I am 40 Year Old. Why My Lower Back Hurts?
Lower back pain may be mild, moderate or severe in intensity. Mild pain may be secondary to muscle ache or spasm of paravertebral muscles.
Moderate to severe pain can be secondary to several causes as follows:
A. Causes of Mild Lower Back Pain in Patients Aged Between 40 to 65 Years Old:
- Undiagnosed scoliosis.
- Prolonged sitting or standing in improper position while travelling or working in front of computer or at desk.
- Sleeping on hard mattress.
- Tear or sprain of ligaments.
- Tear or sprain of paravertebral muscles.
- Stress - physical or emotional.
- Manual work - lifting and carrying heavy object.
- Myofascial muscle disease.
B. Causes of Moderate to Severe Lower Back Pain in Patient Aged Between 40 to 65 Years:
- Disk bulge or herniation.
- Paravertebral or spinal abscess.
- Spinal tumor or osteoblastoma.
- Epidural or spinal hematoma.
- Facet joint arthropathy.
- Posttraumatic epidural or spinal abscess.
- Tear or sprain of ligaments.
- Tear or sprain of paravertebral muscles.
- Facet joint subluxation or injury.
- Subluxation of lumbar vertebrae.
How Common is Low Back Pain?
The prevalence of chronic low back pain has increased significantly from 1992 (3.9%) to 2006 (10.2%). 84% of patients with history of lower back pain pursued active treatment 2.
There isn't any study done to indicate prevalence of low back pain among patients between 40 and 60 years. Substantial heterogeneity exists among low back pain epidemiological studies. Incidence of first ever episode of low back pain is between 6.3% and 15.4%. Recurrence of low back pain at 1 year ranges from 24% to 80%3.
When Should One Consider Further Investigations or Tests for Low Back Pain In Young Adult Aged 40 Years?
If pain continues after 4 to 6 weeks, you must consider further investigations or tests for back pain.
Which Investigations are Most Favorable for Proper Diagnosis of Low Back Pain in 40 Year Old Young Adult?
Most favorable initial investigation is X-Ray and MRI or CAT scan4.
What Other Investigations May Be Needed For Diagnosing The Cause of Low Back Pain In 40 Year Old Young Adult?
- Blood examinations to rule out infection and abscess.
- EMG (Electromyogram) studies to diagnose muscle diseases.
Whom Should a 40 Year Old Young Adult Consult To Treat His Low Back Pain?
It depends on your insurance policies. You may have to see first primary care physician (PCP). PCP may consider further investigations depending on severity of pain and outcome of initial clinical examinations. Eventually after 4 to 6 weeks PCP will advise further investigations. Depending on outcome of investigation, PCP will refer you to specialist for followup treatment. If you do not need any referral from PCP to specialist then you should see Neurologist for initial evaluation and diagnosis. If you are referred for physical therapy (PT) or injection treatment you should consult PMR physician regarding PT or interventional pain specialist for injection treatment.
Who Should Be Consulted for Back Surgery On A Young Adult?
Either Orthopedic Surgeon or Neurosurgeon performs back surgery. Back surgery is subspecialty of Orthopedic and Neurosurgery training.
What Are the Treatment Options For Low Back Pain In Young Adult?
Treatment choices are several non-invasive and invasive treatments. Benign backache may not need any of the following treatment except NSAIDs and rest. But choice is as follows:
A. Noninvasive Treatment for Low Back Pain In Young Adult:
- Non-opioid medications such as NSAIDs (Tylenol, Motrin, Naproxen and Celebrex), antidepressant analgesics (Elavil and Cymbolta) and antiepileptic analgesics (Neurantin and Lyrica).
- Manual treatments which may be helpful for Back Pain are as follows:
- Massage treatment5.
- Spa Therapy6.
- Yoga therapy7.
- Chiropractic manipulations8.
- Physical therapy9.
B. Invasive Treatments For Low Back Pain In Young Adult Are As Follows:
- Interventional Pain Therapy:
- Epidural Steroid Injection10.
- Facet joint injection11.
- Selective nerve root injection12.
- Trigger point injection13.
- Surgical treatment for low back pain in young adult depends on the cause of the pain. Surgical treatment options are:
- Spinal fusion.
- Removal of abscess or hematoma.
- Excision of tumor mass.
- Spinal cord stimulator.
- Intrathecal catheter and pump to deliver intrathecal pain medications.
Modic changes, possible causes and relation to low back pain.
Albert HB, Kiaer P, Jensen TS et al
All The Back Research Center, Part of Clinical Locomotion Science, University of Southern Denmark, Lindevej 5, 5750 Ringe, Denmark. Med Hypotheses. 2008;70(2):361-8.
The Rising Prevalence of Chronic Low back Pain FREE
Janet K. Freburger, PT, PhD; George M. Holmes, PhD; Robert P. Agans, PhD; Anne M. Jackman, MSW; Jane D. Darter, BA; Andrea S. Wallace, RN, PhD; Liana D. Castel, PhD; William D. Kalsbeek, PhD; Timothy S. Carey, MD, MPH
Arch Intern Med. 2009;169(3):251-258. doi:10.1001/archinternmed.2008.543.
The Epidemiology of low back pain.
Hoy D, Brooks P, Blyth F, Buchbinder R.
University of Queensland, School of Population Health, Herston Rd, Herston, QLD 4006, Australia.
Eur Spine J. 2012 Sep 26.
HIZ's relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography.
Hanna H, Tommy H.
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Complement Ther Clin Pract. 2012 Nov;18(4):227-34. doi: 10.1016/j.ctcp.2012.07.001.
The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: a review of the literature.
Netchanok S, Wendy M, Marie C, Siobhan O.
School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan Campus, Nathan/QLD 4111, Australia.
Pain Med. 2013 Jan;14(1):145-58. doi: 10.1111/pme.12002.
Effects of different frequencies (2-3 days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial.
Baena-Beato PA, Arroyo-Morales M, Delgado-Fernández M, Gatto-Cardia MC, Artero EG.
Department of Physical Education and Sport, University of Granada, Granada, Spain.
A Systematic Review and Meta-analysis of Yoga for Low Back Pain.
Cramer H, Lauche R, Haller H, Dobos G.
Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.
Clin J Pain. 2012 Dec 14.
Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative effectiveness study.
Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC.
Palmer Center for Chiropractic Research, 741 Brady St., Davenport, IA 52803 , Palmer College of Chiropractic, West Campus, 90 E. Tasman Dr., San Jose, CA 95134.
Spine (Phila Pa 1976). 2012 Oct 10.
Initial Management Decisions Following a New Consultation for Low Back Pain: Implications of the Usage of Physical Therapy for Subsequent Health Care Costs and Utilization.
Fritz JM, Brennan GP, Hunter SJ, Magel JS.
Department of Physical Therapy, University of Utah, Salt Lake City, UT; Physical Therapy Division, Intermountain Healthcare, Salt Lake City, UT.
Arch Phys Med Rehabil. 2013 Jan 18. pii: S0003-9993(13)00029-4. doi: 10.1016/j.apmr.2013.01.008.
Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain.
Manchikanti L, Cash KA, McManus CD, Pampati V.
Pain Management Center of Paducah, Paducah ; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.
J Pain Res. 2012;5:381-90. doi: 10.2147/JPR.S35924.
Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study.
Fotiadou A, Wojcik A, Shaju A.
Hinchingbrooke Hospital NHS Trust, Huntingdon, PE29 6NT, Cambridgeshire, UK.
Skeletal Radiol. 2012 Sep;41(9):1081-5. doi: 10.1007/s00256-011-1353-6.
A pilot study examining the effectiveness of physical therapy as an adjunct to selective nerve root block in the treatment of lumbar radicular pain from disk herniation: a randomized controlled trial.
Thackeray A, Fritz JM, Brennan GP, Zaman FM, Willick SE.
Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
Phys Ther. 2010 Dec;90(12):1717-29. doi: 10.2522/ptj.20090260.
Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial.
Di Cesare A, Giombini A, Di Cesare M, Ripani M, Vulpiani MC, Saraceni VM.
Complex Operative Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, University of Rome La Sapienza, Piazzale Aldo Moro, 5, 00185, Rome, Italy.
Ther Med. 2011 Feb;19(1):19-26. doi: 10.1016/j.ctim.2010.11.002.