Low Back Pain

Low back pain is a significant problem for our society. It is estimated that low back pain is the most common cause of disability within the population of North America. The costs of low back pain to productivity are enormous. It is, according to research, the second most common symptom-associated reason people seek treatment from their family doctor.

The literature suggests that up to 80% of the population in North America suffers from low back pain. Low back pain can result from car accidents, improper lifting, slipping and/or falling, prolonged sitting, prolonged exposure of the low back to vibrations (e.g. using vibrating machinery) and many other causes including aging. Whether from trauma or from the normal aging process, low back pain can seriously disrupt a person’s life. Many people will suffer from low back pain at some point during their lifetime.

The physiology of low back pain is very complex and beyond the scope of this article. There are many medical research papers that deal with the physiology of low back pain available to the reader. It is important to know, however, that low back pain frequently exists without any objective physical evidence traditionally sought by the medical profession. As a result, the investigation, assessment and treatment of low back pain is often derived mostly from the subjective complaints of pain of the sufferer. Each person will have a different perception of the level of their low back pain and the disability associated with it. Additionally, as with most types of pain, low back pain can be magnified by non-physical factors such as emotional stresses and fatigue that might otherwise appear to be totally unrelated. Because of this the assessment, treatment and ultimate response to treatment of the low back pain will tend to be a very subjective and individualized experience.

While the vast majority of people in North America will experience low back pain at some point during their lifetime, the majority of low back pain incidents do resolve within a relatively short period of time, typically within a few weeks.

Treatment for low back pain can, and usually does, depend somewhat on how long the person has been suffering from it and the intensity of the pain. For many people over the counter pain medications, rest and a few days is sufficient to allow them to resume their normal day to day activities. For others physiotherapy and/or chiropractic treatment will be helpful to relieve the low back pain. TENS, traction, ultrasound and physiotherapy have all been found to be of therapeutic benefit in the first month or so following the onset of low back pain.

When the pain lasts much longer and interferes with a person’s life, other treatments are often attempted including nerve blocks, therapeutic ultrasound, electromyographic biofeedback, therapeutic exercising, physiotherapy, and chiropractic manipulations. In the most severe and prolonged cases of low back pain surgery can sometimes be performed as a last ditch effort at pain control. Diskectomies are performed more frequently in the United States, Canada, and Europe and appear to be more common simply where there are more doctors qualified to perform spine surgeries. In addition to these physical means of treating, medications are also used to treat low back pain. These include acetaminophen, non-steroidal anti-inflammatory drugs, topical analgesics, muscle relaxants, opioids, corticosteroids, and even antidepressants and anticonvulsants.

Typical imaging (x-ray, CT, MRI) is not terribly helpful in assessing low back pain unless the low back pain is caused by trauma or there is neurological deficit. As such imaging studies are often not requested in the initial stages of low back pain. Once the pain has persisted for a period of time, however, imaging may be requested.

In the final analysis the person suffering low back pain must have confidence in their doctor in directing the testing, assessing and ultimately treating of the low back pain. This could, and frequently does, include referrals to other doctors such as physiatrists (doctors that specialize in physical medicine), orthopaedic surgeons, physiotherapists, massage therapists, neurologists and psychologists. Each of these health care specialties has something unique to bring to the treatment of low back pain. With a coordinated and thorough multidisciplinary treatment plan most people can have their low back pain level controlled sufficiently to allow them to carry on a productive and happy life.

*This article is not intended to provide legal advice. It is recommended that you consult your lawyer for advice concerning your particular case.