Low back pain mechanism diagnosis and treatment pdf

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low back pain mechanism diagnosis and treatment pdf

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Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the annulus into the nucleus pulposus. Studies suggested that the degeneration of the painful disc might originate from the injury and subsequent repair of annulus fibrosus. Although there exist controversies about the role of discography as a diagnostic test, provocation discography still is the only available means by which to identify a painful disc. A recent study has classified discogenic low back pain into two types that were annular disruption-induced low back pain and internal endplate disruption-induced low back pain, which have been fully supported by clinical and theoretical bases.

Mechanisms of low back pain: a guide for diagnosis and therapy

Low back pain LBP or lumbago is a common disorder involving the muscles, nerves, and bones of the back. In most episodes of low back pain, a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain. Initial management with non-medication based treatments is recommended. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects.

In the common presentation of acute low back pain, pain develops after movements that involve lifting, twisting, or forward-bending. The symptoms may start soon after the movements or upon waking up the following morning. The description of the symptoms may range from tenderness at a particular point to diffuse pain. It may or may not worsen with certain movements, such as raising a leg, or positions, such as sitting or standing. Pain radiating down the legs known as sciatica may be present.

The first experience of acute low back pain is typically between the ages of 20 and This is often a person's first reason to see a medical professional as an adult. Other problems may occur along with low back pain. Chronic low back pain is associated with sleep problems, including a greater amount of time needed to fall asleep, disturbances during sleep, a shorter duration of sleep, and less satisfaction with sleep.

Low back pain is not a specific disease but rather a complaint that may be caused by a large number of underlying problems of varying levels of seriousness. Women may have acute low back pain from medical conditions affecting the female reproductive system, including endometriosis , ovarian cysts , ovarian cancer , or uterine fibroids. Low back pain can also be caused by an urinary tract infection. The lumbar or lower back region is made up of five vertebrae L1—L5 , sometimes including the sacrum.

In between these vertebrae are fibrocartilaginous discs , which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord. Nerves come from and go to the spinal cord through specific openings between the vertebrae, providing the skin with sensations and messages to muscles.

Stability of the spine is provided by the ligaments and muscles of the back and abdomen. Small joints called facet joints limit and direct the motion of the spine.

The multifidus muscles run up and down along the back of the spine, and are important for keeping the spine straight and stable during many common movements such as sitting, walking and lifting. An intervertebral disc has a gelatinous core surrounded by a fibrous ring. Pain is generally an unpleasant feeling in response to an event that either damages or can potentially damage the body's tissues.

There are four main steps in the process of feeling pain: transduction , transmission, perception , and modulation. This type of cell converts the event into an electrical signal by transduction.

Several different types of nerve fibers carry out the transmission of the electrical signal from the transducing cell to the posterior horn of spinal cord , from there to the brain stem , and then from the brain stem to the various parts of the brain such as the thalamus and the limbic system. In the brain, the pain signals are processed and given context in the process of pain perception. Through modulation, the brain can modify the sending of further nerve impulses by decreasing or increasing the release of neurotransmitters.

Parts of the pain sensation and processing system may not function properly; creating the feeling of pain when no outside cause exists, signaling too much pain from a particular cause, or signaling pain from a normally non-painful event. Additionally, the pain modulation mechanisms may not function properly. These phenomena are involved in chronic pain. As the structure of the back is complex and the reporting of pain is subjective and affected by social factors, the diagnosis of low back pain is not straightforward.

There are a number of ways to classify low back pain with no consensus that any one method is best. Low back pain may be classified based on the signs and symptoms. Diffuse pain that does not change in response to particular movements, and is localized to the lower back without radiating beyond the buttocks , is classified as nonspecific , the most common classification.

The symptoms can also be classified by duration as acute, sub-chronic also known as sub-acute , or chronic. The specific duration required to meet each of these is not universally agreed upon, but generally pain lasting less than six weeks is classified as acute , pain lasting six to twelve weeks is sub-chronic , and more than twelve weeks is chronic. The presence of certain signs, termed red flags , indicate the need for further testing to look for more serious underlying problems, which may require immediate or specific treatment.

It is only suggestive, [38] [39] and most people with red flags have no serious underlying problem. The usefulness of many red flags are poorly supported by evidence. With other causes ruled out, people with non-specific low back pain are typically treated symptomatically, without exact determination of the cause.

Imaging is indicated when there are red flags, ongoing neurological symptoms that do not resolve, or ongoing or worsening pain. Complaints of low back pain are one of the most common reasons people visit doctors. Exercise appears to be useful for preventing low back pain.

A few studies that have contradicted this notion have also failed to include sleep posture and mattress firmness. The most comfortable sleep surface may be preferred. Most people with acute or subacute low back pain improve over time no matter the treatment. The condition is normally not serious, resolves without much being done, and recovery is helped by attempting to return to normal activities as soon as possible within the limits of pain.

Increasing general physical activity has been recommended, but no clear relationship to pain or disability has been found when used for the treatment of an acute episode of pain. These exercises only work if they are limiting low back pain. Generic or non specific stretching has also been found to not help with acute low back pain. Stretching, especially with limited range of motion , can impede future progression of treatment like limiting strength and limiting exercises.

Exercise therapy is effective in decreasing pain and improving physical function, trunk muscle strength and mental health for those with chronic low back pain. Aquatic therapy is recommended for chronic and subacute low back pain in those with a preexisting condition.

Aquatic therapy is not recommended for people that have no preexisting condition that limits their progressive walking. The management of low back pain often includes medications for the duration that they are beneficial. With the first episode of low back pain the hope is a complete cure; however, if the problem becomes chronic, the goals may change to pain management and the recovery of as much function as possible. As pain medications are only somewhat effective, expectations regarding their benefit may differ from reality, and this can lead to decreased satisfaction.

The medication typically recommended first are acetaminophen paracetamol , NSAIDs though not aspirin , or skeletal muscle relaxants and these are enough for most people. Thus, NSAIDs are a second choice to acetaminophen, recommended only when the pain is not handled by the latter.

If the pain is still not managed adequately, short term use of opioids such as morphine may be useful. If prescribed, a person and their clinician should have a realistic plan to discontinue its use in the event that the risks outweigh the benefit. For older people with chronic pain, opioids may be used in those for whom NSAIDs present too great a risk, including those with diabetes, stomach or heart problems.

They may also be useful for a select group of people with neuropathic pain. Antidepressants may be effective for treating chronic pain associated with symptoms of depression, but they have a risk of side effects.

Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control.

Discectomy the partial removal of a disc that is causing leg pain can provide pain relief sooner than nonsurgical treatments. For those with pain localized to the lower back due to disc degeneration, fair evidence supports spinal fusion as equal to intensive physical therapy and slightly better than low-intensity nonsurgical measures. It is unclear if among those with non-chronic back pain alternative treatments are useful.

Acupuncture is no better than placebo, usual care, or sham acupuncture for nonspecific acute pain or sub-chronic pain. Massage therapy does not appear to provide much benefit for acute low back pain. For acute or chronic radicular pain syndromes massage therapy is recommended only if low back pain is considered a symptom.

Mechanical massage tools are not recommended for the treatment of any form of low back pain. Prolotherapy — the practice of injecting solutions into joints or other areas to cause inflammation and thereby stimulate the body's healing response — has not been found to be effective by itself, although it may be helpful when added to another therapy. Herbal medicines, as a whole, are poorly supported by evidence. Behavioral therapy may be useful for chronic pain.

Tentative evidence supports neuroreflexotherapy NRT , in which small pieces of metal are placed just under the skin of the ear and back, for non-specific low back pain. KT Tape has been found to be no different for management of chronic non-specific low back pain than other established pain management strategies. There is strong evidence that education may improve low back pain, with a 2. This was more effective for people with acute rather than chronic back pain.

Overall, the outcome for acute low back pain is positive. At one year, pain and disability levels are low to minimal in most people.

Distress, previous low back pain, and job satisfaction are predictors of long-term outcome after an episode of acute pain. For persistent low back pain, the short-term outcome is also positive, with improvement in the first six weeks but very little improvement after that. At one year, those with chronic low back pain usually continue to have moderate pain and disability.

Prognosis may be influenced by expectations, with those having positive expectations of recovery related to higher likelihood of returning to work and overall outcomes. Low back pain that lasts at least one day and limits activity is a common complaint. It is not clear whether men or women have higher rates of low back pain. Low back pain has been with humans since at least the Bronze Age.

The oldest known surgical treatise — the Edwin Smith Papyrus , dating to about BCE — describes a diagnostic test and treatment for a vertebral sprain.

Hippocrates c. Physicians through the end of the first millennium did not attempt back surgery and recommended watchful waiting. Through the Medieval period , folk medicine practitioners provided treatments for back pain based on the belief that it was caused by spirits.

At the start of the 20th century, physicians thought low back pain was caused by inflammation of or damage to the nerves, [] with neuralgia and neuritis frequently mentioned by them in the medical literature of the time. Emerging technologies such as X-rays gave physicians new diagnostic tools, revealing the intervertebral disc as a source for back pain in some cases. In , orthopedic surgeon Joseph S. Barr reported on cases of disc-related sciatica improved or cured with back surgery.

Since then, physicians have come to realize that it is unlikely that a specific cause for low back pain can be identified in many cases and question the need to find one at all as most of the time symptoms resolve within 6 to 12 weeks regardless of treatment.

Mechanisms of low back pain: a guide for diagnosis and therapy

Painter, D. World Guidelines. Other Pages:. Patient Satisfaction. Safety of Chiropractic. Senior Care.

Low back pain LBP or lumbago is a common disorder involving the muscles, nerves, and bones of the back. In most episodes of low back pain, a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain. Initial management with non-medication based treatments is recommended. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects. In the common presentation of acute low back pain, pain develops after movements that involve lifting, twisting, or forward-bending.

Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment

Background: Back pain has many causes. If no specific cause of the pain can be identified, no imaging studies are indicated on initial presentation. The treatment of acute, nonspecific low back pain focuses on pain relief and functional improvement.

Mechanisms of low back pain: a guide for diagnosis and therapy

Version 1 of this article contained a few instances of very similar text from previous works including [25] , which have now been rephrased and referenced accordingly. F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions any comments will already have been addressed in the published version. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem.

The resonating mission of the FCLB is to protect the public by promoting excellence in chiropractic regulation through service to their member boards. The FCLB encourages regulatory boards to employ best practices in public protection, communicate and network to improve capability, develop consistency in standards, and envision a plan for the future. PACE recognized continuing education courses promote quality chiropractic continuing education programs, provide reliable and scientifically sound educational updates, help chiropractors remain current on licensing and new, effective clinical protocols, and help practitioners avoid isolation through peer-related educational activities. The PACE program reduces onerous paperwork and review processes, provides reliable reports on fulfillment of re-licensing requirements, and helps boards replace with audits for compliance.


PDF | Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the.


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