Book an Appointment
Learn how Regen Doctor is assisting patients in living life to the fullest.
Menu
An estimated 80% of people in the U.S. will suffer from back pain in their lifetime, with lower back pain being the most common form. Lower back pain has as many different causes as it does treatment options to help you find relief. Here’s what you need to know.
Lower back pain is one of the most frequent musculoskeletal complaints. Pain may arise from damage or irritation to any of the structures of the lower back including the:
It can also stem from damage to the internal organs of the pelvis and abdomen, such as the spleen, kidney, pancreas, and liver.
Typically, the symptoms are acute and resolve within a few weeks, depending on the cause of your pain. However, if the pain returns and is persistent for three months or longer, your acute back pain may have evolved into chronic back pain.
Understanding the anatomy and physiological function of the lower back is key to figuring out the cause of your lower back pain. There are three main structures that support the body in the back and also contribute to pain.
The bony spine is positioned so that all 33 individual vertebrae (bones of the spine) interconnect with other spine bones above and below.
This provides a flexible yet stable support structure to protect the spinal cord.
Separating adjacent vertebrae are intervertebral discs that act as cushions that minimize the impact that the spinal column receives.
Since the discs are soft and provide support, they have a tendency over time and with misuse to herniate (bulge) backwards through the outer ligaments and cause irritation to the adjacent nerves. Bulging disc disease is one of the most common causes of chronic lower back pain and accounts for approximately 10% of all low back pain complaints. Disc disease may occur from herniation that results from trauma or heavy lifting.
More commonly, though, chronic low back pain is caused by degenerative disc disease. Degenerative disc disease is due to thinning and degeneration of the discs. It can lead to:
Ligaments attach to each vertebra and provide strength and mobility to the spine as well as the many groups of muscles that are responsible for the spine’s movement. Nerve roots attach to the spinal cord and exit the spine to innervate the skin, muscles, and surrounding structures of the back and lower extremities.
These muscles and ligaments have a tendency to become strained and irritated during strenuous lifting or excessive exercise and can cause local nerve irritation. Myofascial (muscle and connective tissue) and ligament injuries may account for the majority of low back pain cases.
Common lower back pain causes include:
Less common causes include infections, ankylosing spondylitis, and metastatic cancer. Note that risk factors for metastatic cancer are more common in those over 50, with pain not relieved by lying down, symptoms that are worse at night, and pain for longer than one month.
Causes can be acute or chronic. Let’s look at acute pain causes, chronic causes, and specific causes of pain for each of the back’s structures.
Organs in the abdomen and pelvis can also cause pain in the back. This is known as “referred pain” and is most often caused by the kidney, pancreas, spleen, and liver.
This type of pain occurs due to the following changes in the organs:
Nerves at the same level of the lower back activate when these conditions occur, causing pain in the lower back. Even though the pain originates in the organs, you’ll feel it in your back.
Acute pain usually comes on abruptly and occurs during a specific activity. An acute pain episode typically occurs due to:
Vertebral body fractures, ruptured discs, and spinal cord compressions are also acute injuries related to chronic conditions such as osteoporosis, cancer, or spinal stenosis.
Acute pain due to ligament and muscle injury generally responds to mild activity (e.g., stretching and low-impact exercise) and the use of non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen). Talk to your doctor about your acute back pain. They’ll evaluate the cause of your pain, ruling out serious issues like kidney stones, kidney infection, and acute pancreatitis.
In some cases of acute back pain, an emergency room, pain specialist, or spine surgeon are required, along with proper imaging for immediate evaluation. If you experience any of the following, get immediate medical help:
If you have back pain that worsens and includes loss of bowel or bladder control or paralysis in the legs, this could indicate a serious health emergency that requires immediate treatment.
Chronic pain is defined as pain that lasts longer than three months, or beyond the expected duration. Typically, symptoms start gradually but will persist for an extended period of time. With chronic lower back pain, a person may experience pain in their back as well sciatic pain that extends across their hips and down the legs.
There are many causes of chronic lower back pain. They may include:
Bony structures in the spine are susceptible to more than just vertebral body fractures. They can also be affected by:
The intervertebral discs in your spine are susceptible to degradation and injury over time that can cause chronic pain. Some conditions that affect all aspects of intervertebral discs include:
Stress, strain, and injury to the ligaments and muscles can cause chronic back pain. Common sources of this type of pain include:
Getting a proper diagnosis is the first step in treating your pain.
Diagnosing lower back pain can be challenging, but the physicians are up to it, with experience and specialized training in pain management for complex conditions.
To get a diagnosis, your physician will perform a physical exam, looking for tenderness over certain areas of your spine as well as assessing any limitation in your range of motion. They may also order radiological imaging such as X-rays, CT scans, MRIs, or bone scans depending on their clinical suspicion and your medical history.
Regardless of the cause of your pain, central sensitization is a common complication associated with chronic pain of all kinds. This condition involves both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals through the spinal cord to the brain.
Central sensitization occurs when there is an increase in the excitability of neurons within the CNS at the level of the spinal cord and higher. Eventually with enough time, normal inputs from the PNS can begin to produce abnormal responses.
A very light touch of the skin could activate neurons in the spinal cord that normally only respond to painful stimuli. As a result, an input that would normally produce a harmless sensation now produces significant pain. It’s because of this that it’s important to get a diagnosis as soon as possible, so you can avoid further complications.
Contrary to what many people might think, bed rest is not the best treatment for most causes of pain. While an acute injury may need a day or two of limited activity, most physicians agree that staying active and looking for the least invasive pain treatment approach is the best place to start.
For lower back pain management in Phoenix and the surrounding areas, Our Specialists utilizes the following treatments, ordered from non-invasive treatments to surgical interventions.
Nutrition and healthy eating are powerful treatments to combat nutritional deficits that may be affecting your pain levels. Anti-inflammatory foods and a balanced diet of grains, vegetables, and lean protein helps your body heal.
Exercise can improve your pain by increasing flexibility and range of motion. Another benefit to exercise is the release of hormones called endorphins, your body’s natural pain relievers.
Back braces may be all you need to get some support while you heal from an acute injury.
Combined with proper nutrition and gentle exercise, back braces keep you active to help you regain your flexibility and range of motion.
This is a treatment that teaches a patient to become aware of processes that are normally thought to be involuntary inside of the body (such as blood pressure, temperature, and heart rate control).
This method enables you to gain some conscious control of these processes, which can influence and improve your levels of pain. A better awareness of one’s body teaches one to effectively relax, thereby reducing pain.
Physical therapy and occupational therapy can decrease or prevent functional limitations.
Especially for pain caused by misuse or misalignment, physical therapy can teach you how to use your body more safely and effectively to prevent further or future injury.
Gentle massage of your tender areas may help relieve muscle spasms or contractions and improve the discomfort associated with it.
Massage can also help you relax, decreasing stress and tension.
Targeted adjustments, especially combined with other treatments, may significantly reduce low back pain.
Manipulations open up blocked channels in the spine for proper nerve transmission and less pain.
Small needles are inserted into specific points on the body during acupuncture.
These needles cause your body to release endorphins (more natural pain relievers). Acupuncture can also help you relax, decreasing stress, tension, and muscular spasm.
Epidural steroid injections can help with some common pain syndromes (e.g., degenerative disc disease).
This method involves injecting a steroid into the epidural space of the spinal cord where the irritated nerve roots are located. The medicine then spreads to other parts of the spine, reducing inflammation and irritation.
Trigger point injections can be an effective treatment for muscle spasms. The procedure involves injecting a local anesthetic and steroid into a “trigger point,” the apparent root of the pain.
Medial branch blocks (MBBs) are a minimally invasive non-surgical treatment that is used for arthritis-related neck and back pain.
The injections work by reducing the inflammation and irritation in whichever facet joints of the spine are causing pain.
Also known as the Racz procedure, lysis of adhesions can help remove excessive scar tissue in the epidural space when conservative treatments for lower back pain have failed.
A study performed in 2005 found that lysis of adhesions resulted in significant pain relief for patients with chronic pain with few, if any, adverse effects. This procedure can be helpful for patients with vertebral body compression fractures, post-laminectomy syndrome, radiculopathy, and disc disease.
These techniques involve inserting a small catheter through a needle into the epidural space or directly next to affected nerves.
Local anesthetic and other medicines are given through the catheter for extended time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long-lasting.
Transcutaneous electrical nerve stimulation, or TENS unit therapy, is a technique that relieves pain by applying mild electric current to the skin at the site of the pain.
The electric impulses interfere with normal pain sensations and replace pain signals with a slight tingling sensation.
Spinal cord stimulation uses an implanted electrical device to decrease the perception of pain by confusing the spinal cord and pain processing centers in the brain.
Initially, a trial is done to see if this device will help you long-term. In the initial trial, your pain physician places a small electrical lead in the epidural space through a needle. Painful signals are replaced by tingling electrical signals. If you have success in your trial, you may decide to have a permanent SCS device implanted.
This method involves tiny electrodes being placed close to the affected nerves. The electrodes release a small electrical current that inhibits pain transmission and may provide pain relief.
To complete a percutaneous discectomy, your doctor inserts a needle through the skin into the affected disc.
Disc material is suctioned out of the bulging disc to relieve pressure within the disc.
Needles are placed along the vertebral bodies in close proximity to the discs and electrical stimulation is initiated.
When the appropriate nerves are located, they are anesthetized and destroyed using electricity. This disc denervation essentially deactivates the nerves.
These are both minimally invasive procedures that can treat osteoporotic fractures.
The method stabilizes crushed vertebrae by injecting an acrylic cement into the vertebra. Vertebroplasty is effective in relieving pain, most likely because of the added support and stability it provides the spine.
Implanted pain pumps are also available and can be extremely helpful by providing long-term pain control for back pain.
With this procedure, pumps are implanted next to the spine, with medicine released to the targeted area. Patients will have a trial period before they get a more permanent implant.
Nerves away from the spinal cord are called peripheral nerves. These nerves can often be sources of pain and can be blocked with local anesthetic.
If pain relief is successful, ablation uses heat to destroy the nerve more completely for long-term relief.
Surgical procedures are typically done when all conservative treatments are unsuccessful in reducing pain or when the spinal cord or exiting nerves are severely damaged or compressed. Serious compressions are characterized by bladder or bowel incontinence, lower extremity weakness, spasticity, or loss of sensation.
Invasive surgical procedures include:
Long-term, these surgeries may not provide complete pain relief. In addition, surgical options for low back pain do have a significant risk of complications, including bleeding, nerve damage, epidural scarring, and prolonged recovery times.
Again, surgical procedures are typically done when conservative management by pain specialists have been exhausted, life-threatening complications have arisen, or neurological symptoms like weakness, bowel or bladder changes, or loss of sensation have occurred. The evidence does not support routine surgical fusion or surgery alone for the treatment of chronic lower back pain.
There have been great strides in lower back pain treatments and pain management, and early intervention can make a big difference.
If you have any questions or are simply looking for more information please contact us and our friendly team will be happy to answer your questions and help in any way we can.
