Pain In Lower Back Side – Causes, Symptoms, Treatment

Pain In Lower Back Side – Causes, Symptoms, Treatment

Pain In Lower Back Side/Acute Back Pain or short-term Back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases, a few months are required for the symptoms to disappear. Exercising, bed rest, and surgery are typically not recommended for acute back pain.

Acute Back Pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight. Acute back pain can last for a few days to a few weeks. Most back pain is what’s known as “non-specific” (there’s no obvious cause) or “mechanical” (the pain originates from the joints, bones, or soft tissues in and around the spine).

Causes of Pain In Lower Back Side

Most people have at least one backache in their life. Although this pain or discomfort can happen anywhere in your back, the most common area affected is your lower back. This is because the lower back supports most of your body’s weight. Low back pain is the number two reason that Americans see their health care provider. It is second only to colds and flu.

You will usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.

Causes of sudden low back pain include:

  • Compression fractures to the spine from osteoporosis
  • Cancer involving the spine
  • Fracture of the spinal cord
  • Muscle spasm (very tense muscles)
  • A ruptured or herniated disk
  • Sciatica
  • Spinal stenosis (narrowing of the spinal canal)
  • Spine curvatures (like scoliosis or kyphosis), which may be inherited and seen in children or teens
  • Strain or tears to the muscles or ligaments supporting the back
  • An abdominal aortic aneurysm that is leaking.
  • Arthritis conditions, such as osteoarthritis, psoriatic arthritis, and rheumatoid arthritis.
  • Infection of the spine (osteomyelitis, diskitis, abscess).
  • Kidney infection or kidney stones.
  • Problems are related to pregnancy.
  • Problems with your gall bladder or pancreas may cause back pain.
  • Medical conditions that affect the female reproductive organs, including endometriosis, ovarian cysts, ovarian cancer, or uterine fibroids.
  •  Pain around the back of your pelvis, or sacroiliac (SI) joint.

Back pain can also be triggered by everyday activities at home or work, and by poor posture. For example, back pain may be triggered by:

  • bending awkwardly,
  • lifting, carrying, pushing or pulling incorrectly,
  • slouching in chairs,
  • standing or bending down for long periods,
  • twisting,
  • coughing,
  • sneezing,
  • muscle tension,
  • over-stretching,
  • driving in hunched positions, or
  • driving for long periods without taking a break.

Sometimes, you may wake up with back pain and have no idea what has caused it.

Causes By Specefic Disease and Pain In Lower Back Side

The causes of lower back pain in the left side

Cauda equina syndrome – It is a medical condition that is caused by displacement infection inflammation in the lumber 4 vertebrae and sacrum. It may cause the problem are

  • Progressive motor/sensory loss, new urinary retention or incontinence, new fecal incontinence
  • Saddle anesthesia, anal sphincter atony, significant motor deficits of multiple myotomes

Fracture – Fracture in any vertebrae and pelvic region due to trauma, infection, displacement of vertebrae

  •  Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years
  • Contusions, abrasions, tenderness to palpation over spinous processes

Infection – It is another cause of lower back pain. It is caused by postoperative spine or failure back syndromes, direct injection push to the spine, foreign body, etc.

  • The spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery
  • Fever wound in the spinal region, localized pain, and tenderness

Malignancy – It is one kind of tumors and abnormal bone growth

  • History of metastatic cancer, unexplained weight loss
  • Focal tenderness to palpation in the setting of risk factors

Pediatric red flags are the same as adults with a few notable differences:

Malignancy

  • age less than 4 years, nighttime pain

Infectious

  •  age less than 4 years, nighttime pain, history of tuberculosis exposure

Inflammatory

  • age less than 4 years, morning stiffness for greater than 30min, improving with activity or hot showers

Fracture

  • activities with repetitive lumber hyperextension (sports such as cheerleading, gymnastics, wrestling, or football linemen)
  • Tenderness to palpation over spinous process, positive Stork test

Lumbosacral muscle strains/sprains

  •  follows traumatic incident or repetitive overuse, pain worse with movement, better with rest, restricted range of motion, tenderness to palpation of muscles

Lumbar spondylosis

  • The patient typically is greater than 40years old, pain may be present or radiate from hips, pain with extension or rotation, the neurologic exam is usually normal.

Disk herniation

  • usually involves the L4 to S1 segments, may include paresthesia, sensory change, loss of strength or reflexes depending on severity and nerve root involved.

Spondylolysis, Spondylolisthesis

  • similar to pediatrics, spondylolisthesis may present back pain with radiation to buttock and posterior thighs, neuro deficits are usually in the L5 distribution.

Vertebral compression fracture

  • localized back pain worse with flexion, point tenderness on palpation, may be acute or occur insidiously over time, age, chronic steroid use, and osteoporosis are risk factors.

Spinal stenosis

  • back pain which can be accompanied with sensory loss or weakness in legs relieved with rest (neurologic claudication), neuro exam normal.

Tumor

  • history of metastatic cancer, unexplained weight loss, focal tenderness to palpation in the setting of risk factors
  • 97% of spinal tumors are metastatic disease; however, the provider should keep multiple myeloma in the differential
  • vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess
    • The spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery, fever, wound in the spinal region, localized pain, and tenderness
    • The granulomatous disease may represent as high as one-third of cases in developing countries.
  • Fracture

    • Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years, Contusions, abrasions, tenderness to palpation over spinous processes

Pediatrics

Tumor

  • fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • Osteoid osteoma is the most common tumor that presents with back pain – classically, the pain is promptly relieved with anti-inflammatory drugs such as NSAIDs.

Infection – vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess

  • fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • The epidural abscess should be a consideration with the presence of fever, spinal pain, and neurologic deficits or radicular pain; discitis may present with a patient refusing to walk or crawl.

A herniated disk, slipped apophysis

  • Acute pain, radicular pain, positive straight leg raise test, pain with spinal forward flexion, recent onset scoliosis

Spondylolysis, spondylolisthesis, lesion or injury to the posterior arch

  •  Acute pain, radicular pain, positive straight leg raise test, pain with spinal extension, tight hamstrings

Vertebral fracture

  • acute pain, other injuries, traumatic mechanism of injury, neurologic loss

Muscle strain

  • acute pain, muscle tenderness without radiation

Scheuermann’s kyphosis

  • chronic pain, rigid kyphosis

Inflammatory spondyloarthropathies

  •  chronic pain, morning stiffness lasting greater than 30min, sacroiliac joint tenderness

Psychological Disorder (conversion, somatization disorder)

  •  normal evaluation but persistent subjective pain

Idiopathic Scoliosis

  •  positive Adam’s test (for larger angle curvature), most commonly asymptomatic
  • Of note, no definitive evidence that scoliosis causes pain, but patients with scoliosis have more frequently reported pain; therefore the provider should rule out other causes before attributing pain to scoliosis:


The Symptom of Lower Back Pain Left Side

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

  • Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected and pain radiation.
  • In general symptoms of pain are clear up on their own within a short period.
  • Pain. It may be continuous, sudden, thunder pain, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending, or twisting.
  • Patients who have been taking steroids for a few months may increase the risk of pain
  • Drug abusers or the patient who taking drugs
  • Patients with cancer with previous cancer disease may cause pain.
  • Pain may be radiating to the whole back region
  • Patients with depressed immune systems and weak immune response.
  • Stiffness and increase pain in the morning
  • Pain may be decreased by elevating the leg in bed and sleeping

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

  • Weight loss and muscle spasm in the back rejion
  • Elevated body temperature (fever)
  • Inflammation (swelling) on the back
  • Persistent back pain – lying down or resting does not help
  • Pain down the legs
  • Pain reaches below the knees
  • A recent injury, blow, or trauma to your back
  • Urinary incontinence in some patients you pee unintentionally (even small amounts)
  • Difficulty in urinating passing urine is hard
  • Fecal incontinence you lose your bowel control (you poo unintentionally)
  • Numbness tingling sensation around the genitals
  • Numbness paresthesia around the anus
  • Pain and numbness around the buttocks
  • Dull ache,
  • Numbness,
  • Tingling,
  • Sharp pain,
  • Pulsating pain,
  • Pain with movement of the spine,
  • Pins and needles sensation,
  • Muscle spasm,
  • Tenderness,
  • Sciatica with shooting pain down one or both lower extremities
  • Additionally, people who experience severe pain symptoms after a major trauma (such as a car accident) are advised to see a doctor immediately. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought as early as possible.

Pain may increase with

  • Biomechanical risk factors.
  • Sedentary occupations.
  • Gardening and other yard work.
  • Sports and exercise participation, especially if infrequent.
  • Obesity.
  • Exercises to strengthen lower back muscles.
  • Learn how to lift heavy objects.
  • Sit properly.
  • Back support in bed.
  • Lose weight, if obese.
  • Choose proper footwear.
  • Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problems

  • Non-mechanical pain (unrelated to time or activity)
  • Thoracic pain
  • Previous history of carcinoma, steroids, HIV
  • Feeling unwell
  • Weight loss
  • Widespread neurological symptoms
  • Structural spinal deformity

Indicators for nerve root problems

  • Unilateral leg pain > low back pain
  • Radiates to foot or toes
  • Numbness and paraesthesia in the same distribution
  • The straight leg raising test induces more leg pain you can observe
  • Localized neurology (limited to one nerve root) dee to nerve compression.

Diagnosis of Lower Back Pain Left Side

  • Straight leg raise (SLR) – It is a manual test performed by raising the patient’s leg to 30 to 70 degrees. Ipsilateral leg pain and one side leg pain in the right or left leg pain at less than 60 degrees is a positive test for lumbar disk herniation. It may be the likelihood ratio (LR) of 2, negative likelihood ratio (NLR) of 0.5. If the pain reproduction occurs contralaterally, it is a positive test for a lumbar disk herniation with LR of 3.5 and NLR of 0.72.
  • One leg hyperextension test/stork test – It a simple and manual or home test the patient can do it own have the patient stand on one leg and (while being supported by the provider) have them hyper-extend their back. Repeat this maneuver on both sides. If pain with hyperextension is the resulting increase positive for a pars interarticularis defect or associate abnormalities.
  • Adam test – Patient has to bend over with feet together and arms extended with palms together. The practitioner should observe from the front side of you. If a thoracic lump is present on one left side or the other right side lower back pain, it is an indication of scoliosis.There are numerous other examination techniques; however, they have mixed and anonymous evidence for inter-practitioner reliability and poor sensitivities or specificities lower back pain.
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Lab Test

  • Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine, Serum Electrolyte,
  • Bone scan – It is a bone scan that may be used for detecting bone tumors or compression of nerve root fractures caused by brittle bones and osteoporosis. The patient may receive an injection of a tracer (a radioactive substance) into a vein at the same time. The tracer collects or examiner in the bones and helps the doctor detect bone problems with the aid of a special camera.
  • Electromyography (EMG) – It one kind of test that helps assess the electrical activity in a muscle and nerve impulse velocity or nerve root compression and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body that are causing pain.
  • Evoked potential studies – It may involve two sets of electrodes are placed one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal that is transmitted to the brain.
  • Nerve conduction studies (NCS) – It also uses two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage for lower right and left side back pain.

Imaging

  • X-rays – These are very accessible at most clinics and outpatient offices. This imaging technique can be used to assess for any structural instability. If x-rays show an acute fracture, it needs to be further investigated using a computed tomogram (CT) scan or magnetic resonance imaging (MRI).
  • CT Scan – It is the preferred study to visualize bony structures in the spine. It can also show calcified herniated discs. It is a less accessible inpatient in office settings compared to x-rays. But it is more convenient and reliable than MRI. In the patients with lower right and left-back pain, that have non-MRI comparable implanted devices, CT myelography can be performed to visualize herniated disc.
  • CT myelography -It is a special kind when the patient has either a contraindication to having an MRI such as heart problem, open-heart surgery, or having a pacemaker device or defibrillator or be used when a standard CT or MRI is negative or equivocal. Myelography is a CT scan or an MRI with intrathecal administration of contrast for lower back pain. CT myelography visualizes a patient’s spinal nerve roots in their passage through the neuroforamina area. CT myelography can be used to assess the underlying root sleeve and nerve root compression. A CT is a poor test for the visualization of nerve roots, making it challenging to diagnose radicular disease.
  • Electromyography (EMG) – It is complete after three weeks of symptoms, not before the lower right and left back pain. Diagnostic tests such as EMG or nerve conduction studies are accurate only after three weeks of persistent symptoms of right or left lower back pain. The primary reason or why using an EMG or nerve conduction study is to identify the delayed three weeks or more time following the development of pain is because of fibrillation potentials after an acute injury in the brain and spinal cord lead to an axonal motor loss. These do not develop until two to three weeks following injury for the lower right and left back pain.
  • Cerebrospinal fluid analysis – It is a useful test for investigating the right and left lower back pain if there is an involvement of neoplasm or infectious cause or radiculopathy symptoms and radiating pain syndrome. The recommendation for lower right and left back pain in lumbar puncture is in the case of a patient with negative or nondiagnostic neuroimaging, without knowing primary cancer and its related condition, who has progressive neurological symptoms and has failed back syndrome to improve it properly.
  • MRI – It is the preferred and most sensitive study to visualize herniated disc, bulging disc, or sequestered disc. MRI findings will help to find the soft tissues, ligament, tendon, cartilage even spinal cord clearly to surgeons and other providers plan procedural for lower right and left side back pain care if it is indicated.
  • Bone scintigraphy – It is a special type of test that is done when some or above mention test failed to identify the causes of right and left lower back pain with single-photon emission computed tomography (SPECT) is more sensitive in detecting facet joint lesions and bony lesion, none spurs and allows more accurate anatomical localization of lower back pain. A recent study suggested that SPECT could help to identify patients with lower back pain who would benefit from facet joint intraarticular injections []. Facet joint block (FJB)injection is an indispensable diagnostic instrument in order to identify painful or painless back pain from painless facet joints and to plan the intervention strategy.
  • Foraminal nerve root entrapment test – It is best visualized on T1-weighted MRI where are used to identify the high contrast fat tissue and the nerve root sheath that is of great help for lower and right or left ba. In here usually, a combination of hypertrophic degenerative facets with osteophytes spurs posteriorly, and vertebral osteophytes and/or disc herniation anteriorly diminishes the anteroposterior diameter of the foramen and it associate condition. Foraminal height is erased by degenerative disc disease and subsequent disc height loss or not. In this case, the normal rounded (oval) appearance of the nerve root sheath is lost in combination with loss of the surrounding fat tissue, nerve root compression should be considered to identifying the lower right and left side back pain.


Treatment of Lower Back Pain Left Side

Not all treatments work for all conditions or for all individuals with the same condition treatment, and many find that they need to try several treatment options to determine what works best for the patients. The present stage of the condition (acute or chronic) is also helping to find a determining factor in the choice of treatment. Only a minority of people with lower right and left back pain (most estimates are 1% – 10%) require surgery and the rest may not surgery.

Non-medical

Treatment for back pain generally depends on how long your pain lasts

Acute (short-term) back pain – usually gets better on its own. Exercises or surgery are usually not recommended for this type of pain. There are some things you may try while you wait for your pain to get better. Simple you can take the medication are following-

  • Acetaminophen, aspirin, or ibuprofen will help ease the pain.
  • Get up and move around to ease stiffness, relieve pain, and have you back doing your regular activities sooner.

Chronic (long-term) back pain – is typically treated with non-surgical options before surgery is recommended.

Nonsurgical Treatments

  • Traction – It involves using pulleys and weights to stretch the back, which may allow a bulging disk to slip back into the right place. Your pain may be relieved while in traction, even pain returns once you aren’t in traction.
  • Practice healthy habits – such as exercise, relaxation, regular sleep, proper diet, and quitting smoking, drinking plenty of water.
  • Manipulation – Professionals use their hands to adjust or massage the spine or nearby tissues that may be injured to help in healing
  • Acupuncture This Chinese practice uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as a part of a comprehensive treatment plan for low back pain. But it has a side effects and controversy of pain management.
  • Acupressure A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for right and left back pain. Move your body properly while you do daily activities, especially those involving heavy lifting, pushing, or pulling. Back pain is generally treated with non-pharmacological therapy first, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended.
  • Heat therapy –  It is useful for back muscle spasms or weakness or other conditions. A review concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.
  • Regular activity and gentle stretching exercises – It is encouraged in uncomplicated lower back pain and is associated with better long-term treatment outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended that are work surprisingly.
  • Outdoor exercises  – It is associated with better patient satisfaction, although it has not been shown to provide functional improvement in satisfaction level. However, one scientific study found that exercise is effective for chronic back pain, but not for acute pain. If used, they should be performed under the supervision of a licensed health professional.
  • Massage therapy – may give short-term pain relief, but not a functional improvement for lower back, for those with acute lower back pain. It may also give short-term pain relief and functional improvement for those with long-term (chronic) and sub-acute lower pack pain, but this benefit does not appear to be an effective result after 6 months of treatment. There have not appeared to be any serious side effects associated with massage.
  • Spinal manipulation Spinal manipulation for lower back pain is a widely-used method of treating back pain, although there is no evidence of long-term benefits.
  • Back school – It is an intervention that consists of both education and physical exercises. A 2016 Cochrane scientific review found the evidence concerning back school to be very high-quality effectiveness and was not able to make generalizations as to whether back school is how much effective.
  • Heat Or Ice Therapy – Applying heat pads, ice packs, or using both alternatively sometimes can help to relieve stiffness, inflammation, and muscle spasms related to the right and left side of lower back pain. Cold compresses can be used to reduce swelling in the back muscle.
  • Braces – For patients with chronic lower back pain or a deformity in the spine due to trauma, the doctor may recommend wearing a brace to provide support to the spine. Back braces can help to maintain the right proper posture, limit strenuous movement, or unusual movement and the spine to provide relief from lower back pain.
  • Physical Therapy – The physical therapist may apply heat, ice, electrical stimulation, and other mechanisms to release muscle weakness and stiffness from the back muscles. He may also help the patient learn posture correction techniques to prevent the pain from recurring lower back pain.
  • Exercise – Your doctor may advise you to perform light stretching exercises to increase the flexibility of the muscles in the back. He may also recommend certain or exercises to strengthen the core and improve the overall well-being of the patient.


Medication

If non-pharmacological measures are not effective, medications may be tried.

  • Analgesics – It is with or without paracetamol may improve pain and function compared with treatment for lower right and left back pain. It is taken by mouth or applied to the skin. Examples include acetaminophen and aspirin. Your doctor may suggest steroid or numbing shots lessen your pain reliever to erase the lower back pain. However, long-term use of NSAIDs or opioids may be associated with well-recognized adverse effects.
  • Non-steroidal anti-inflammatory drugs – (NSAIDs) may be more effective than placebo at improving pain intensity in lower back pain and people with chronic low back pain. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include mainly or first choice etodolac, then tramadol, aceclofenacetoricoxib, ibuprofen, and naproxen. Nonsteroidal anti-inflammatory drugs were again the first-line pharmacologic agents recommended followed by tramadol in first-line and duloxetine as the second-line treatments.
  • Antidepressants  – It is used to decrease chronic low back pain or improve function compared with placebo in people with or without depression. The antidepressants such as tricyclic antidepressants and SNRIs, muscle relaxers, N-methyl-d-aspartate (NMDA) receptor antagonists, and alpha 2 adrenergic agonists are also the most effective pharmacological therapies for the treatment of lower back pain.
  • Muscle Relaxant – Benzodiazepines may improve pain, but studies of non-benzodiazepine muscle relaxants have given conflicting results. Muscle relaxants, such as baclofentolperisoneeperisone, methocarbamol, carisoprodol, and cyclobenzaprine, may be prescribed to control muscle spasms and their associate low back pain.
  • Gabapentin – The initial stage of treatment for lower back pain, neuropathic pain, and chronic back pain are often treated with gabapentin or pregabalin It is Considere’s most effective treatments are in general recommended in chronic low back pain. They have also indicated for postherpetic neuralgia, diabetic neuropathy, and mixed neuropathy.
  • Tricyclic antidepressant (TCA) – It is a type of drug that can be used to treat back pain this use is different from its mode of action in treating depression, which usually requires a much higher dose. Examples include amitriptyline and imipramine that are used to treat the right and left side lower back pain.
  • Epidural corticosteroid injections – It is a type of injection or local injections with corticosteroids and a local anesthetic that are pushed in the joint space to reduce the nerve entrapment related to lower back pain to improve chronic low back pain treatment in people without sciatica. Facet-joint corticosteroid injections may be more effective than placebo at reducing pain.
  • Epidural glucocorticoid injections – are beneficial for up to three months in duration in patients with acute lumbar radiculopathy and lower back pain. This injection benefit is modest yet clinically significant in the short-term. If a patient has not improved after six weeks of conservative management, they would be eligible for an epidural glucocorticoid injection to treat the right and left side lower back pain.
  • Oral steroids tablets – These a very simple and are often prescribed for acute low back pain, and chronic low back pain although there is limited evidence to support their use. It is basically used to remove nerve-related inflammation, edema, hematoma. There is evidence that a single dose of steroids, such as dexamethasone, may provide lower back pain relief.
  • The serotonin-norepinephrine reuptake inhibitor (SNRI) – duloxetine is useful in treating chronic pain, osteoarthritis, and the treatment of fibromyalgia and associate pain. Furthermore, the efficacy of duloxetine in the treatment of comorbid depression is comparable to other antidepressants. Venlafaxine is an effective treatment for neuropathic pain, as well as another neuropathic agent. A TCA can also be utilized, such as nortriptyline. TCA medications may require time six to eight weeks to achieve their desired effect.
  • Topical lidocaine and ointment – is a useful treatment for neuropathic pain and allodynia as in postherpetic neuralgia. Separately, topical capsaicin cream and ointment is an option for chronic neuropathic or musculoskeletal pain unresponsive to other treatments for conservative management failed.
  • Opioids – are considered a second-line option; however, they may be warranted for pain management for patients with severe persistent pain, chronic or neuropathic pain secondary to malignancy. Opioid therapy should only start with extreme caution for patients with chronic back pain and musculoskeletal pain. The drug has the major side effects of opioids are significant and frequent and may include opioid-induced hyperalgesia, constipation, dependence, and sedation or its associate problem.
  • Epidural corticosteroid injection – (ESI) is a procedure in which steroid medications are injected into the epidural space of the spinal cord. Steroid medications help to reduce inflammation and thus decrease pain and improve functional mobility. ESI has long been used to both diagnose and treat back pain, although recent studies have shown a lack of efficacy in treating lower back pain.
  • Topical pain relief – such as creams, gels, patches, or sprays applied to the skin stimulates the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
  • Carisoprodol – This muscle relaxant was investigated in two high-quality studies on acute low back pain. The first scientific study compared carisoprodol with diazepam [. Carisoprodol was superior in performance on all the outcome parameters that are measured. A comparison of carisoprodol with cyclobenzaprine‐hydrochloride in the second scientific study revealed no statistically significant differences between the two treatments [.
  • Chlorzoxazone – This is an old muscle relaxant that was compared with tizanidine in one high-quality scientific study in a very small sample of patients with degenerative lumbar disc disease and low right or left side back pain[.
  • Cyclobenzaprine‐hydrochloride – Cyclobenzaprine was compared with diazepam in a low-quality trial on chronic low back pain, but no significant differences between the treatments were identified in this scientific study [. There was also no range of difference between cyclobenzaprine and carisoprodol in one high-quality study on acute lower back pain [.
  • Diazepam In comparison with carisoprodol, diazepam was found to be inferior in performance on muscle spasm, global efficacy, and functional status in a high-quality trial on acute or chronic low back pain [. In a very small high-quality comparing diazepam with tizanidine, there were no differences in pain, functional status, and muscle spasm after seven days of the study [.
  • Tizanidine This muscle relaxant was compared with chlorzoxazone and diazepam in two very small high quality [. Both trials did not find any significant differences in pain, functional status, and muscle spasm after 7 days of end result.
  • Pridinol mesylate – One low-quality trial showed no differences between this muscle relaxant and thiocolchicoside on pain relief and global efficacy for low back pain management.
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Recommendations for the oral drug treatment of nonspecific low back pain, with evidence-based doses
Drug recommendation Dosage Recommendation*2 Recommendation grade
Nonsteroidal anti-inflammatory drugs
Ibuprofen
Diclofenac
Naproxen
1.2 g/d, at most 2.4 g
100 mg/d, at most 150 mg
750 mg/d, at most 1.25 g
Positive (“should”)
(“should”)
(“should”)
B
B
B
COX-2 inhibitors
(off-label use for acute low back pain)
Celecoxib 200 mg/d
Etoricoxib 60–90 mg/d
Open (“can”) 0
Paracetamol (acetaminophen) 500–1000 mg/d, at most 3 g Open (“can”) 0
Low-potency opioids
Tramadol
Tilidin N
Depending on the preparation
50–100 mg
50–100 mg
Open (“can”) 0

modified from [

The recommendations and grades listed here (positive [“should”] and open [“can”]) are derived from the German National Disease Management Guideline for Low Back Pain [,which employs the evidence classification of the Centre for Evidence-Based Medicine (CEBM) at the University of Oxford.

 

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Surgery of Low Back Pain

Surgery for back pain is typically used as a last resort when the serious neurological deficit is evident. A 2019 systematic review of back surgery studies found that, for certain diagnostic criteria, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term.

Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome and when the conservative management failed. The major causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord and not cure. There are multiple surgical options are offered by the surgeon to treat right and left side lower back pain, and these options vary depending on the cause of the pain and your doctors may refer to a surgeon for following a surgical procedure.

NIH’s National Institute of Neurological Disorders and Stroke (NINDS) lists the following as some of the surgical options for low back pain. But NINDS also cautions that “there is little evidence to show which procedures work best for their particular indications.”

  • Vertebroplasty and kyphoplasty These procedures are used to repair compression fractures of the vertebrae caused by osteoporosis. Both procedures include the injection of glue-like bone cement that hardens and strengthens the bone.
  • Spinal laminectomy/spinal decompression – This is performed when spinal stenosis causes a narrowing of the spinal canal that results in pain, numbness, or weakness and paresthesia. The surgeon removes the bony walls of the vertebrae and any bone spurs that are pinched in nerve or muscle, aiming to open up the spinal column to remove the access pressure on the nerves.
  • Discectomy – This procedure is used to remove a disk when it has a herniated disc or nerve entrapment and presses on a nerve root or the spinal cord disorder. Laminectomy and discectomy are frequently performed for lower back pain or right side or left side back pain together.
  • ForaminotomyIn this procedure the surgeon specially enlarges the bony hole where a nerve root exits the spinal canal for trauma or blunt trauma to prevent bulging discs or joints thickened with age from pressing on the nerve root compression for right and left side lower back pain.
  • Nucleoplasty also called plasma disk decompressionThis laser surgery and more secure and comfortable surgery uses radiofrequency energy to treat people with low back pain associated with a mildly herniated, prolapse, sequestrated disk problem. The surgeon inserts a needle into the disk that is a monitor in the c-arm machine. A plasma laser device is then inserted into the needle and the tip is heated, creating a field that vaporizes the tissue in the disk space, reducing its size and relieving pressure on the nerves that are causing it pain.
  • Spinal fusion The surgeon removes the spinal disk between two or more vertebrae, then fuses the adjacent vertebrae using bone grafts or metal devices secured by screws. It is a more safe treatment but its major complication that infection, postural problems, further displacement problems.  Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.
  • Artificial disk replacement – This is considered an alternative to spinal fusion surgery for the treatment of people with severely damaged disk pain and complicated fracture. The procedure involves the removal of the disk and its replacement by a synthetic disk or artificial disk that helps restore height and movement between the vertebrae.

Some surgical treatments are not recommended by NINDS, which cautions, for example, that intradiscal electrothermal therapy is “of questionable benefit.” NINDS notes that radiofrequency denervation provides only temporary pain relief and that “evidence supporting this technique is limited.”


Treatments you can try yourself

Stay active

  • One of the most important things you can do is to keep moving and continue with your normal activities as much as possible.
  • It used to be thought that bed rest would help you recover from a bad back, but it’s now known that people who remain active are likely to recover quicker.
  • This may be difficult at first, but do not be discouraged – your pain should start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.
  • There’s no need to wait until you’re completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity and may distract you from the pain.

Back exercises and stretches

Simple back exercises and stretches can often help reduce back pain. These can be done at home as often as you need to. For information about exercises and stretches that can help, see:

  • back pain pilates workout video
  • Versus Arthritis: exercises to manage back pain

A GP may be able to provide information about back exercises if you’re unsure what to try, or you may want to consider seeing a physiotherapist for advice. Read about how to get access to physiotherapy. Doing regular exercise alongside these stretches can also help keep your back strong and healthy. Activities such as walking, swimming, yoga and pilates are popular choices.

Hot and cold packs

  • Some people find that heat (such as a hot bath or a hot water bottle placed on the affected area) helps to ease the pain when back pain first starts.
  • Cold (such as an ice pack or a bag of frozen vegetables) on the painful area can also help in the short erm. However, do not put ice directly on your skin, as it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth or towel first.
  • Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.
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Relax and stay positive

Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition may make things worse.

  • 10 stress busters
  • breathing exercises for stress

Although it can be difficult, it helps to stay positive and recognize that your pain should get better. People who manage to stay positive despite their pain tend to recover quicker.

Specialist treatments

Exercise classes

  • A GP may suggest attending an NHS group exercise programme if they think it might help to reduce your pain.
  • These programs involve classes, led by a qualified instructor, where you’re taught a mix of exercises to strengthen your muscles and improve your posture, plus aerobic and stretching exercises.

Manual therapy

  • Manual therapy is the name for a group of treatments where a therapist uses their hands to move, massage and apply careful force to the muscles, bones, and joints in and around your spine.
  • It’s usually done by chiropractors, osteopaths or physiotherapists, although chiropractic and osteopathy are not widely available on the NHS.
  • Manual therapy can help reduce back pain, but it should only be used alongside other measures such as exercise.
  • There’s also some evidence that a therapy called the Alexander technique may help with long-term back pain. However, the National Institute for Health and Care Excellence (NICE) does not currently recommend this treatment.

Psychological support

  • A GP may suggest psychological therapy, in addition to other treatments such as exercise and manual therapy.
  • Psychological therapies such as cognitive-behavioral therapy (CBT) can help you manage your back pain better by changing how you think about your condition.
  • While the pain in your back is very real, how you think and feel about your condition can make it worse.
  • If you’ve been in pain for a long time, a specialist treatment program that involves a combination of group therapy, exercises, relaxation, and education about pain and the psychology of pain may be offered.

Nerve treatment

A procedure called radiofrequency denervation may sometimes be used if:

  • you’ve had back pain for a long time
  • your pain is moderate or severe
  • your pain is thought to originate from the joints in your spine
  • The procedure involves inserting needles into the nerves that supply the affected joints. Radio waves are sent through the needles to heat the nerves, which stops them from sending pain signals.
  • You’re awake while the treatment is being done and a local anesthetic is used to numb your back. You will not need to stay in hospital overnight.
  • As with all procedures, radiofrequency denervation carries a risk of complications, including bleeding, bruising, infection, and accidental nerve damage. Discuss the risks with your surgeon before agreeing to treatment.

Spinal fusion surgery

  • Spinal fusion surgery is another type of surgery for back pain. It may be recommended if there’s significant damage to the bones in your back (vertebrae).
  • Spinal fusion surgery can be used to fuse 2 vertebrae together to strengthen them. This can also help to reduce any related nerve pain as it stops the damaged vertebrae from squeezing the nerves that pass through the spine.
  • It’s possible that this type of surgery could cause permanent damage to some of the nerves in your back. This may lead to some partial paralysis in your legs and bowel or urinary incontinence. This complication is estimated to happen in around 1 in every 200 procedures.

Treatments not recommended

A number of other treatments have sometimes been used for non-specific back pain (back pain with no identified cause) but are not recommended by the National Institute for Health and Care Excellence (NICE) because of a lack of evidence.

These include:

  • belts, corsets, foot orthotics and shoes with “rocker” soles
  • traction – the use of weights, ropes and pulleys to apply force to tissues around the spine
  • acupuncture – a treatment where fine needles are inserted at different points in the body
  • therapeutic ultrasound – where sound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous electrical nerve stimulation (TENS) – where a machine is used to deliver small electrical pulses to your back through electrodes (small sticky patches) attached to your skin
  • percutaneous electrical nerve stimulation (PENS) – where electrical pulses are passed along needles inserted near the nerves in the back
  • interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing
  • painkilling spinal injections (although these can help if you have sciatica)

LIFESTYLE CHANGES TO TREAT LOWER BACK PAIN

  • Replace your mattress – The softer your mattress, the less evenly your weight will be distributed, and the more likely you are to experience discomfort. A medium to firm mattress is your best option. Before you commit to a new mattress make sure you’ve diagnosed exactly what your back issues are. Do some research to figure out what kind of mattress will suit your needs. The Emma mattress is an excellent option or browses more mattress reviews.
  • Change how you sleep – Pain can cause difficulty sleeping and lack of sleep can make the pain even worse – it’s a vicious cycle that’s hard to break. Small changes like rearranging your sleeping position, reducing or increasing the number of pillows, or relaxing with a hot shower before bed can make a difference.
  • Change your clothes – Constrictive clothing like skinny jeans and Spanx can restrict the spine’s normal range of motion and inhibit normal conditioning of muscles. This causes the lower back to become more susceptible to strain and injury, say experts. So let it all hang out, ladies – doctor’s orders.
  • Get online – The Mayfair Clinic offers the Back in Shape Programme – free to join, or £15 per month for Premium membership, it’s ideal if you’re housebound and need expert advice. Or take a look at the clinic youtube channel.
  • Exercise your core – Exercising the muscles in your abs and back can have a positive impact on lower back pain. Even doing something as simple as correcting your posture while you’re sitting at your desk has a lasting effect. If you feel like taking it a step further, practice sitting upright on an exercise ball for 30 minutes a day, or take up Pilates.
  • Have a foot check-up – According to a study in the journalRheumatology, women whose feet roll inwards when they walk may be especially prone to lower back pain. If you suspect that your feet might not be helping, it’s worth speaking to a specialist about your concerns. You can then look into taking extra measures, such as wearing orthotics to correct the arch of your feet.
  • Keep moving – You may think the best way to deal with pain is to lie still, but there’s nothing worse for lower back pain. Stretch your body out, go for a walk, and enjoy the fresh air. Even better, take part in a yoga class.
  • Get a massage – Research found that those who received weekly massages experienced less pain after 10 weeks compared to those who didn’t. General relaxation rubdowns also worked as well as structural massages that target specific body parts. Another study revealed that 63% of people experienced a moderate improvement in lower back pain when they underwent six osteopathic manual treatments over 8 weeks, with 50% reporting substantial improvement.
  • Try acupuncture – A 2013 study reported that acupuncture might actually provide more relief than painkillers. Acupuncture works by changing the way your nerves react and can help with inflammation around the joints.
  • Stop smoking – Smoking compromises blood supply to the spine, which can cause the intervertebral discs to age more quickly. This increases susceptibility to injury and herniation.
  • Sit less – In recent years, sitting has been coined the new smoking and for good reason – sitting in a chair puts 30% more pressure on the spine than standing or walking. If you sit at a desk all day (or on the sofa all evening), get up and walk around at least once an hour. Avoid slouching and, if you can, adjust your seat so it tilts slightly back.

When to Contact a Medical Professional

Call your provider right away if you have:

  • Back pain after a severe blow or fall
  • Burning with urination or blood in your urine
  • History of cancer
  • Loss of control over urine or stool (incontinence)
  • Pain traveling down your legs below the knee
  • Pain that is worse when you lie down or pain that wakes you up at night
  • Redness or swelling on the back or spine
  • Severe pain that does not allow you to get comfortable
  • Unexplained fever with back pain
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs
  • You have had back pain before, but this episode is different and feels worse
  • This episode of back pain has lasted longer than 4 weeks

Prevention

There are many things you can do to lower your chances of getting back pain. Exercise is important for preventing back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

It is also very important to learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give your body a wide base of support when lifting.
  • Stand as close as possible to the object you are lifting.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, do not bend forward.
  • Do not twist while you are bending down for the object, lifting it up, or carrying it.

Other measures to prevent back pain include:

  • Avoid standing for long periods. If you must stand for your work, alternate resting each foot on a stool.
  • Do not wear high heels. Use cushioned soles when walking.
  • When sitting for work, especially if you are using a computer, make sure your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods.
  • If you drive a long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Do not lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Do exercises on a regular basis to strengthen your abdominal and core muscles. This will strengthen your core to decrease the risk of further injuries.
  • Learn to relax. Try methods such as yoga, tai chi, or massage.

References

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