Acute Low Back Pain

Have you ever performed a small physical task or maneuver and then experienced an acute attack of back pain that causes you to take a deep breath and scream?

Or have you ever felt a burning pain from your back radiate down into your toes and make you  weak and useless for anything else.  If so, you are among the 85 percent of us who will have at least one acute episode of low back pain (LBP) in their lifetime. Most causes of acute low back pain are temporary and self limiting, but there are some serious causes with associated warning signs which make early medical evaluation important.

The most common cause of sudden LBP is injury to the supporting muscles and ligaments in and around your spine---spasm, tears and swelling lead to the sensation of pain. However, bone fractures, infections, disc impingement on nerves, connective tissue disorders and even tumors are among the more serious possibilities.  A patient’s history is very important in assessing low back pain. A history of systemic disease (cancer, heart valve disease and osteoporosis for example), unexplained weight loss, fever, age over 50 years,  and duration of more than one month would be indications to seek medical attention. In addition, if the pain is not localized to the back but radiates down the leg or into the foot, is associated with urinary or bowel control problems, or is combined with lower extremity weakness, medical evaluation is indicated.

Sciatica is a term used to describe irritation of the nerve root, with sharp or burning pain radiating down the back or side of the leg to the foot. Associated with numbness and tingling, sciatica often worsens with coughing or sneezing.

Your primary care provider’s evaluation will center on the history and physical examination. Their main focus will be on differentiating between self limiting and more serious causes of the pain.  Since 90 percent of patients with acute LBP will improve spontaneously, most patients will not need x-rays or other radiologic studies such as CT scans or MRIs.

Although at one time bed rest was a cornerstone of therapy, multiple studies have shown that recovery from pain is equally rapid and complete without bed rest, even in patients with sciatica. Walking and normal activities should be resumed as quickly as possible.  Spinal manipulation, yoga, acupuncture all have been studied as therapies and all seem to have a beneficial effect. However, they should be used with the input and advice of your PCP.

Analgesics such as acetaminophen, aspirin and non steroidal anti-inflammatory medicines will provide relief. However,  opioids such as oxycodone should be avoided in most cases because of their potential for sedation, gi symptoms and long term abuse.