What low back pain is and why we need to pay attention

People of all ages suffer from low back pain, which is a very common condition. In 2015, the global point prevalence of activity-limiting low back pain was 73%, meaning that 540 million individuals were suffering from the condition at any given time. Low back pain is becoming the leading cause of disability around the world. Low-income and middle-income countries, including Asia, Africa, and the Middle East, have seen the greatest increases in disability caused by low back pain in recent decades, owing to health and social systems that are ill-equipped to deal with this growing burden on top of other priorities like infectious diseases

1.Causes of low back pain:

Several regions are innervated and have been demonstrated to create pain when stimulated, despite the fact that clinical testing is unable to reliably identify the tissue source of most low back pain. In some circumstances, a local anesthetic is used to ease discomfort. Many imaging (radiography, CT scan, and MRI) findings seen in patients with low back pain are equally frequent in people who do not have such pain, and their use in diagnosis is a point of contention. Nonetheless, some MRI anomalies are more common in persons with low back pain than in those without, at least in people younger than 50 years.

2.Neurological symptoms associated with low back pain:

Radicular pain and radiculopathy:

When the nerve roots are involved, radicular pain arises, which is generally referred to as sciatica. Sciatica is a phrase that clinicians and patients use interchangeably to describe various types of leg or back pain and should be avoided. A history of dermatomal leg pain, leg pain worse than back pain, aggravation of leg pain when coughing, sneezing, or straining, and the straight leg raise test are all used to diagnose radicular pain. Radiculopathy is characterized by weakness, loss of feeling, or loss of reflexes associated with a specific nerve root, or a combination of these symptoms, and can coexist with radicular discomfort. People who have low back pain plus radicular pain or radiculopathy are said to be more seriously affected and have worse outcomes than those who merely have low back pain.

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Lumbar spinal stenosis:

Lumbar spinal stenosis is characterised by pain or other discomfort that extends into one or both lower limbs when walking or standing for an extended period of time, and is often eased by rest or lumbar flexion (neurogenic claudication). It’s frequently caused by a combination of degenerative changes such facet osteoarthritis, ligamentum flvum hypertrophy, and bulging discs restricting the spinal canal or foramina.

3.Pathological causes of low back pain:

Vertebral fractures, inflammatory illnesses (e.g., axial spondylarthritis), cancer, infections, and intra-abdominal causes are all potential reasons of low back discomfort that may require specific treatment.

Vertebral fracture:

Under the age of 50, symptomatic mild trauma vertebral fractures owing to osteoporosis are uncommon, but the incidence rises significantly with age. Despite the fact that age-specific incidence is not changing, the population burden is increasing as the population ages. In certain studies, mild trauma vertebral fractures have been linked to an elevated risk of mortality of two to eight times.

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Axial spondylarthritis:

Axial spondylarthritis (Axial Spondylarthritis) is a chronic inflammatory illness that mostly affects the axial skeleton in young adults (onset peak 20–40 years). Although historically assumed to be a disease of young males, population studies show only a modest male prevalence. Both persons who have already established structural damage in the sacroiliac joints or spine apparent on radiographs (radiographic axial spondylarthritis; also known as ankylosing spondylitis) and those who have not yet developed such structural damage are classified as having axial spondylarthritis (non-radiographic spondylarthritis).

Malignancy:

Back pain is a common symptom in persons who have metastatic cancer; vertebral metastases affect 3–5% of cancer patients, and 97 percent of spinal tumors are metastatic. Malignancy, on the other hand, is a rare cause of low back discomfort. Adenocarcinomas, which include breast, lung, prostate, thyroid, and gastrointestinal cancers, are the most common solid tumours to spread to the spine. It’s less crucial if you’ve had previous tumours in the past. People over the age of 60 are more likely to develop myeloma, which manifests itself as persistent bone discomfort.

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Infections:

Spondylodiscitis, vertebral osteomyelitis, epidural abscess, and facet joint infection are all examples of spinal infections.Bacterial infections are classified as pyogenic (e.g., Staphylococcus aureus and S epidermidis) or granulomatous (e.g., Staphylococcus aureus and S epidermidis) (eg, tuberculosis, brucellosis). Recent increases in the frequency of spinal infection can be linked to an ageing population with associated comorbidities, as well as enhanced case detection thanks to advanced imaging tools.

Cauda equina syndrome:

Although not exactly a cause of low back pain, cauda equina compression, which is most commonly caused by disc herniation, can be fatal. It’s uncommon, and most primary care doctors will never see a true instance in their careers. Early diagnosis and surgical treatment are likely to be beneficial; thus, when there is a new onset of perianal sensory alteration or bladder symptoms, or bilateral severe radicular pain with low back pain of any duration, there should be a low threshold for further testing.

4.Impact of low back pain:

Disabilities in general:

From 1990 to 2015, the GBD 2015 study assessed disease burden for 315 causes in 195 nations and territories, providing a thorough assessment of the patterns and levels of acute and chronic diseases, as well as their burden and disability globally. In 2015, low back pain was responsible for 601 million years lived with disability (YLD), a 54 percent increase since 1990.

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5.Risk factors and triggers for episodes of low back pain:

Although the impact of low back pain on systems and people differs between low- and middle-income countries and high-income countries, there appear to be less underlying differences in risk factors between regions. People with other chronic illnesses, such as asthma, headaches, and diabetes, are also more likely to experience low back discomfort.

6.Conclusion:        

Low back pain is becoming the leading cause of disability around the world. Low back pain is becoming more common, especially in low- and middle-income nations, putting strain on already overcrowded health-care and social systems. Low back pain is more common and burdensome in working populations, and it is linked to increased activity limitations in older adults. The majority of occurrences of low back pain are transient, and nociceptive sources cannot be pinpointed.

Recurrences, on the other hand, are widespread, and a few persons develop chronic, crippling pain as a result of a variety of biophysical, psychological, and social variables. The costs of health care and lost work time due to low back pain are large, but they differ significantly between nations and are influenced by societal norms, health-care systems, and legislation. Although there are various global programmes to address the global burden of low back pain as a public health problem, cost-effective and context-specific solutions for addressing low back pain are needed to lessen the existing and expected future burden.

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