The work-up of a patient with lower back pain symptoms typically begins with a detailed medical history and focused physical examination. The expectation of the work-up is to determine the cause of a patient’s pain. In some cases, the exact cause of an individual’s pain cannot be determined; in these cases, the practitioner will look to exclude certain ominous diagnoses, including nerve root pain and spinal pathology. Additionally, the practitioner will address certain prognostic factors that are related to lower back pain by inquiring about specific issues related to work, depressed mood, psychosocial distress, pain severity, patient perceptions to pain, previous lower back pain, over-exaggeration of symptom reporting, and degree of impairment. These “yellow flags” help the practitioner develop the most ideal treatment plan and reassessment schedule for each patient.
Moreover, the practitioner will address other areas including patient age (20 years and younger or 55 and older), thoracic pain, pain that is non-mechanical, corticosteroid use, previous cancer, unexplained weight loss, general unwellness, structural changes, and wide-spread neurological discrepancies. These factors are known as “red flags” and may be indicative of serious underlying pathology, including infection, tumor, inflammatory disorders, cauda equina syndrome, or fracture. Patients exhibiting these red flags may not have a serious underlying issue; however, they are at a heightened risk. If a patient presents with multiple red flags, they should be further evaluated.
Lower back pain may accompany many conditions, including:
Disc herniation: This is a common cause of lower back pain that is the result of damage or injury to the intervertebral disc. Disc damage can occur with the normal aging process or be the result of acute traumatic event. The damage leads to a weakening of the outer region of the intervertebral disc, which allows the inner region to protrude out. This can cause irritation and inflammation of the surrounding spinal nerves, resulting in pain.
Osteoarthritis: This is a degenerative condition that results from the breakdown of cartilage. This breakdown can occur because of the aging process, or may occur because of an acute traumatic event. If there is severe damage to the cartilage, bone can begin to rub against bone, which can result in significant pain.
Spondylolisthesis: This condition occurs when one vertebrae essentially slips off another. A large percentage of patients who have this condition report no related symptoms; it is therefore often classified as non-specific lower back pain. It is estimated that approximately 5% of the population has this structural deformity.
Spinal stenosis: This condition occurs when there is spinal column narrowing, resulting in spinal canal restriction. Patients with this condition will often report pain relief when leaning forward.
Spinal (vertebral) fracture: A tremendous force to the spine usually causes this condition.
Compression fracture: This type of spinal fracture most commonly occurs in women who have gone through menopause, and in patients who have taken corticosteroids for a prolonged period of time. Compression fractures can occur without any extreme force being placed on the vertebrae.
Spinal deformities: This type of condition refers to genetic issues with the spinal curvature, including scoliosis and kyphosis. Current prevalence rates of these types of spinal deformities are unavailable, however, earlier reports suggest that prevalence rates are quite low, with less than 2% of the population being affected.
Spinal infections: In rare circumstances, lower back pain may be caused by an infection that has infiltrated into the spinal area. Infection of the spine should be suspected in any patient who presents with lower back pain combined with a fever, as well as in patients who have recently had surgery, those who are immuno-compromised, or those who regularly use drugs.
Various factors have been identified that increase an individual’s risk of suffering from persistent lower back pain, including pain perception, and mental health issues including depression and anxiety, employment status, and gender. A recent five-year long prospective study investigated factors that are prognostic of long-standing outcome in lower back pain patients. The results found that an individual’s severity of pain, as well as their beliefs in regards to persistent pain, was predictive of a poorer outcome at both six-month and five-year follow-ups.
Global Neuro & Spine Institute physicians are double and triple-board certified, fellowship trained, and remain on the cutting edge of technology. In our practice, we use the most advanced techniques and the highest standards to develop an individualized and comprehensive treatment plan for each of our patients. We are also very proud of our policy to place great importance on educating those we treat, while addressing any questions or concerns that may exist.
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