosis and management relies on practitioners having extensive clinical experience. It requires doctors who are willing to take a thorough history and perform a comprehensive exam. Taking the time to piece together the patient's signs and symptoms allows for a specific and personalized treatment plan.
Chou R, Qaseem A, Owens DK, et al. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154:181-189GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29.Could my low back pain be a serious disease?
Less than 5% of cases of low back pain are caused by a serious medical condition. Low back pain associated with serious pathology often comes with particular signs and symptoms. Seek immediate medical care if your lower back pain is accompanied by:
Unexplained weight loss
Pain that wakes you out of sleep at night
Loss of bowel or bladder control
Loss of sensation in the perineum or genitals
A trauma (fall, blow to the back, vehicle accident, etc.)
Fever or illness
Loss of sensation or strength in your legs
A history of cancer
A history of osteoporosis
A recent surgery
How should my low back pain be treated?
Major medical organizations including The American Medical Association and The American Academy of Family Physicians cite low back pain treatment guidelines developed by The American College Physicians, the largest specialty medical organizations in the U.S. The guidelines are based on multiple systematic reviews and were published in the Annals of Internal Medicine in 2017. These treatment guidelines recommend that acute, subacute and chronic low back pain be treated initially with non-prescription therapies such as acupuncture, spinal manipulation, yoga, massage, heat, exercise, mindfulness-based stress reduction and lifestyle modification.
If first line treatments fail, guidelines indicate that prescription medications should be administered at the lowest effective dose for the shortest time period and does not preclude the continuation of first line therapies.
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians, Qaseem A, Wilt TJ, McLean RM, et al. Ann Intern Med. 2017;166(7):514-530.Below is a copy from the Journal of the American Medical Association Patient Page summarizing current practice guidelines for the treatment of low back pain.
JAMA Patient Page: July 20, 2021; Qaseem A, Wilt TJ, McLean RM, et al. Ann Intern Med. 2017;166(7):514-530.Available at: http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
Most of us will suffer with low back pain sometime in our lives. While it may be difficult to find a specific cause, most low back pain is not due to a serious medical condition. Major medical organizations recommend non-prescriptive first line treatments such as acupuncture, spinal manipulation, yoga, massage, heat, exercise, mindfulness-based stress reduction and lifestyle modification. Practitioners who are willing to take a thorough history and perform a comprehensive exam can work with you to develop a specific and personalized plan that gives you pain relief and gets you back to living your life and meeting your goals.