- Lower back pain (LBP) affects 80% of the population at some point in life
- Causes and symptoms of lower back pain (LBP)
- Lower back pain risk factors, indicators, and diagnosis
- Treatment of Lower back pain (LBP) with medications and psychotherapy
- Lower back pain (LBP) treatment with natural methods including exercise, and physical therapy
- Final thoughts: risks of addiction on prescription drugs
The scourge of lower back pain is at epidemic levels worldwide, signing in as the leading cause of disability and absenteeism from work in all parts of the globe, and affecting some 32 million people in the U.S. This has led to a continually growing collection of treatment strategies comprising prescription drugs, chiropractic care, surgery of various types, psychotherapy, and lifestyle adaptations that include a multitude of exercises and other natural techniques.
To understand LBP’s overarching cause, we have to take a look at the structure of the back and spine. The spine’s main function is to act as a strong shield that protects the sensitive vertebral column with its array of nerve endings that, together with the brain, constitute the heart of our central nervous system. With all that however, the spine needs to be malleable enough to permit bending and flexibility.
The problems begin right there however, for the spine itself is an intense hub for nerve endings and can thus harbors a complex assortment of areas that can develop non-kidney related pain. For example, there can be strains to the large back muscles, injuries to the ligaments that protect the spine, disc or individual vertebra dislocations, and many more possibilities for joint or nerve damage.
The good news is that much of the non-kidney related pain that we often experience will simply go away on its own after a few days or weeks. In fact, the relevant and much documented statistic is that half of the back pain we experience will dissipate on its own volition within two weeks, and 90% within three months. The leftover pain, i.e. the pain that will not go away either on its own or as a result of some treatment, will become known as chronic pain, i.e. pain that lingers for at least 12 weeks.
According to the Global Burden of Disease, low back pain is the single leading cause of disability worldwide. Here are some facts relating to low back pain in America:
- It is thought that some 32 million Americans complain from lower back pain at any given time.
- Half of the American workforce reveal they’ve had low back pain in the past year.
- At the level of the most readily identifiable costs, which by no means represent all cost expenditures, Americans spend over $50 billion a year on non-kidney related lower back pain.
- Nearly a third of female adults suffer from lower back pain compared with a quarter for men, yet men claim their pain affects work 33% more so than women.
- 54% of U.S. citizens who have non-kidney related low back pain conduct their work while sitting.
- Most causes of back pain are not associated with serious conditions like cancer, arthritis, broken bones, and the like.
- Back pain is on top of the list of reasons why we visit our doctor every year, and it is also one of the top causes of work-related absenteeism.
We mentioned in the overview that 50% of the non-kidney related lower back pain experienced in the United States will disappear after 2 weeks. This can happen when, once we feel the pain, we:
- Rest for a period of time
- Get good sleep over a few nights
- Get a deep tissue massage
- Get some physical therapy
- Do some stretching exercises
- Do some low back pain exercises
- Use cold or heat treatment
- Use prescription or over the counter medications
- Or indulge in some stress-relief techniques like yoga or meditation
If none of the above resolve our problem, then it is time to go to the doctor for tests.
There are two non-kidney related conditions that may be at play following a few days filled with pain that may need emergency-type attention. These are:
- Sharp abdominal pain, often accompanied by vomiting diarrhea or constipation, watery stools, spasms, bloating, gas, or rectal bleeding, all of which produced by a condition known as bladder and bowel dysfunction (problems with urinating and passing stools)
- Primary neurologic disease known as Myelopathy, or damage to the spinal cord. Its symptoms consist of progressive weakness in the legs and hands associated with clawing of the feet, numbness of hands and feet, and foot pain
Fortunately, these two conditions don’t present themselves too often.
There are almost as many symptoms of non-kidney related lower back pain as there are types and causes of pain. Take pain in the back (and sometimes in the buttock) as an example: this can at times develop either quickly, gradually, or in episodes, with certain movements exacerbating it, while walking or resting may alleviate it. In general though, the symptoms that are associated with lower back pain (LBP) include:
- Shooting pain down one or both lower extremities (aka sciatica)
- Sensation of pins and needles
- Pain as the spine bends or twists
- Sharp pain
- Pulsating pain
- Muscle spasms
- Dull ache
- Incontinence of bladder and/or bowel
Studies have revealed that 90% of people with non-kidney related lower back pain in America never find out what caused their pain. Only 10% of Americans can attribute their lower back pain to an identifiable cause. The other fact that raises eyebrows is that the vast majority of (non-kidney related) cases of low back pain is when that pain is chronic, meaning that it either persist and recurs regularly, or that it lasts for longer than 12weeks.
There are literally dozens of causes for lower back pain. Here is a short list of only list those with the highest incidence in America:
Lumbar herniated (slipped) disc
This can occur at any level in your spine when the soft center of a lumbar disc tears through the harder outer layer and pressures the closest nerve root.
Degenerative disc disease
Part of the aging process is that vertebral discs lose their jelly-like mass and wear down, restricting their ability to resist pressures. They can thus transfer pressure to the disc wall that may tear and become painful or weak (and may lead to herniation).
This is also referred to as spondylosis or degenerative arthritis of the spine, and it is associated with aging and obesity. It is slowly progressive, and it may cause stiffness in the back and neck. Younger people may develop it as well, mostly through injury or heredity.
Lumbar spinal stenosis
This is a medical condition in which the spinal canal where the nerve roots are located narrows, compressing the spinal cord and nerves, and causing pain.
Facet joint dysfunction
This is also known as osteoarthritis. The facet joints have cartilage around the discs and are surrounded by capsular ligaments that enhance your back’s flexibility and enable you to bend and twist.
This condition of the back occurs when one vertebra slips over the adjacent one. The pain ensues when the affected nerves are compressed.
This nerve is your body’s longest nerve and one of the most important ones. It begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg, and it is caused by a variety of low back conditions, including lumbar degenerative disc disease.
This is mostly due to weak or brittle bones such as from osteoporosis that cause a fracture in the cylindrical vertebra.
This is the forward curvature of the upper body, known as thoracic Kyphosis. This combination of forward and reverse curves in the spine allows people to sit and stand upright. This deformity can cause lower back pain if it leads to the breakdown of the discs, facet joints, sacroiliac joints, or stenosis.
There are naturally many other risk factors for non-kidney related pain in general and lower back pain in particular. Among those, the most prominent risk factors include:
- Autoimmune disease
- PMS (Premenstrual Syndrome)
- Pelvic inflammatory disease (PID)
- Kidney stones
- Cervical dysplasia
- And other conditions
The kidneys are vital organs that are located in the upper abdominal area against the back muscles on both sides of the body. The kidneys serve to continually rid the body of excess fluids and waste material. Kidney-related pain is caused primarily either by urinary tract infections or kidney stones, this latter usually producing symptoms of extreme and relentless pain, until the stones are either removed or made to dissolve.
The trouble with the pain that can emanate from the kidneys is that it can so readily be confused with other causes of low back pain. It is therefore essential to look out for typical kidney related issues through the typical symptoms that urinary tract infections or kidney stones produce. Those include:
- Flank pain
- And very painful urination
Kidney pain can be on the left or right side of the lower back, or on both sides of the low back area.
When the diagnosis points to an infection, antibiotics are used for kidney treatment, often together with ibuprofen Tylenol or acetaminophen Motrin. On the other hand, kidney stones can pass naturally or, when needed, can be taken out surgically.
When comparing men and women’s lifestyles, women live overall healthier lives with less obesity and frequently less stress at work. Yet women have a greater gender bias towards low back pain. When it comes to lower back pain, women are clearly disadvantaged: nearly a third of female adults suffer from lower back pain compared with only a quarter for men. Here is a short list of reasons:
This is the most common cause of vertebral compression fractures, especially in women over the age of 50. Women are almost twice as likely as men to have a compression fracture.
This is a degenerative disease that generates muscle pain, stiffness, pain in the low back and legs, and fatigue, and women are 3 times more likely to develop it than men.
This is a degenerative joint disease that constitutes the most common type of arthritis. It produces pain in the knees, hips and lower back. It is prevalent in both men and women up to age 45, but beyond that, it is more prevalent in women.
Coccydynia (tailbone pain)
This makes sitting painful, and women are 5 times more likely than men to develop it. It affects women at an average age of 40 and can become chronic.
Sacroiliac Joint Dysfunction
The sacroiliac joint serves as a shock absorber between the upper body and pelvis commonly producing low back and leg pain. It produces chronic pain that is more prevalent and frequently more severe in women.
This is a disorder that produces widespread pain and fatigue and that is difficult to diagnose and treat. Over 80% of those who develop fibromyalgia are women.
Here again, there are almost as many drug medications for non-kidney related pain, both over the counter and prescription drugs, than there are types or causes of pain. Here is a brief listing, starting with NSIADS:
Non-steroidal anti-inflammatory drugs (NSAIDs) are used in pain management techniques to alleviate the symptoms of pain. These are pain suppressant drugs that function by way of a chemical process in which they block the effects of Cox 1 and Cox 2. Those are special enzymes that help produce prostaglandins, which in turn cause inflammation that results in pain. Examples of NSIADs drugs are such brand names as Celebrex, Motrin, Advil, Indocin and several other medications.
Here are some of the effects of depression and the pain depression causes:
Exhaustion, Fatigue, and Sleeplessness
Many people with depression find it hard to get to sleep or have fitful nights. Research has shown that over 80% of people with depression suffer from some kind of insomnia, while hypersomnia (oversleeping) is also possible. Irrespective, people with depression appear close to exhaustion, dragging themselves through as few chores as possible, their body movements slow and lethargic.
Digestive and Metabolism Problems
Depression usually means loss of appetite and weight, although some individuals may find solace in binging on food and gaining weight. One might also feel nauseous with either bad diarrhea or even worse constipation.
Migraines and Aches in the Joints and Muscles
Depression can make any chronic pain worse, including migraine headaches, back and other pains. This is particularly regrettable, since it is frequently the case that it was the initial pain that contributed to the depression.
The current standard for dealing with depression is by the use of antidepressant medication (ADM). The main benefit of these drugs in pain management techniques is that they relieve the symptoms for as long as patients keep taking the drugs -they bring about a near absence of symptoms. However, they usually have to be prescribed for life, especially for patients who have a history of chronic depression, for going off the medication may throw the patient into a severe depression with a risk factor 3 to 5 times that of the general population.
Commonly used antidepressant drugs include:
- Celexa (citalopram)
- Zoloft (sertraline)
- Paxil (paroxetine)
- Lexapro (escitalopram)
Selective Serotonin Reuptake Inhibitors (SSRIs), are a relatively new class of anti-depressant and anti-anxiety medication, usually prescribed in non-kidney related pain management techniques together with psychotherapy. The issue with SSRIs is, once again, that once one stops taking the medications, the anxiety disorder can rear its ugly head again, in full force, requiring additional pain management and pain relief techniques.
SSRIs are commonly used drugs for the treatment of Generalized Anxiety Disorder (GAD) as well as various other anxiety and phobia disorders. Such drugs include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Escitalopram oxalate (Lexapro)
- Citalopram (Celexa)
The Food and Drug Administration (FDA) has approved only a few anti-seizure drugs for the treatment of chronic pain. These include:
- Carbamazepine (Tegretol) for trigeminal neuralgia, diabetic neuropathy pain and postherpic neuralgia
- Gabapentin (Neurontin) for postherpetic neuralgia, or shingles pain, and also diabetic neuropathy
- Pregabalin (Lyrica) specifically for postherpic neuralgia and diabetic neuropathy.
- And various other anti-seizure medications.
Corticosteroid drugs have been shown to reduce spontaneous discharge in an injured nerve, which reduces neuropathic pain. Prednisone or prednisolone are often used for pain relief although the most commonly prescribed corticosteroid for pain is Dexamethasone.
High-strength painkillers known as opioids represent the most widely prescribed class of medications in the United States, despite their propensity for addiction and other harmful health conditions. And over the last decade, the number of prescriptions for the strongest opioid drugs has increased nearly fourfold, with only limited evidence of their long-term effectiveness or risks among pain relief techniques.
The rising use of legal prescription opioids, primarily painkillers such as Oxycodone and Hydrocodone (Oxycontin and Vicodin), have taken patients from pain care to increased opioid addiction. Deaths and other harmful health conditions from these prescription drugs and heroin have spiked, and pain treatment surveys suggest that hundreds of thousands of patients nationwide may be on potentially dangerous dosages.
There’s no commonly accepted pain relief program to tell people with back pain how to manage the condition effectively. People with low back or other chronic pain can only be encouraged to seek relief through a variety of treatments that may include:
Contingency Management and Cognitive Behavioral Therapy (CBT) are behavioral pain management treatments designed to help modify the patient’s expectations and behaviors related to pain, to increase skills in coping with various life stressors, to help restore a degree of normalcy to brain function, and to ultimately improve overall health. Moreover, psychotherapy treatments such as cognitive-behavioral therapy (CBT) have shown relatively good results, especially when applied in concert with pharmacotherapies.
When applied correctly, physical therapy can be the corner stone and highly beneficial part of a pain management program. Physical therapists have at their disposal various possible treatments and techniques such as electrical stimulation, muscle-release techniques, heat, ultrasound, to aid your back muscles and soft tissues for pain relief. Physical therapy typically aims at boosting your flexibility and improve posture by strengthening back and abdominal muscles. By providing pain relief and enhancing flexibility, this type of pain management program has also been known to bring about improved overall health.
Here is a short list of what else you can do to mitigate the pain that you may be living with:
- Cortisone injections
- Chiropractic care
- Massage and manipulation
- Losing weight (for overweight people)
- Yoga, meditation and other relaxing techniques
- Cold and hot therapy
If you have back or joint pain, there will be times when all you want to do is lie in bed all day. Lying in bed used to be what doctors prescribed the most, although it has been shown in many studies that it is stretching, exercise and staying flexible that does your back pain, and overall health, the most good.
There are many simple stretches and exercises that can be performed in 20 to 30 minutes as part of your daily routine. If you are just starting out, even a simple act of sitting upright on an exercise ball for 30 minutes a day will engage your core muscles.
The muscles in your abs and back play a critical role in supporting your lower spine. These muscles don’t get a good workout during the course of a normal day—they need to be specifically targeted through stretches and exercise.
The best type of stretches is often prescribed by a physical therapist in order to avoid committing yourself to a wrong type of stretches that may do more harm than good. Appropriate stretching of the muscles along with practice exercise workouts will help improve range of motion and generate stress relief and relief for less than optimally used muscles.
Generally speaking, people with LBP can concentrate on stretching the lower back muscles, abdominal muscles, hips, and legs.
Core strengthening exercises
Core exercises build abs and other core muscles. If you have back problems, osteoporosis or other health concerns, this type of exercises is best for you, although the exercises should only be undertaken after consultation with a licensed physical therapist or doctor. These exercises include:
- Abdominal crunch
- Single-leg abdominal press
- Single-leg abdominal press variations
- Double-leg abdominal press
Dynamic stabilization exercises
These exercises comprise the use of various types of exercises to stabilize your core muscles and may include use of exercise balls, balancing machines or specific stabilizing exercises. By keeping your trunk steady as you move one or more of your extremities, you can begin to develop your dynamic stabilization.
Many people embark on the prescription drug odyssey when they are first prescribed an opioid drug like Vicodin or Oxycontin to mitigate genuine pain. Because it is difficult to diagnose, they tell their doctor that they have lower back pain.
For someone just starting on Oxycontin, this prescription drug is sufficient not just to alleviate the pain, but also to conjure a high: total relaxation of the body’s main muscle groups, and an exalted form of euphoria in which the Oxycontin user feels as though a ton of bricks has just been lifted off their chest.
Many prescription drug users then graduate from low to high dosages, and from infrequent to frequent use.
By then the addiction has taken over, and any attempt at quitting the abusive cycle is met with vicious withdrawal symptoms. In that phase of the cycle, the highs have evaporated, but the users can’t quit, so many find it easier to just carry on with their habit, delving into a life of regret and ultimate distress.
Beware of pain-relief prescription drugs like opioids. If you have to take them for genuine low back pain, take them for a few days only, and then revert to one of the other above described pain alleviating strategies.