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AN ORTHO-PINION

David Casper, MD
Any views or recommendations shared in the Ortho-pinions blog are solely those of the authors and do not necessarily represent those of the American Academy of Orthopaedic Surgeons.

Low back pain is one of the most common reasons that patients seek medical advice. If you personally have not had an issue with low back pain, I would bet that you know a relative, friend, or colleague that has dealt with this debilitating condition. Whether acute or chronic, low back pain can range from an occasional nuisance to an incapacitating condition that affects a patient’s daily life. Regardless of whether the pain is mildly symptomatic or severe in nature, the vast majority of back pain complaints can be treated without surgery.

Inciting events that can cause low back pain range from a laborious day of yard work to poor lifting mechanics. When dealing with the acute onset of low back pain, rest and nonsteroidal anti-inflammatories are always a good start. If the pain fails to improve, seeking medical advice is warranted.

To assess for low back pain, the primary care physician will start by obtaining a thorough history and conducting a physical exam. The history helps the physician to diagnose possible inciting events and may include questions about the location of pain; the frequency of and duration of symptoms; as well as any history of previous symptoms, treatment, and response to treatment. Hopefully, the physician will be able to identify any inciting events that can be avoided in the future.

Additionally, a physical exam will help to define musculoskeletal pain from pinched nerves or an arthritic spine. Patients who have decreased sensation or motor function in their lower extremities, bowel or bladder issues, fevers or chills, recent weight loss or weight gain, or strictly night pain associated with their back pain, may have a more serious condition that will likely require imaging of the spine. For those patients believed to have a musculoskeletal source of pain, no imaging is required or recommended at the initial physician visit.

Once the physician rules out any serious condition that may be the root of the patient's back pain, he or she will initiate a therapy regiment, as well as possible pharmacologic treatment. Therapy is typically conducted two to three times per week for a period of four weeks, after which the patient will return to the physician in order to undergo re-evaluation. Pharmacologic adjuncts that may help to expedite recovery of low back pain include acetaminophen, nonsteroidal anti-inflammatories, and muscle relaxers. Benzodiazepines and opioids should be avoided. Other treatment modalities that have demonstrated efficacy in treating low back pain include yoga, massage, spinal manipulation, and acupuncture.

If a patient’s low back pain fails to improve after four weeks, the physician will likely order x-rays of the low back and, possibly, advanced imaging, such as an MRI scan. It is important to note that it may take patients up to six months of physical therapy to resolve all of their symptoms, and often-curative measures for low back pain include lifestyle changes, such as a healthy diet and exercise.

In summary, the vast majority of patients with low back pain can be treated conservatively, and only on rare occasion is surgery necessary. With physical therapy, diet, and exercise, more often than not back pain can be alleviated on a permanent basis. Though not a quick fix, with good compliance over a period of months, these modalities have a proven track record of effectiveness in treating this disabling condition.

Learn more about Low Back Pain.

This Ortho-pinion was originally written for A Nation in Motion, the AAOS's award-winning public awareness campaign dedicated to sharing the stories of people whose lives were improved by orthopaedic surgery.