I Am 65 Years Old. My Lower Back Hurts, Should I Be Worried?
Yes, 5 to 10% of lower back pain in senior citizens older than 65 years can be a serious problem. Lower back pain can be acute or chronic in nature. Acute pain lasts less than 3 months and chronic may last for more than 3 to 6 months. Lumbar pain among senior citizens lasting more than week should be investigated and should not be neglected.
What Are The Causes Of Low Back Pain in Elderly People?
- Discogenic – Bulge disk, herniated disk, degenerative disk disease.
- Inflammatory – Discitis, facet joint arthritis, osteomyelitis.
- Injuries – Whiplash injury after automobile or work accident or fall may cause i) Fracture of vertebrae, facet joint, lamina, transverse process or spinous process ii) Tear and sprain of ligaments. iii) Tear and sprain of muscles. iv) Dislocation of facet joint or vertebrae.
- Osteoporosis – Fracture of body of vertebra (compression fracture), facet joint, spinous process and transverse process.
- Cancer And Metastasis – Primary cancer: breast, lung, prostate.
- Failed Back Syndrome – Pain may persist after back surgery secondary to – i) recurrent disk herniation, ii) surgical injuries to facet joint, iii) facet joint- hypermobility, joint instability, iv) muscular deconditioning and iv) fibrotic scar tissue of surrounding nerve, ligaments, muscles and joint.
- Mechanical or Musculoskeletal Problems: i) Sprain: ligament and muscles, ii) Tear: ligament, synovial membrane iii) Spasm – muscle iv) Disk abnormalities – herniation, degenerative disk disease, fracture of disk v) Facet joint – dislocation, fracture, and wearing down of the facet joints.
- Bone Disease – Osteoporosis, scoliosis, spondylolisthesis, rheumatoid arthritis, osteoarthritis, ankylosis spondylitis, and spinal stenosis.
- Systemic Disease – Endometriosis, kidney disease, fibromyalgia, chronic fatigue syndrome, and muscle pain.
How Common Is “Low Back Pain Among Senior Citizens”?
Majority of back pain (98%) among patients aged between 18 and 85 years is nonspecific and self-limiting. Lower back pain is a common complaint among elderly patients 6. Low back pain is the third most common complaint among patient who are 75 years and older, as shown in US national survey of primary care physicians. Image study has revealed up to 85% of people with low back pain, despite a thorough medical examination, has not shown any specific cause of the pain. Only 2% of patients continue having symptoms beyond 4 week and supported by specific diagnosis. Low back pain is second most common symptom after upper respiratory tract infection to consult primary care physician in USA. It is also second most common pain symptom after headache indicated frequent emergency room visit. After initial episode of backache 50% will have more than one incident. Radicular pain or sciatica may be associated with low back pain in elderly patients and 80% of patients will eventually recover with or without surgery.
Which Are The Common Diseases Causing Low Back Pain In Older People?
- Facet joint disease caused by osteoarthritis and rheumatoid arthritis often causes low back pain in elderly people.
- Arthritis in older people may cause facet joint hypertrophy, degenerative disk disease, and spinal stenosis, which causes low back pain.
- Back pain often radiates to the legs though predominant pain stays in the back.
- Other medical conditions causing low back pain in older people are muscle spasm and ligament sprain, or tear of paravertebral back muscles.
Should A 65-Year-Old Adult Like Me Be Having Other Symptoms In Addition To Low Back Pain and Discomfort?
Yes, you could be having other symptoms. You may be unable to sleep because of severe pain. Weight loss could be the other symptoms. Weight loss may be because of chronic illness like infection or cancer causing pain and discomfort in the back. Having fever could suggest infection, discitis or epidural abscess. Pain may radiate to both or one leg.
Recently I Noticed My Back Pain Shoots Down The Legs, Am I Getting Worse?
Sharp burning radiating pain to legs may be secondary to pinch nerve. There are five lumbar nerves and one sacral nerve that provides sensory and muscle fibers to leg. If any one or more of these 6 nerves are pinched either within foramina, a bony tunnel, where nerve comes out of spine (foraminal stenosis) or within spinal canal (spinal stenosis) then the pain may radiate to lower leg and is often documented as sciatica pain.
Pinch nerve in elderly can be benign or serious. Benign causes of pinch nerve are disk bulge, disk herniation, osteophytes or subluxation of vertebrae and disk degenerative disease. Serious conditions causing pinch nerve pain is rare. Serious conditions are epidural hematoma, epidural abscess, metastasis or primary vertebral cancer and fracture of lumbar vertebrae secondary to osteoporosis.
When Should An Elderly Person Like Me Consider Back Pain Condition As Emergency And Visit ER Or Specialist?
If you have pain associated with persistent and continuous tingling, numbness and weakness, then you should see a specialist or visit ER as soon as possible. Numbness and weakness may be secondary to spinal or foraminal stenosis. Symptoms like persistent numbness and leg weakness indicates serious pressure over nerve and need immediate medical attention. Pain with occasional tingling and numbness lasting short period is secondary to benign pinch nerve, but need further investigation to evaluate cause of pain and treatment options.
When Should I Consider Further Investigation?
Any acute or chronic lower back pain in elderly patient above 65 years old should be investigated as soon as possible.
Which Investigations Are Most Favorable To Diagnose Back Pain in Older People5?
Most favorable initial investigation is X-Ray and MRI or CAT scan.
Which Other Investigations May Need To Be Considered?
- Blood examinations to rule out infection and abscess.
- EMG (Electromyogram) studies to diagnose muscle diseases.
- Ultrasound studies.
Whom Should An Older Person With Low Back Pain Consult?
Initially you should consult a primary care physician and after initial clinical evaluation further investigations will be suggested as indicated. Diseases such as degenerative disk disease, epidural hematoma and epidural abscess are curable diseases without any residual complications if treated earlier. Following initial evaluation and investigation you may be referred to see a neurologist, PMR physician, neurosurgeon or orthopedic surgeon.
Who Should I Consult For Back Surgery?
Back surgery is performed by either orthopedic surgeon or neurosurgeon. Back surgery is subspecialty of orthopedic and neurosurgery training.
What Are The Treatment Options For Older People With Lower Back Pain?
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:
Noninvasive Treatment Options For Older People With Low Back Pain:
- Non-Opioid medications such as NSAIDs (Tylenol, Motrin, Naproxen and Celebrex), antidepressant analgesics (Elavil and Cymbalta) and antiepileptic analgesics (Neurontin and Lyrica).
- Manual Treatments, which may be helpful, are as follows:
- Massage Treatment6.
- Spa Therapy7.
- Yoga Therapy8.
- Chiropractic Manipulations9.
- Physical Therapy10.
Invasive Treatment Options For Older People With Low Back Pain Are As Follows
- Interventional Pain Therapy
- Epidural Steroid Injection11.
- Facet joint injection12.
- Selective nerve root injection13.
- Trigger point injection14.
- Surgical treatment for Back Pain depends on cause of the pain. Surgical treatment16 that may be necessary are
- Discectomy – to remove one or more disk.
- Spinal fusion – Fused or unite two or more vertebrae by using bones or metal.
- Removal of abscess or hematoma.
- Excision of tumor mass.
- Spinal cord stimulator.
- Intrathecal catheter and pump to deliver intrathecal pain medications.
- Excision of cancer – Removal of benign or malignant cancer tissue.
How Can An Elderly Person Like Me Prevent Further Deterioration or Recurrence of Low Back Pain?
Maintain appropriate posture when
- Sitting At Home: Appropriate, good lumbar support.
- Automobile seats – Adequate low-back support such as small pillow or rolled towel.
- Sleeping: Appropriate mattress – firm to hard. Plywood or mattress pad can be helpful.
- Lifting – Do not lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to your body, don’t stoop over to lift. Tighten your stomach muscles to keep your back in balance.
- Daily yoga exercise can strengthen back muscle.
See your physician if you have continuous back pain for more than a 3 to 4 days. Earlier diagnosis and interventions can prevent complications.
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- 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.
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- The prevalence of low back pain in the elderly: A systematic review of the literature.Bressler, HB, Keyes WJ, Rochon PA, Badley E: Spine 1999 24(17):1813-1819.
- 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.
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