Pain Pointers: Low Back Pain

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LOW BACK PAIN (LBP):is probably the most common pain malady in all of medicine after HAs. It is one of the more common pain diseases seen in young persons. Most cases relate to muscle spasm rather than to joint mediated pain. Additional pain patterns relate to ligament & tendon generated pain. Most people have back pain because they have injured themselves in ADL (activities of daily living) because they are not in good muscular shape, or they have succumbed to a "repetitive stress injury" pattern from repeated, abnormal, harmful motion at work. Stretching of the large paraspinal muscle groups should be a common daily activity prior to any exercise.

Back surgery should be avoided until a) a motor (movement) problem is about to be present as signaled by weakness in the involved extremity (but this becomes a near emergency at this point and surgery is immediately mandatory), b) the pain which had been nearly intolerable, abates, c) the pain is intolerable. In this latter circumstance, extreme care should be exercised because several published studies demonstrate when a person has back surgery only for pain, one third improve, one third do not change, and one third worsen. Appropriate diagnosis, therapy involving exercise and other muscle therapy, will most commonly relieve the discomfort without surgery.

Prevention programs are divided into three categories. Primary prevention aims to reduce the occurrence of NSLBP before it occurs. Secondary prevention aims to reduce severity and/or the recurrence of NSLBP episodes. Tertiary prevention involves the reduction of disability and restoration of function in chronic LBP patients.

A back school consists of a group of individuals with or without NSLBP as it is often preventive as it is therapeutic. The objective is to transfer a defined amount of knowledge to help the individual or patient change behavior and increase function. Providing information to the patient with back pain is a two way process. It involves both the patient's and the health care provider's concepts and theories about the symptomatology. The educator must be sensitive to patient beliefs, understand patients' prior experience with the health care system, and provide and reinforce the same message to the patient. Patients with acute NSLBP should be given information including the promising natural history of NSLBP, simple symptom control methods, activity modifications that are reasonable and know-how regarding avoiding aggravation of current symptoms and recurrences. The patient should be told there is no need for sophisticated diagnostic tools at the present time, since there are no indications of a serious condition.

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