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Chronic Back Pain

Common Causes for Chronic Back Pain

Acute lower back pain affects 65-85% of the adult population.1 Given the large number of adults impacted by lower back pain, this is also the most common reason for missed work and doctor's visits. The majority of patients will get relief within 8-10 weeks without treatment from a doctor.

Examples:

  • Back Strain
  • Back Sprain
  • Degenerative Arthritis of the Back Flare Up
  • Mechanical Irritation of a Nerve Root
  • Discogenic Tear
  • Bony Fracture or Contusion

The good news is that 90% of acute back pain caused by disc herniations will resolve in 2-3 months regardless of treatment.2 However, if you fall within the 10% of patients where the acute back pain hasn't resolved within this time frame you may need to consider spine surgery if you experience any of the following.

Surgery Indications:

  • Progressive Neurologic Weakness
  • Neurologic Injury to Bowel or Bladder Function
  • Surgically Correctable Pain Unamenable to all Conservative Treatments
  • Surgical Instability or Nerve Compression

Symptoms and Types of Chronic Lower Back Pain Include:

  • Lumbar Spondylosis: This conditions is often used to describe degenerative arthritis (osteoarthritis) of the spine. As we age, spinal discs lose moisture and shrink, bone spurs develop and bones become weaker.
  • Lumbar Stenosis: Disc degeneration ligament thickening leading to Facet hypertrophy (or narrowing of the Canal). This eventually leads to a compromise of the nerve roots exiting the canal and cutting off their vascular supply.
  • Lumbar Disc Herniation: This is basically a mechanical disc impingement that caused patients to experience a burning or tingling numbness in the legs typically associated with a static position vs. movement. This nerve pain typically radiates down the leg and can go all the way down to the foot and ankle (in a dermatomal pattern). There may also be sensory, motor and reflex changes associated to the area impacted by the disc herniation. This radiating nerve pain can result in Radiculitis which often impacts the Sciatic Nerve and referred to as "Sciatica."
  • Discogenic Pain: Is caused from Physical Compression of the nerve root or Chemical Irritation of the nerve root resulting in nerve damage. Symptoms include weakness, numbness, and muscle atrophy.

Reference
1. Arnold YL Wong, Jaro Karppinen and Dino Samartzis. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Discord. April 18, 2017; 12-14.

2. Andrew J. Schoenfeld and Bradley K. Weiner. Treatment of Lumbar Disc Herniation: Evidence-based Practice Int J Med. July 21, 2010; 209-214.

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