Lower Back Pain: Part 1
Lower back pain affects about 90% of the population at some point in their lives. We’re talking about the prevalence of this condition in GOOD times, with 5% experiencing issues with back pain every single year. You can just imagine what the percentages will be when heavy lifting becomes part of the activities of daily survival after a disaster.
Lower back pain is one of the top five most common reasons for visiting the doctor and is the most common cause of work-related disability in the United States. The economic impact of back pain, likewise, is gigantic: 2% of the work force is compensated for issues related to back injuries yearly, with health care costs exceeding 26 billion dollars annually.
Therefore, it’s clear that those that will be medically responsible for their families in troubled times should know how to diagnose and treat this problem. Without high technology like MRIs, CAT scans, and X-rays, this isn’t so easy.
It’s often difficult to find the proven cause of any one case of back pain; indeed, almost 90% of people with back pain may not find a definite cause of their problem. With appropriate measures, luckily, the grand majority of these cases will improve within 4-6 weeks.
Simple lower back pain is usually described as dull or “aching” but improves with bedrest and simple painkillers. Lower back pain associated with symptoms that affect the whole body (called “systemic”) is of more concern. These include fever, chills, weight loss, night sweats, etc. Evaluate for urinary infections or intestinal issues, chronic medical conditions such as diabetes, and tumors. Pain that wakes a person up in the middle of the night is especially important to evaluate further. So is pain that doesn’t improve despite major pain treatment.
An important parameter is the length of time the person has been in pain. Less than 6 weeks is considered “acute” pain and over 12 weeks is considered “chronic”. As 80-90% of lower back pain episodes go away before 6 weeks, anything longer should put you on alert that something may be wrong. Having said that, we are talking about persons who have not yet been given, say, at least 2 weeks of treatment along with decreased activities.
The location of the pain is important in determining the cause. Pain from muscle issues usually remains in the back on either side of the spine. Nerve involvement, however, causes pain to be felt elsewhere as well. This pain in areas remote from an injured or diseased area is said to be “radiating”.
If pain radiates below the knee, there is a possibility that a spinal disc has been damaged or “herniated”. This, of course, depends on the location of the herniation; more than 90% of herniated discs occur in the lower back. Disc pain may worsen when your patient coughs, sits up, or bears down. A time-honored test on physical exam is the “straight leg test”, which can be done sitting or lying down:
Sitting: Your patient sits up with knees bent at 90 degrees. Slowly extend one leg until the knee is straight. A herniated disc will usually produce pain down the back of the leg below the knee when the leg is raised.
Lying down: The patient lies back with both legs extended. Raise the affected leg toward their head. A herniated disc will produce pain down the back of the leg below the knee when the leg is raised up.
More common than a herniated disc, especially in the hard labor we’ll see in survival situations, is “Sciatica”. This is irritation of a nerve (indeed, the largest single nerve in the body) that travels down the back of each leg. As such, pain will radiate down one buttock and, usually, down the back of the thigh.
The age of the patient is another factor. Teenagers with significant lower back pain may have had trauma from athletics or other activities or may have some as-yet undiagnosed deformity that they were born with.
Elderly patients may have loss of calcium from bones (also called “osteoporosis”) that make them prone to fractures from even mild trauma. Older individuals are also prone to degenerative conditions such as arthritis or “spinal stenosis” that may cause nerve compression. The pain appears similar to sciatica but is worsened by back extension and relieved by bending forward or by any prolonged standing or activity.
Lower back pain is also common when there is pressure in the belly pushing on the spine, such as in pregnancy or, unhappily, in the presence of an abdominal tumor of some sort. Other red flags include loss of muscle strength, sexual function, incontinence, and numbness in certain areas. Different areas affected may indicate problems with a specific nerve. In many of these cases, you may have little that you can do without the modern diagnostic tests available in medical centers today.
In Part 2 of this article, we’ll discuss ways that you can treat lower back pain both naturally and conventionally, as well as prevention. For general information about pain relief, here are two articles to check out:
Dr. Bones, the Disaster Doctor
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