Facts on Low Back Pain

Low back pain can be localized or referred, and can be defined as pain located at the base of the spine due to different causes such as sprains, strains, a neoplasm, ankylosing spondylitis, osteoarthritis, or intervertebral disc herniation.¹ It is a common condition and is frequently associated with poor posture, sitting for a long time, obesity, abnormal body mechanics, or loosening of the abdominal muscles.¹

On estimate, the prevalence of low back pain is between 31% and 47%, and affects more women than men.² In addition, 60% to 80% of people will experience at least one occurrence of low back pain in their lifetime. Among them, 30% to 40% will suffer from the condition every year.³

People with less education are more likely to be affected by low back pain. Those with osteoarthritis, vital exhaustion, depression, fear avoidance, or post-traumatic stress syndrome have also been found to be at a higher risk for the condition.² For patients who receive treatment for acute low back pain, 80% are able to return to work within a month, while 7% of the patients will progress to chronic low back pain on average. However, for patients who do not receive treatment for acute low back pain, more than 60% will develop chronic low back pain or recurrences.²

Low back pain can last less than one month to as long as more than three months. The severity of pain also ranges from mild to unbearable.⁴ Patients with low back pain may also present with fever, weight loss, prolonged morning stiffness, pain when lying down, acute fracture and viscerogenic pain related to a non-musculoskeletal organ system.⁴ Significant motor weakness in the legs, unexpected bowel and/or bladder dysfunction may also be present. Other symptoms also include having localized tenderness when palpating the affected area or severe pain with little movement of the affected part of the spine.⁴

The treatment required for low back pain depends on the chronicity of the pain.⁴ Treatments currently available for acute low back pain include patient education, rehabilitation therapies, medications, manual therapy, physical modalities such as superficial hot/cold treatment, acupuncture, and surgery.^4,5 Similarly, for chronic cases, treatments include patient education, manual therapy, medications.⁶

Patient education is highly recommended and consists of clinicians informing the patients about what low back pain is and to remain active, as well as advocating against bed rest. On the other hand, contrasting evidence have been found on the effectiveness of rehabilitation therapies such as the use of back schools, and is not recommended.⁵ The most commonly used medications include acetaminophen (paracetamol), nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and short-term opioid use.⁵ Manual therapies commonly used include massage and spinal manipulative therapy, of which both are effective in reducing pain intensity for sufferers of low back pain. In particular, studies have found spinal manipulation to be more effective in reducing pain intensity than other methods such as ultrasound and NSAIDs.^7,8

If the above non-surgical methods are ineffective, injections and surgery may be used to treat low back pain. There are different types of injections and two main surgical methods which are decompression surgery and fusion surgery.⁵

Chiropractic care is also effective in treating low back pain and provides an alternative and more personalized method for pain relief for patients who do not respond well to more evidence-informed methods.⁹ Numerous evidence have been found in support of chiropractic care in the management of low back pain for both acute and chronic cases. In some cases, chiropractic care has been found to be even more effective than other treatment methods such as the use of opioids and medical care.^10,11,12 Apart from spinal manipulation, chiropractors also help patients to independently manage their low back pain through methods such as patient education, exercise, diet and lifestyle modifications.⁹ Currently, high-velocity, low-amplitude (HVLA) techniques have the strongest evidence for the treatment of low back pain among other manual therapies. As such, it is usually used unless there are contraindications.⁹ Chiropractic care has been clinically shown to improve pain and disability and is hence a suitable method of management for low back pain.^10,12

References

1. O’Toole MT, editor. Mosby’s medical dictionary. 10th ed. St. Louis, Mo: Mosby; 2017.

2. von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine. 2013;38(7):540. doi: 10.1097/BRS.0b013e318275d09c

3. Mohseni-Bandpei MA, Critchley J, Staunton T, Richardson B. A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiother [serial online]. 2006 [cited 2016 Jan 12];92(1):34-42. Available from: ScienceDirect. http://sciencedirect.com/

4. Borenstein DG, Calin A, Swezey RL. Fast facts: low back pain. 2nd ed. Abingdon, Oxford: Health Press; 2012.

5. Dagenais S, Haldeman S. Evidence-based management of low back pain. 1st ed. St Louis, Mo: Elsevier Mosby; 2012.

6. Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2016. doi: 1002/ejp.931

7. Von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: A double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine. 2013;38(7):540-8.

8. Mohseni-Bandpei MA, Critchley J, Staunton T, Richardson B. A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Physiotherapy. 2006;92(1):34-42.

9. Globe G, Farabaugh R, Hawk C, Morris C, Baker G, Whalen W, et al. Clinical practice guideline: Chiropractic care for low back pain. JManipulative Physiol Ther. 2016;39(1):1-22. doi: 1016/j.jmpt.2015.10.006

10. Haas M, Sharma R, Stano M. Cost-Effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain. Journal of Manipulative and Physiological Therapeutics. 2005;28(8):555-63.

11. Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, et al. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results of a pragmatic randomized comparative effectiveness study. Spine. 2013;38(8):627-34. doi: 1097/BRS.0b013e31827733e7

12. Isaza A. Chiropractic vs tramadol and all other opioids for the treatment of nonspecific chronic low back pain: Which treatment is more effective at reducing disability? Original Internist [serial]. 2015 [cited 2016 Jan 14];22(4):381. Available from: General Onefile. http://find.galegroup.com