Overview Low Back Pain

If you have lower back pain, you are not alone. About 80 percent of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days. In a large survey, more than a quarter of adults reported experiencing low back pain during the past 3 months.²

Non-specific low back pain has become a major public health problem worldwide and affects people of all ages and is a leading contributor to disease burden worldwide.3 The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11–12% of the population being disabled by low back pain.⁴

Most low back pain is acute, or short term, and lasts a few days to a few weeks. It tends to resolve on its own with self-care and there is no residual loss of function. The majority of acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move.²

• Subacute low back pain is defined as pain that lasts between 4 and 12 weeks.
• Chronic back pain is defined as pain that persists for 12 weeks or longer,even after an initial injury or underlying cause of acute low back pain has been treated.

About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain persists despite medical and surgical treatment.²

The majority of LBP does not have a clear cause but is believed to be the result of non-serious muscle or skeletal issues such as sprains or strains.^1,4 Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute to low back pain.²

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination. Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumors and spinal stenosis.²

Treatment for low back pain generally depends on whether the pain is acute or chronic.² Nonsteroidal anti-inflammatory drugs (NSAIDs) are often first-line therapy for low back pain.⁶ Spine stabilization exercises have been shown to decrease pain, disability, and risk of recurrence after a first episode of back pain.⁷ A clear understanding of the biochemical lesions underlying pain generator and of the interplay between muscle spasm and pain, is essential for choosing the most appropriate medication for each patient with acute low back pain. The goals of the pharmacological treatment for acute low back are, therefore, not only the relief of pain, but also the reduction of muscle spasm and inflammation. Muscle relaxants should be preferred for those patients with a muscle contracture as main component of pain.⁸ It works by relaxing both skeletal muscles and vascular smooth muscles, thus demonstrating a variety of effects such as a reduction of myotonia, improvement of circulation, and suppression of the pain reflex.⁹

References :

1.      Acute Lower Back Pain [image on the internet]. C2018 [cited 2018 Apr 24]. Available from : http://www.physiotherapylinks.com.au/acute-low-back-pain/ 

2.      National Institute of Neurological Disorders and Stroke. Low back pain fact sheet. C2014. [updated 2017 May 10; cited 2018 Apr 24]. Available from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.

3.      Maher C, Underwood M, Buch binder R. Non-spesific low back pain. The Lancet. 2017; 389(10070).p.p736-47.

4.      Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. The Lancet. 2012; 379(9814).p.482-91.

5.       Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-50.

6.       Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tul-der MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;(1):CD000396.

7.       Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976). 2001;26(11):E243-E248.

8.       Betrame A, Grangie S, Guerra L. Clinical experience with eperisone in the treatment of acute low back pain. Minerva Med. 2008; 99:347-52.

9.       Rusinyol FC, Perice RV, Boronat ER, Bosch FF. Effects of two different doses of eperisone in the treatment of acute low back pain. The Journal of Applied Research. 2009; 9(1):23-9.