Lumbago: The Great Pain in Your Back

Lumbago: The Great Pain in Your Back

Lumbago is a general term to describe pain in the lower back, specifically the lumbar region. It is a prevailing disorder that affects about 80% of the world’s western population.  It involves the nerves, bones, and muscles in the back. The pain experienced may be mild to severe, can be acute (lasting less than 6 weeks) or chronic (lasting more than 12 weeks) and is generally felt in the lower back and may radiate down to the buttocks and upper thighs. Since it is the most common type of pain in adults, it is the leading cause of missed work days, as well as visits to the emergency room, which means it puts a significant strain on not only our well-being, but also the economy as a whole.

There are three classifications of the underlying causes of lumbago – mechanical, non-mechanical, and referred pain.  Muscle strain or torn ligaments are examples of mechanical causes.  Non-mechanical classifications include continuous sensory and motor loss, history of cancer, invasive spinal procedures, trauma at an early age, new urinary retention, and overflow incontinence. These would be considered “red flag” clinical clues and would require further evaluation. Referred pain, meanwhile, is mostly associated with internal organ dysfunction that manifests into lower back pain.

Most of the time, non-medication treatments, like bed rest or heat application, are suggested for initial management of pain symptoms.  However, if those do not work, aspirin or ibuprofen are recommended.  If usual treatments do not work and simple medications are not enough, opioids may be suggested.  However, due to the side effects of opioids, they are not generally prescribed, except for severe cases. For chronic disc-related pain, surgery is also a common option.

Chronic lumbago can also sometimes affect a person’s mood.  If that is the case, counseling or anti-depressants are recommended, to help with these unfortunate effects.

The onset of lumbago typically starts between 20 and 40 years of age.  It affects both men and women equally, and it is far more common among people between the ages of 40 and 80.

Signs and Symptoms of Lumbago

The common beginnings of lumbago may start after movements that involve twisting, bending forward, or lifting heavy objects.  Symptoms typically develop soon after making those movements, or when waking up the next morning.  The symptoms are described anywhere from aching in a certain spot, to diffused pain, stiffness, and muscle tension. You may also experience inflammation and swelling in the area, or around certain joints. More than half of the people who initially experience lumbago have recurring episodes, and may feel an increase in pain, as compared to their first episode.

If your lumbago also involves numbness in the back, buttocks, or legs, with a radiating tingle that goes down the leg and into the foot, it may also be an indication of irritation of the sciatic nerve.

Issues associated with long term lumbago include sleep disorders, such as: disruption during sleep, greater amount of time to fall asleep, truncated sleep, and overall less quality sleep. The majority of people who suffer from chronic lumbago also show signs of anxiety and depression.

Causes

Lumbago itself is not a disease per se, it is a symptom of a larger problem. However, many of the underlying issues associated with lumbago, have varying levels of severity. Non-serious skeletal or muscle issues, such as strains and sprains, account for the majority of lumbago cases.  Other contributing factors to lower back pain include poor posture, bad sleeping positions, stress, obesity, and even smoking. Physical causes may include a herniated disc, broken vertebra(e), osteoarthritis, disc degeneration, or in more rare instances, infection or tumors on the spine.

Medical conditions affecting a woman’s reproductive system may also lead to acute lower back pain.  Some of these conditions include uterine fibroids, ovarian cysts, ovarian cancer, and endometriosis.  It is also noted that half of pregnant women have experienced lumbago, mainly due to changes in their center of gravity and posture, which can cause muscle and ligament strain.

Since Lumbago is such a broad term, we’ve broken it down into four major categories that might help provide a baseline understanding of it. They are each included below along with a few examples:

Inflammatory Lumbago

This includes chronic conditions like arthritis and IBS (inflammatory bowel disease).

Malignant Lumbago

This serious and potentially life-threatening form of lumbago includes bone metastasis from soft tissue cancers, such as thyroid, prostate, lung, and breast.

Lumbago Caused by Infections

This form of lumbago is often caused, or associated with, the onset of an abscess, osteomyelitis, or other infections in the body.

Musculoskeletal Lumbago

This category often takes the form of muscle spasms, muscle strains, osteoarthritis, herniated discs, compression fractures, and spinal stenosis.

Diagnosis

Many factors must be considered when diagnosing lumbago because pain is always subjective, and the back is such a complex part of our body. It is not often a straightforward diagnosis, and can sometimes be challenging, and take months, if not years. Many factors, such as the patient’s health history, as well as a detailed physical examination, are taken into consideration, before making a diagnosis. The majority of lumbago is caused by joint and muscle issues, but there must be a distinction between those related to muscles, and other issues, such as infections, spinal tumors, fracture of the spine, and neurological problems.

Classification

There are a variety of ways to categorize lumbago, but there does not seem to be a fundamental agreement among medical professionals, as to which method is best.  The three most common and widely used classifications, are organized by pain symptoms that are listed below:

Mechanical Pain

Lower back pain associated with strains, sprains, compressed nerves, herniated discs, joint disease, degenerative discs, or broken vertebra. Around 90% of lumbago cases fall under this category.  And of those, around 75% are “non-specific”, but are mainly due to ligament injury, or muscle strain.

Non-Mechanical Pain

Lower back pain associated with infections, tumors, or conditions related to inflammation, such as spondyloarthritis.

Referred Pain

Referred pain is typically described as pain felt in one location, that originates in another.  For example, pain from internal organs that results from kidney stones, kidney infections, gallbladder disease, or an aortic aneurysm, which then manifests itself as lower back pain.

Based on the symptoms and signs, lumbago can be classified as follows:

Non-Specific

This category includes lower back pain that is typically localized to the lower back, without spreading beyond the buttocks, and does not change in response to specific movements. It is also the most common classification.

Radicular

This type of pain is described as radiating down the leg, below the knee, felt on one side (as in the case of a herniated disc), or on both sides (as in the case of stenosis), and can vary in severity with certain movements, or positions.  About 7% of cases fall into this category.

Red Flag

The Red Flag category includes pain that comes with fever, muscle weakness, trauma, or history of cancer.  It may signal more serious hidden problems that should be looked at immediately.

Beyond these, there are also multiple different classifications for the duration, and term of the pain. These include acute, sub-chronic, or chronic.  Generally, pain that lasts less than 6 weeks is considered acute.  Any pain that lasts 6-12 weeks is regarded as sub-chronic, and chronic pain is listed as lasting longer than 12 weeks.

Red Flags

As mentioned above, certain signs require immediate attention and testing, as they may indicate serious issues that may need urgent, or specific lumbago treatment. However, it should be noted, that though “red flag” symptoms may be present, it may not always mean that testing will uncover a serious issue.  Most people with red flag symptoms have no further serious underlying diagnosis. The appearance of the symptoms are merely suggestive.

For example, the factors in discovering a fracture include age of the patient, the use of corticosteroids, and skin markings indicative of compelling trauma. Those red flags merely point toward a possible diagnosis, but they don’t represent one, in and of themselves.

Performing any diagnostic imaging or lab testing, especially if there are no red flags present, is not shown to be useful for diagnosing lumbago, especially in the first four weeks after symptoms start. Furthermore, people with non-specific lumbago, with other causes ruled out, are usually treated for their symptoms first, without determining the specific cause.

Testing and Imaging

When red flag symptoms are present, a person is experiencing ongoing or worsening pain, or if they have neurological symptoms that do not resolve on their own, it is typical to order some type of testing, such as imaging.  Where there may be a suspicion of cancer or infection, early imaging (MRI or CT Scan) is recommended. To identify disc disease, the preferred method is an MRI rather than a CT Scan.

Very few physical tests prove to be useful to perform a diagnosis.  However, the one physical test that is typically used is called the straight leg raise.  This test is performed with the patient lying down on their back, either on an exam table, or on the floor, while the person examining them lifts their leg while the knee is straight.  Depending on the patient’s experience of pain while performing this test, it can be determined if the cause is a herniated disc.

An invasive procedure called lumbar provocative discography may also help with those suffering chronically high levels of pain in the lower back.  It can determine if the pain is disc related.

Treatment and Management

Factors such as age, weight, and activity level, may help determine the best course of treatment for lumbago. The type of treatment will also depend on whether the pain is mechanical, non-mechanical, or referred.

For those suffering from acute pain, and experiencing mild to moderate issues, the goal is to return to normal function, and get them back to work, while reducing pain levels. When the complaint is not serious, it will typically clear up with very little being done, and getting back to normal activities, within pain limits, helps in recovery.

However, those people that suffer from sub-chronic, and chronic lumbago, may find multidisciplinary treatments helpful.  If initial non-medication treatments do not work, NSAIDs (non-steroidal anti-inflammatory drugs) may be effective.

Physical Management for Lumbago

For acute episodes of lower back pain, increasing general physical activity, such as walking, is one of the best, and easiest recommendations for relief. Other common suggestions include hot or cold compresses, and gentle stretches.

For sub-chronic low back pain, the use of heat therapy may help alleviate pain.

For truly chronic lumbago, physical therapy has been shown to be most effective.  It has also been shown that after 6 months of completing a session of physical therapy, it helps to improve long-term function, as well as reducing another episode of lumbago.

Management Through Medication

The first level of medications that are usually recommended to treat lumbago are NSAIDs (no aspirin) or muscle relaxants.  NSAIDs (non-steroidal anti-inflammatory drugs) are a type of medication that is used to help decrease pain, and reduce fever, among other things.  Muscle relaxants help, and may be beneficial to relieve symptoms like pain, hyperreflexia and spasms. Usually these will be more than enough to help the majority of people manage their pain.

Although opioids and morphine have been useful in dealing with pain that is not managed with other treatments, they carry many risk factors, not the least of which is addiction, as well as powerful interactions with other medications. They also carry a greater risk of side effects, such as constipation, nausea, and dizziness.  Some specialist groups have even cautioned against using opioids to treat long term low back pain. In 2016 it was announced by the CDC that opioids were not the preferred treatment for managing lumbago, as they carried too many risks.

Management Through Surgery

With those affected by a herniated disc, or spinal stenosis, surgery may be most useful way to correct chronic lumbago.  The partial removal of a disc, called discectomy, may help to alleviate pain in the leg, and provide relief quicker than non-surgical treatments.  Other conditions, not related to disc problems, may not benefit from surgical procedures.

Spinal fusion surgery has also been performed on people who have lower back pain due to disc degeneration. It should be noted, that there is some evidence to show that this type of surgery, as compared to intensive physical therapy, show equal benefits.

Management Through Alternative Medicine

Popular alternative methods to treat lumbago include chiropractic care, acupuncture, yoga, massage therapy, and herbal remedies.

Prevention

To help prevent lumbago from occurring, exercise is key, along with living an active and healthy lifestyle.  Exercise has also been shown useful in lessening, or even preventing, a recurrence of lower back pain, especially in those people who have had pain for more than 6 weeks. A medium-firm mattress is also recommended for those with chronic lumbago.

Conclusion

Lumbago is a broad term used to describe pain in the lower back, specifically in the lumbar region.  It is a widely common complaint throughout the western world, afflicting about 80% of the population. It is usually caused by excessive bending, twisting, or other repetitive motions involving the lower back, and it is the leading cause for emergency room visits in the United States.

Other causes can be related to herniated discs, spinal stenosis, or osteoporosis, and more serious conditions like tumors, can also be attributed to lumbago. For most who experience lumbago, the pain they experience usually goes away after a few days, or a few weeks.  For those who have long term lumbago, treatments can range from medication to surgery, depending on the severity of the problem and pain.  The key thing to remember, is that injury prevention is key, to a healthy back. Find the right mattress for you, exercise daily, and try to stay active as possible, and your chances of experiencing lumbago will stay low!

 

These statements have not been evaluated by the Food and Drug Administration. Products discussed are not intended to diagnose, treat, cure, or prevent any disease.

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