Decoding Serious Lower Back Pain : Understanding Causes and Seeking Treatment

1. Introduction

   1. What is Serious Lower Back Pain

      Serious lower back pain is a significant and often debilitating discomfort in the lumbar back of the spine, which is the region between the ribcage and pelvis. It is mostly known to occur in people overdoing strenuous activities.⁽¹⁾ This pain is typically severe enough to limit the person’s ability to engage in normal daily activities, which may persist for an extended period of time.

      Serious lower back pain is characterized by its intensity, duration, and its impact on a person’s overall quality of life. It affects an individual’s mobility, work, sleep, and other essential functions.
      

      It may need medical attention to identify and address the underlying cause and implement an appropriate plan.

   2. Significance of Addressing Underlying Cause of Lower Back Pain

      Addressing the underlying cause of lower back pain is of extreme importance for various reasons: 

      • Identifying the specific cause allows for targeted and effective treatment. Tailoring the treatment according to the underlying cause maximizes the likelihood of successful pain management.
      • Some conditions if not treated can worsen over time. By addressing the root cause further damage and potential complications can be prevented.
      • Chronic lower back pain significantly impacts the quality of life of a person. Addressing the underlying cause can help an individual experience substantial relief, regaining a higher level of functioning and quality of life.
      • It can help reduce the need for extensive and potentially expensive interventions such as surgeries and prolonged rehabilitation.
      • Knowing and understanding the specific cause of lower back pain provides reassurance and confidence for the individual.
      • It can be helpful in improving mental well-being and reducing psychological burden.

2. Musculoskeletal Causes of Lower Back Pain

   Musculoskeletal causes are related to the bones, muscles, ligaments, and other structures that make up the spine and surrounding areas.

   Disc Herniation 

   Disc herniation is a condition where the soft gel-like center of the intervertebral disc protrudes and leaks out, pressing nearby nerves. This can be anywhere along the spine but is commonly seen occurring as a result of wear and tear over time.⁽²⁾ The symptoms experienced include:

   • A sensation of numbness, tingling, or weakness in the legs and buttocks
   • Sharp, shooting pain from the buttock down the back of the leg
   • Problems with control over the bladder or bowel

   Disk herniation can be diagnosed with the help of physical examination, MRI and CT scan, and electromyography.

   Conservation, measures such as rest, physical therapy, and medication can be helpful. Sometimes more invasive interventions such as epidural injection and surgery (microdiscectomy) may be needed.

   Spondylolisthesis 

   Spondylolisthesis is a condition in which one vertebra slips forward or backward in relation to the adjacent vertebra.⁽⁸⁾ It often causes pain and nerve compression. The most common symptoms include: 

   • Sensation of pain in the lower back, buttocks and hips
   • Stiffness
   • Muscle tightness

   This condition can be diagnosed with the help of an X-ray, MRI, and CT scan. The treatment approaches include physical therapy, bracing, pain management, and in severe cases surgery.

3. Degenerative Disc Disease

   It is a condition in which the intervertebral disc breaks down and loses its cushioning ability, leading to pain, and potential nerve compression.⁽⁹⁾ It leads to:

   • Pain in the lower back
   • Episodes of acute pain
   • Pain radiating to the legs

   Degenerative disc disease can be diagnosed with MRI and CT scan, and discography. It can be treated with the help of physical therapy pain management, and in severe cases surgical intervention like disc replacement or fusion.

4. Facet Joint Dysfunction

   Dysfunction or degeneration of the small joints in the spine leading to pain and a limited range of motion is known as facet joint dysfunction.⁽¹⁰⁾ The symptoms include:

   • Localized pain in the lower back
   • Stiffness
   • Radiating pain

   Diagnosis involves physical examination, diagnostic facet joint injections, X-ray, and MRI scans. Treatment involves physical therapy, facet joint injection, and in severe cases facet joint denervation.

5. Spinal Stenosis

   It is a condition in which there is a narrowing of the spinal canal, putting pressure on the spinal cord or nerve roots. It may lead to pain and potential neurological symptoms.⁽¹¹⁾

   The symptoms of spinal stenosis include: 

   • Pain
   • Weakness and numbness
   • Tingling in the lower back, buttocks, and legs that may worsen on walking and standing.

   The diagnostic methods include MRI and CT scans and sometimes nerve conduction studies. The treatment may involve physical therapy, medication, epidural injections, and in severe cases surgery.

6. Inflammatory and Autoimmune Conditions That Can Cause Lower Back Pain

   Ankylosing Spondylitis 

   It is a type of inflammatory arthritis that affects the spine primarily and leads to pain, stiffness, and fusion of the vertebrae.

   The symptoms of ankylosing spondylosis include:⁽³⁾

   • Gradual onset of lower back pain
   • Early morning stiffness or stiffness after periods of inactivity

   Ankylosing spondylosis can be diagnosed with the help of physical examination, physical therapy, and exercise. In severe cases, biologic therapies are given.

   Rheumatoid Arthritis 

   Rheumatoid arthritis is a condition in which autoimmune disorders can cause inflammation of the joints including the spine, leading to pain and reduced mobility.

   The symptoms include:

   • Pain in lower back
   • Swelling and stiffness in multiple joints
   • Morning stiffness

   The diagnostic method includes blood tests, X-rays, and MRI scans. Rheumatoid arthritis can be treated with disease-modifying antirheumatic drugs, biologic therapies, physical therapies, and lifestyle modifications.⁽⁴⁾

7. Traumatic Causes

   Traumatic causes of serious lower back pain are the result of sudden forceful incidents or accidents that may lead to injuries in the lower back.

   Fractures 

   These are the breaks and cracks in the bones of the spine. There are different types of fractures including compression fractures, burst fractures, flexion-distraction fractures, and fracture-dislocation.

   The symptoms of fractures include: 

   • Severe and sharp pain
   • Inability to move spine

   The diagnosis of fracture involves X-rays, CT scans, and MRI scans. To treat fractures an individual, needs immobilization with braces or surgery, depending on the severity of the fracture.

   Contusions and Hematoma 

   This is bruising or collection of blood in the lower back due to direct impact or trauma. The symptoms presented by the patient with contusion and hematoma include: 

   • Localized pain
   • Tenderness
   • Swelling
   • Neurological symptoms if there is pressure on the spinal cord

   This type of trauma can be diagnosed with the help of clinical examination, X-rays, MRI scans, and sometimes CT scans. To treat them conservative management for minor injuries and surgical intervention for severe cases may be needed.

8. Nerve-Related Causes of Lower Back Pain

   If the cause is nerve-related, there would be irritation or compression of the nerve in the spinal column or the surrounding areas. Some of the nerve-related causes of serious lower back pain include:

   Sciatica 

   Sciatica is the compression and irritation of the sciatic nerve. It may occur due to herniated disc or spur.

   The symptoms include: 

   • Sharp, shooting pain radiating to the lower back or both legs
   • Numbness, tingling and muscle weakness

   To diagnose sciatica clinical examination is needed. Sometimes MRI and CT scans may also be performed. Treatment of sciatica involves conservative methods like rest, physical therapy, and medication. In severe cases, epidural injections or surgery may be the solution.⁽¹²⁾

   Peripheral Neuropathy 

   Damage to the peripheral nerves may occur due to various causes including diabetes, autoimmune conditions, or certain medications.⁽¹³⁾ The symptoms of peripheral neuropathy include 

   • Numbness and tingling
   • Burning pain
   • Muscle weakness in legs and feet

   Clinical examination is done to diagnose this condition along with nerve conduction studies and sometimes blood tests. Treatment approaches include managing the underlying condition and giving pain relief medication and physical therapy.

   Cauda Equina Syndrome 

   Compression of a bundle of nerves at the base of the spinal cord typically due to a herniated disc, tumor, or other spinal abnormality is known as cauda equina syndrome. The symptoms include:

   • Severe lower back pain
   • Urinary or bowel dysfunction
   • Numbness in the saddle area
   • Weakness in the legs

   Clinical assessment needs to be done along with MRI and other imaging studies to diagnose cauda equina syndrome.⁽¹⁴⁾ Cauda equina is a medical emergency requiring immediate surgical intervention.

9. Other Causes of Lower Back Pain

   According to the American Association of Neurological Surgeons, lower back pain is extremely debilitating for about 9 in 10 people.⁽⁵⁾

   Some of the common causes of serious lower back pain include: 

   • Heavy lifting
   • Strenuous exercise
   • Poor posture
   • Sprain due to sudden twisting, damaging a person’s ligament
   • Strain or injuries to muscle or tendons, which are the band of tissue that connects to muscle and bones
   • Pinched nerve or nerve damage

   It is important for a person with serious lower back pain to consult a doctor to get the symptoms they are experiencing treated.

10. When to Consult a Doctor

    If the lower back pain lasts for more than 2 weeks, a doctor should be consulted. If the pain is there with progressive weakness or numbness prompt attention may be needed.

    It is advised by the American Association of Orthopaedic Surgeons to speak with a doctor if along with pain there is fever and unexplained weight loss.⁽⁶⁾

    Also, if anyone experiences back pain after an injury or fall needs to see a doctor.⁽⁷⁾ Loss of bladder control or problems with urination along with pain in the lower back, also are signs that a person needs to see a doctor.

11. Conclusion

    Lower back pain is experienced by many people, but it is not always serious for everyone. Sometimes lower back pain may be a serious condition if it results from degenerative disc disease, herniated disc, degenerative spondylolisthesis, ankylosing spondylosis, and others.

    Anyone experiencing lower back pain needs to contact a doctor, particularly, if they experience a fall or any other injury and the pain is continuing for more than 2 weeks or if there is worsening in pain.

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