MMS Physician Focus: September 2009
By Janet Pearl, M.D., M. Sc.
Taking proper care of your back isn't something most people
learn in school or even at an annual checkup. Yet low back pain
affects approximately four out of five Americans and is the leading
reason for missed work, according to the National Institute of
Neurological Disorders and Stroke (NINDS). To make matters worse,
roughly 15 to 20 percent of those with acute back pain eventually
develop prolonged back pain. Given these statistics, the
odds are strong that most people will battle low back pain at some
point. Understanding what causes back pain and how to prevent it
can help minimize the risk of back injury.
Low back pain can be either acute or chronic.
Acute low back pain lasts between a few days and a few weeks and is
most often caused by an injury to muscles, ligaments or joints. If
the discs (the cushions between the vertebrae or bones of the back)
become overly compressed, they can develop tears and even rupture,
causing severe pain. Chronic or ongoing low back pain, which
afflicts 2 to 8 percent of Americans, usually is related to either
an injury or a degenerative condition of the spine. As people age,
discs lose fluid and flexibility, and joints become arthritic,
decreasing the space for nerves and resulting in pain.
Reducing the risk. Whatever activity you
undertake, following these basic guidelines can reduce the chances
of developing low back pain:
Stretch and warm up before activities to keep your back and
supporting muscles flexible and strong.
Pace your activities and take breaks every hour.
When lifting, use proper techniques. Specifically, lift with
your knees. Pull in your stomach muscles and keep your head down
and in line with a straight back. Keep the object close to your
body and do not twist when lifting it. And don't lift
objects you think are too heavy.
When traveling on long trips, get up from your seat every hour
and stretch; pack lightly and check heavy bags.
Prevent falls - especially on ice or wet ground and at home
(where most falls occur) - by wearing proper foot gear, watching
where you step, taking shuffling steps, and holding a railing if
possible.
If you're obese, lose weight. Obesity increases the
deterioration of joints and discs.
Quit smoking, which reduces blood flow to the lower spine and
causes the spinal discs to degenerate.
Treating the pain, with cautions Treat acute
low back pain with a combination of bed rest (maximum of two days),
over-the-counter analgesics, and stretching. This regimen can often
relieve symptoms and prevent the pain from getting worse. However,
warnings are in order. Over-the-counter products, while easing pain
and reducing inflammation, can present problems, especially if
taken with alcohol or in excess of recommended doses. NSAIDS
(non-steroidal anti-inflammatory drugs), such as ibuprofen, can
cause ulcers or bleeding in the gastrointestinal tract even if
taken properly. Also, acetaminophen can be toxic to the liver in
doses greater than four grams (and even less if taken with alcohol
or by someone with liver disease). Acetaminophen is also contained
in other medications, so an accidental overdose is possible if
you're not careful. Read medication labels and track how much of
this drug you're taking.
When to see a physician Seek a physician's help
if you experience any of these symptoms:
Back pain with fever, difficulty with bowel or bladder
function, or numbness and weakness in the legs These signs could
indicate serious conditions, so seek medical attention immediately,
as urgent surgery may be necessary
Severe back pain, especially after an injury.
Back pain that lasts longer than two to three weeks. Alert
your primary care provider who may order tests and refer you for
physical therapy.
Low back pain that lasts longer than two months (chronic low
back pain). Visit a board certified Pain Medicine physician who can
evaluate your condition and help you manage pain and its effects
with a comprehensive treatment plan. The goal is to help you
recover your function.
For more information, including fact sheets and tips on exercise
for prevention, visit www.ninds.nih.gov or www.familydoctor.org. Use
the search function for 'low back pain.'
Janet D. Pearl, M.D., M.Sc. is the Founder and Medical
Director of Complete Pain Care, a pain medicine practice in
Framingham, Mass. Physician Focus is a public service of the
Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult their personal
physician for treatment. Comments are welcome atPhysicianFocus@mms.org
