Low back pain

Low Back Pain may be caused by a variety of conditions or processes. Low Back Pain is common and is believed to affect up to 90% of people at least once during their lifetime. It can be very uncomfortable but is usually not serious.

As people age, bone strength and muscle elasticity and tone tend to decrease. The discs between the vertebrae in the spine begin to lose fluid and flexibility, which decreases cushioning to the vertebrae. Pain can occur when a sprain, strain, or spasm occurs in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

CAUSE
The exact cause of Low Back Pain may be difficult to identify. In other cases the pain can be traced to a specific cause. The most common being sprain, strain, or spasm in one of the muscles or ligaments in the back caused by lifting a heavy object or over-stretching

Other causes include:
• Disc protrusion: the discs between the vertebrae may become weaker and bulge out. In an extreme case this may lead to a prolapsed disc.
• Prolapsed disc (slipped disc or herniated disc): a disc bulges so far out that it puts pressure on the spinal nerves in the back. This may cause leg pain (sciatica) since these nerves in the lower back run all the way down to the legs.
• Spinal stenosis: the spinal column runs through a narrow opening in the vertebrae. If this opening becomes too narrow the nerves may become trapped, which causes pain.
• Collapsed vertebra: the vertebrae give much of the structural support to the spine but these may become damaged as a result of disease or injury. Severe osteoporosis may result in a vertebra collapsing and by doing so disturb the surrounding structures.
• Musculoskeletal pain syndromes such as myofascial pain syndromes and fibromyalgia may cause Low Back Pain.
• Infections of the bones of the spine such as osteomyelitis or sacroiliitis can cause Back pain that is usually worse at night and worse when sitting or standing for a long time.
Pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, irritation to joints and discs, or congenital abnormalities in the spine.

Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Build up of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.

NOTE: Occasionally, low back pain may indicate a more serious medical problem. Back pain should be discussed with your Doctor.

SIGNS AND SYMPTOMS
Low back pain means a pain or ache somewhere between the bottom of the ribs, at the back, and the top of the legs. The pain often begins suddenly, and may follow an obvious strain or injury, but may develop for no obvious reason. In other cases the pain can develop slowly.

The pain may travel to or be felt elsewhere. It often goes into the buttocks, but may go further down the leg and even into the foot.

The pain may be worse on bending and is often worse sitting, especially in an easy chair. Sometimes turning over in bed and sitting up are agonising. Coughing or sneezing can often make the pain much worse. The muscles of the back may go into painful spasm.

TREATMENT OPTIONS
Always consult your Doctor for diagnosis and advice. A thorough medical history and physical exam can usually identify any medical conditions or family history that may be associated with the pain. Medical imaging such as an X-ray, MRI scan or CT scan may be ordered by your GP or consultant if he or she thinks that your back pain is associated with a certain structural abnormality in your spine. In many cases scans and tests show no clear explanations for the pain.

In the majority of people, Back Pain usually goes away within one month. Your Doctor may recommend medications to ease the pain and/or inflammation, cold/hot packs, osteopathic or chiropractic manipulation, TENS stimulation, back exercises and in some cases, surgery. Ask your Doctor if you require bed rest or decreased activity - in most cases, it is recommended that you have no more than 2 days of bed rest or decreased activity. People with sciatica may require 2-4 days of bed rest. Ask your Doctor for advice.

In most cases it is advisable to continue normal activities. Paracetamol or ibuprofen may help to reduce the pain. Some people find that applying hot or cold packs to the painful area can give some pain relief. It is advisable to not apply the hot or cold packs directly on the skin but to wrap the packs in a thin towel or cloth.

Transcutaneous electrical nerve stimulation (TENS), ultrasound, acupuncture, traction and biofeedback are other types of therapies, which may help to relieve Low Back Pain.

SURGERY
In the most serious cases where Back Pain has not responded to other treatments, surgery may be required. It is advisable to carefully consider the potential benefits and risks of back surgery before committing to the procedure. There are some types of Low Back Pain caused by nerve damage and surgery will not restore the function of these nerves. A small percentage of people will benefit from back surgery and in other cases surgery may worsen the pain, cause nerve damage and affect bowel and bladder function.

PHARMACIST'S ADVICE
1. Ask your MedAux Pharmacist for advice on Back Pain. Apply an icepack to the base of your spine for five minutes. Never apply ice directly to the skin. Follow with 20 minutes of heat e.g. a hot water bottle wrapped in a towel, placed on the base of the spine. This will help reduce inflammation. You can use it on the spine while you sit down, or when you lie on the bed.
2. If there is swelling and pain your Pharmacist may recommend some anti-inflammatory and pain relieving tablets containing ibuprofen. It is important to seek medical advice for any persistent pain.
3. Never take pain relievers, which have been prescribed, for another person. Not all pain relief tablets are the same. Different pain relievers have different effects, different dose recommendations and are suitable for different sorts of pain. Some types of pain relievers may have side effects which the patient may not be aware of e.g. Non-steroidal Anti-inflammatory Drugs (NSAIDs) should not be taken by people with an allergy to aspirin, or by those with asthma, peptic ulcer or with risk factors for cardiovascular disease.
4. A cream containing the active ingredients heparinoid and hyaluronidase might be used to slow any bruising and help prevent swelling. Ask your Pharmacist.
5. Lumbar support cushions provide excellent lower back support while sitting at the office and during travelling. As your Pharmacist about special support cushions.
Aspirin should not be given to children under 16 years of age unless specified by a Doctor.

ORGANISATION & GROUPS
Indian Society of Study of Pain (http://www.isspap.org/pain-problems.php)