Lower back pain

Almost everyone will experience it at least once in a lifetime and people who chronically suffer from it develop their own strategies on how to relieve their back pain. President John F. Kennedy e.g. was using a rocking chair. In many industrialized countries back pain is a main cause preventing people from work and therefore has a relevant economic impact.

Bilde1Most patients experience back pain in the lower back (lumbar) as it carries a lot of load of the stiff rib cage.

In most cases, there are no severe underlying reasons for the onset of back pain. However, some “red flags” have to be respected:

A feeling of numbness, pins and needles or a loss of strength in the legs should let you thing of a more severe reason for the pain. Especially, any disturbances in urination or bowel opening and numbness around the anus can be a sign of a neurologic disorder that needs immediate clinical diagnostics. Back pain in conjunction with a fall (also low- energy trauma in the elderly!), fever, bacterial infections, a diagnosed cancer or general weakness as well as a known osteoporosis or steroid therapy could also have a serious background.

In the majority of cases, none of these warning signs is present and there is no need of radiological assessment or blood testing at this point.

Man suffering from low back painTreatment involves several modalities of which clear evidence exists that they are beneficial. These are pain medication, physical training (physiotherapy) and psycho- social mentoring. Bedrest is valued counterproductive and there is no certainty that warmth or other physical methods are helpful. Only after several weeks of this therapy and no change of complaints further diagnostic tests should be considered (x –ray, MRI scan, local infiltration,..) to maybe allow a further specification of the underlying reason. In the majority of cases this does not happen and an unspecific back pain is diagnosed.

There are numerous risk factors on different levels for developing unspecific back pain. Apart from smoking, overweight, low level of physical activity and alcohol, psychosocial factors like depression, distress and disposedness for somatization are promoting unspecific back pain. There are also work- related factors like heavy physical work (carrying/ lifting), monotonous position of the body, exposition to vibration, low level of qualification, dissatisfaction with working conditions and mobbing. Therefore, a long- lasting, multilevel therapy is necessary. One of the most important points, however, is to stay active!