What is lower back Pain?
Lower back pain (also known as lumbar pain) most commonly is the discomfort experienced after heavy pushing/ pulling or lifting. Many also have a back ache from repetitive bending or stooping.
Quickcare or ER?
Here are some RED FLAGS that will send you to the ER:
- If you have a history of IV drug abuse or fever, then a back pain could be a serious infection.
- If you have had any nerve problems, Weight loss, Trauma
- If the pain has lasted greater than 6 weeks
What will you doctor ask?
Your doctor will want to know your aching back symptoms. Remember, your symptoms are your description of your condition to your doctor. This is your story
Where is the pain?
What makes it better?
What makes it worse?
Was there a fall or trauma?
How bad is the pain?
Is it chronic pain?
Is it a dull ache in the back?
Is anything associated with the pain such as numbness or paralysis (can’t walk)?
Your doctor will want to know if you have a stomach ache and back pain.
What will you doctor look for?
Your doctor will look for signs. Remember, a sign is an objective finding that a doctor sees on exam.
I look for the location of the pain; Where on the lower back?
Is it lower left back pain? Is it going into the legs?
I like to check the range of motion. In other words, how far you bend down and up and side-to-side.
A doctor will suspect a nerve problem if there are complaints of numbness, like the leg going to sleep (paresthesia).
If the patient cannot move a leg (paralysis), it implies that there is nerve damage.
A very uncommon event is loss of bowel or bladder. This means that patients are pooping and peeing all over themselves. They cannot control themselves. That is a true emergency.
An important point is whether to do an x-ray. A fall or trauma implies that there could be a fracture. Then an x-ray is needed.
What is your doctor thinking?
Your doctor will think of many back pain causes. This list of possible causes for bach aches is called a differential diagnosis.
Your doctor is wondering if this is simply a muscle strain or does it involve a nerve damage. Compressed nerves in the lower back occur with a condition called spinal stenosis. A common complaint with a more severe form of compressed nerves is pain in the back of legs. Such radiation of pain suggests spinal stenosis has led to sciatic nerve involvement. This is called sciatica.
A herniated disc is another consideration when evaluating a patient with severe back pain.
Also, lower back ache causes include kidney stones, Shingles, and kidney infection to name a few.
A possible surgical emergency is cauda equine syndrome. During this syndrome, the nerve roots from the sacrum are impinged causing leg weakness and numbness to the buttocks area. Patients may also lose control of their urination.
An infection to the back bones (vertebrae) will cause back pain. This may be seen in IV drug abusers.
What is the treatment for muscle strain?
I try to avoid the opioids but realize their usefulness in the acute setting. Usually a good shot of a narcotic is a nice start for severe lower back pain relief.
I usually put persons on anti-inflammatory drugs such as Naproxen for the day time.
Then I will try muscle relaxants such as Soma or Flexeril for the night. Careful. The muscle relaxers make you very sleepy. If you are taking a muscle relaxer such as Baclofen and then stopping the medication, withdrawal symptoms may include spasticity, itchiness and, in severe cases, hyperthermia. Another alternative are benzodiazepines such as Valium.
I love physical therapy. Three times per week for three weeks is my standard therapy regimen.
Preventative measures include Yoga and Pilates.
How long will you be sick?
What if it still hurts? Then you have to consider a disc problem and/or a nerve etiology. A great test for it is an MRI.
Let me tell you a story
Juan is fieldworker. Day-after-day he stoops over the crops to pick our country’s vegetables. Not a very glamorous line of work, but he is able to bring home a steady paycheck for his family and send home some money to his momma. “Doctor, I threw out my back.” This is one of the most common complaints that is heard in both clinics and Emergency Departments. “It’s killing me!”
Poor Juan. Just looking at him, I could tell he was hurting. He was sitting a the edge of the bed with his hand pushing down on the gurney. This position made his back ramrod straight. Any slight easing up on the arms and an instant grimace over came him.
Juan is still crying out to “do something!!
In Juan’s case, he had no trauma or fall. His pain was local, sharp, severe and constant. There was no associated numbness or paralysis
His story points to muscle strain.
Juan’s middle back pain, although severe, was not that bad. No nerve problems. He walked in and walked out.
After two weeks of light duties at work, Naproxen at day time and Soma at night, he was back harvesting our country’s food.
Thank you, Juan.
I hope this helps