Low back pain is a very common condition that most people experience at some point in their life. It is one of the most common reasons patients see their doctor or miss days at work. Back pain can range in intensity, onset, duration and course. Many factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the 3rd decade of life, and overall prevalence increases with age until the 60-65 year age group and then gradually declines1.
The vertebral column (backbone) is made up of 33 vertebrae. These vertebrae are then grouped into divisions based on region: 7 cervical (neck), 12 thoracic (upper back), and 5 lumbar (lower back), 5 fused sacral and 4 fused coccygeal (tailbone). A fibrous disc (intervertebral disc) connects each pair of vertebrae. Each vertebral body is connected to the adjacent level by small joints called “facet” joints. These joints provide mobility and range of motion of the vertebral column; finally, thirty-one pairs of spinal nerves are rooted to the spinal column and travel out of through “neuroforamina” – the spaces between the vertebral bodies.
Back pain can be caused by many different pathologies. Often, there are multiple etiologies involved. In general, back pain can be divided into “axial” back pain – pain across the low back, and radicular back pain – back pain with radiation down the leg/foot. Axial back pain can be caused by degenerative disc disease, osteoarthritis of the spine, fracture of the vertebral body or muscle sprain. Radicular back pain is often secondary to a nerve or spinal cord problem, such as disc herniation or spinal canal stenosis (narrowing of the spinal canal).
Your physician will often start with a physical exam. Often, an x-ray is obtained initially to evaluate for degenerative changes and rule out any acute fractures. If the pain persists > 6 weeks and/or there are neurological symptoms associated with the back pain, an MRI is then ordered to evaluate the nerves, spinal column and discs.
Most back pain is acute and will resolve with time and conservative management. Initial conservative management includes anti-inflammatories, muscle relaxants or nerve pain medication and a trial of physical therapy. If conservative management fails, advanced interventional treatment options may be recommended. Interventional options include epidural steroid injections, radiofrequency ablation, spinal cord stimulation, or vertebral augmentation for acute fractures. The appropriate interventional option depends on the cause of the pain, and a pain physician can help determine the appropriate steps after a thorough evaluation and review of available imaging.
Valley Pain Consultants physicians have received extensive training in Pain Management, and always stay current with all new and up to date through many educational meetings throughout the year. To schedule an appointment, please call (480) 467-2273.
Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):769-81. doi: 10.1016/j.berh.2010.10.002. PMID: 21665125.