Aging Begins at 30

Low Back Pain

"Oh, my aching back!" you said.

Consider a pile of children's blocks alternated with cushions and stabilized with guy ropes. In your spine, the blocks are boney vertebrae, the cushions are soft golf-ball like sacs, and the guy wires are the muscles and ligaments of your back. You can get pain from either vertbral or cushion (disc) trouble, but without muscle strength, the spine is unstable and susceptible to injury.

Every year 5% of the population, 900,000 people, get low back pain.

Risk factors are repetitive lifting, vibration, smoking and alcohol abuse, multiple pregnancies, inactivity, osteoporosis, a familial trend, and anxiety associated with depression. Occupation has something to do with back pain since 11 of every 100 garbage collectors and 4 of every 100 nursing assistants get back pain yearly. Poor posture and obesity add to the insults to the back.

Low back pain is one of the most expensive benign conditions in America. The cost of care is staggering, approximately $25 billion yearly. Legal, workmen's compensation, and disability-related costs add another $100 billion dollars yearly.

In your lifetime 80% of you will get back pain. Most back pain doesn't last long as you are almost always better within two to six weeks. Only 10% of back pain lasts more than six weeks. Stay with a simple diagnosis and treatment. Chronic low back pain lasting more than three months occurs in only 5% but incurs 87% of the total cost. When your back hurts, you may think you've "ruptured a disk", but this serious problem makes up 2% or less of back pain. Usually the muscles are merely out of condition and have allowed small ill-defined injuries or strains to occur.

Be patient. Treat yourself with bed rest (2-4 days), aspirin or an equivalent drug, and you'll be surprised how much better you become, nine times out of ten. Return to work and usual activity in the elderly occurs in 87% with careful rehabilitation against 41% with no rehab. X-rays are needed only in the aged, in those with a long duration of symptoms, with unequal knee or ankle jerks, abnormal lab tests, and in those with point tenderness over the spine.

The approach to back pain is often multidisciplinary: medical, surgical, psychological, and reconditioning. Some people get so distressed that anti-depressive medication can be invaluable in their return to normal. Doctors need to recognize that. Stressful life events, such as family crisis, mental or employment problems, may lead to pain in the back problems.

In the middle aged and elderly, if the back pain is new, sneaks up on you unaware, wakes you at night, causes writhing, and is associated with problems elsewhere in the body, beware! Fever is a danger signal too. Perhaps you get no relief by lying down or you cannot lie still. Change in bowel or bladder function or increased pain on coughing or paralysis will cause worry in the mind of your doctor. The cause of your backache may be something serious within or outside your spine. It might be a penetrating peptic ulcer or an inflammation of the pancreas. Don't tough it out. See your doctor.

Rarely in the elderly, arthritic overgrowths of bone in and around the spinal canal can lead to pinching of the spinal cord or nerves, and cause pain that makes the person stand and walk leaning forward to open the spinal canal as far as possible.

Success rate with operations for low backpain varies around 70%. It is best with an exact diagnosis, in white collar workers, in the psychologically stable, and in those not expecting compensation. Operative treatment can be delayed in practically all cases for 3 months when the need for it may have disappeared in 80%. Multiple surgeries may increase rather than reduce disability.

Ask your doctor to refer you to a good physical therapist for gentle exercises. You can also learn how to sit and how to lift. You can do yourself more harm saying "Cheers" with a beer mug at arms length than by lifting a 30 pound weight close to the navel.

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See related Patient Topics Back Pain, Bones, Joints and Muscles or Brain and Nervous System.

See related Provider Topics Back Pain, Bones, Joints and Muscles or Brain and Nervous System.

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