House Calls
Each year, more than 65 million Americans suffer from low back pain. It can take many forms from a persistent ache in the lower back to shooting pain down the legs. For some, the pain is so intense and the muscles so tight that it’s difficult even to stand up straight.
The spinal column, an intricate network of nerves, discs and bones, starts in the brain and runs down the length of the back. More than 50 motor and sensory nerves running through the spinal column play a critical role in the body, controlling every movement and function.
Because of the large number of nerve roots in the spinal column, there are multiple reasons for low back pain.
The most common is a pinched or irritated nerve in the spinal cord. For example, a spinal disc may bulge and press on a nerve root, causing irritation. Causes may include high levels of activity or stress, or a mechanical problem in the spine.
The good news is that more than 90 percent of all low back pain can be mitigated without surgery.
The first and most simple step is for people to educate themselves and make small changes to their daily routines to allow the spine to rest in its neutral, or natural, position. This may include:
Implementing proper ergonomics at work;
Learning safe lifting techniques;
Doing basic exercises to alleviate pain and prevent further problems from occurring.
Such simple lifestyle changes often alleviate low back pain. They do not, however, work in all cases. If a fever accompanies the pain or if it is related to a recent injury, the individual should call his or her primary care physician immediately or visit the emergency room.
In many cases, a primary care physician can prescribe medications to relieve pain, swelling or irritation. If these treatment options fail to provide relief within two weeks, it may be time to consider other options.
Diagnostic testing is the next step for patients with chronic back pain. Standard X-rays can be used to identify degenerative changes as well as instabilities in the spine. As a second step, CAT and MRI scans can assist in determining the diagnosis and degree of the problem.
The physician and patient then determine a course of treatment based on the patient’s diagnosis, symptoms and lifestyle. Most opt for conservative treatment, such as physical therapy, weight control, steroid injections, nonsteroidal anti-inflammatory medications, rehabilitation, limited activity or alternative medicine.
If surgery is necessary, there are a variety of options available to help relieve the pressure on the nerve.
Dr. Haleh Agdassi is a physiatrist at the Palo Alto Medical Foundation. The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.
