Chronic Back Pain: When to See a Doctor

Low back pain is also called lumbago and is a common painful sensation in the lower part of the back. It is not only uncomfortable but it can greatly affect your daily life. Learn what to do if you experience persistent low back pain and whether you should seek medical help

Understanding Lower Back Pain

The lower back begins below the ribcage and is anatomically referred to as the lumbar region.

The lumbar region consists of several structures which include:

• The 5 lumbar vertebrae designated L1 to L5. They are the bony support for other structures in the lower back.
• Between the vertebrae are intervertebral discs. These are flat, round, rubbery pads that serve as shock absorbers to cushion the spine during movement.
• Ligaments are strong fibrous tissue that holds the vertebrae together.
• Tendons connect muscles to their attachment points on the spinal column.
• There are nerves moving out through the vertebrae from the spinal cord to supply many areas in the body.

How Common is Lower Back Pain?

Most people experience low back pain some time in their lives. According to a survey done by the National Institute of Neurological Disorders and Stroke (NINDS), estimates place the incidence of the first episode of low back pain for an individual at 6.3% to 15.4%. For one episode in a 1 year period, the incidence is 1.5% to 36%. More than a quarter of adults reported experiencing low back pain within the previous 3 months.

There is no sexual predilection with regard to persistent low back pain. The severity can range from a dull, unrelenting ache to a sudden onset, sharp pain that leaves the person incapacitated.

Chronic back pain usually develops over time and might be a consequence of age-associated changes in spinal anatomy. It has been found that sedentary lifestyles contribute to the onset and progression of chronic back pain. Particularly when the lax workdays are punctuated by weekends of vigorous physical activity.

Types of Back Pain

Low back pain is often short term, lasting only a couple of days to a few weeks. It usually dissipates on its own with no influence on functional capacity of the individual.

Acute low back pain. Most acute low back pain is due to mechanical disruptions in the structures that comprise the back.

Subacute low back pain. This condition is one that has been present for 4 to 12 weeks. 

Chronic back pain. This type of persistent low back pain lasts for 12 weeks or longer, even if there is adequate treatment for initial injury and underlying condition if any. 

What Causes Low Back Pain?

The human spine, unlike that of any other animal, stays upright. The spine also serves as a passage through which nerves from the brain are connected to and from other parts of the body to coordinate functions like walking, running, and writing. Just like all other human parts, the spine undergoes aging and damage from wear and tear from gravity, injury from physical activity, among other

Let us go into detail about the most common causes of persistent lower back pain.

Degenerative and Herniated Discs 

Degenerative disc disease (DDD) affects the intervertebral discs. With age, the discs become thinner, lose their rubbery consistency, and become tough. Age-associated spinal changes also result in arthritis and disc herniation (slipping). 

This leads to pressure on the spinal cord and nerves resulting in pain. Increased friction from thinned discs causes abnormal bone growth. Osteophytes, as these bones are called, can worsen the situation by pinching spinal nerves.

Spondylolisthesis

This condition affects just the lower vertebrae. It occurs when a vertebra slips forward beneath another one. Though treatable, it is a cause of persistent lower back pain. Other symptoms of nerve compression like stiffness in back and legs, thigh pain, and numbness of legs, among others might be present.

It can be hereditary. Factors that increase the risk of its development are rapid puberty growth, birth defects, and strenuous sporting activities.

Scoliosis

Scoliosis is a condition where the vertebral column curves to one side. It can occur in any region but is most common in the lower back and chest. It usually presents during childhood and spontaneous resolution with growth is common. 

However, depending on the severity of the curvature, treatment might be necessary. Management consists of physiotherapy and wearing a brace. Some patients may need surgical intervention. 

Persistent low back pain is a common complication. If it affects the chest, there might be respiratory problems and reduced capacity for exercise.

Spinal stenosis

This is the narrowing of space within the spinal column. It results in increased pressure on the spinal cord and nerve fibers that exit the spine.  It can occur anywhere on the spine but most often occurs in the lumbar region. Some people may be asymptomatic. But, others may experience persistent low back pain which may be associated with tingling, numbness, and the weakening of muscles. 

Muscle or ligament strain

Muscle spasms are a common symptom, and it may be due to poor posture and heavy lifting.

Aside from these direct causes of persistent low back pain, serious medical conditions like may be the culprit. Diabetes, kidney problems, and cancer that has spread to the spine can be responsible but this is not common. In about 60% of cases, even with advanced medical equipment like MRI and CT scans, the cause may not be confirmed. 

When to See a Doctor About Persistent Low Back Pain

 Usually, low back pain resolves on its own within a few weeks. If yours does not resolve or even worsens, you should see a doctor. 

• If the pain is severe enough to interfere with daily activities and does not subside with rest
• Spreads down either or both legs
• There is associated abnormal sensation in or weakness of lower limbs

To exclude rare instances where the pain is from serious medical conditions, you should see a doctor when:

• It is associated with a fever
• Unexplained weight loss
• Consequence of trauma
• Results in bladder or bowel issues

Other indications for a medical consultation includes:

• If you are experiencing your first low back pain after 50
• If you have been treated for cancer in the past

Key Takeaways

Persistent low back pain is a common condition that can be a great source of discomfort for sufferers. Causes can be from the spine itself or surrounding muscles. Rarely, it can be due to serious medical problems like cancer. In many cases, the underlying cause might not be identified. If pain is severe or has associated symptoms, seeking medical care is advisable.

Learn more about Orthopedics here.