Treatment for Low Back Pain Attributed to Underlying Presumptive Etiology
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American Journal of Drug Delivery and Therapeutics www.pubicon.net
Review Article
Treatment for Low Back Pain Attributed to
Underlying Presumptive Etiology
A. Krishna Sailaja*
Associate Professor, RBVRR Women’s college of pharmacy, Affiliated to Osmania University,
Hyderabad, India
ABSTRACT
Address for In these days back pain is becoming a serious problem in middle age
Correspondence and old age people. Back pain is not a disease but it is a symptom for
specific problem in the body. In this review a detailed discussion was
Associate Professor, made on the reasons, associated problems and various treatments
RBVRR Women’s available for the treatment of back pain.
college of pharmacy,
Affiliated to Osmania Keywords: Low back pain, Presumptive etiology, Old age people,
University, Hyderabad, Middle age people.
India.
E-mail: shailaja1234
@rediffmail.com
INTRODUCTION
Back pain is an extremely common Musculoskeletal disorders also one of the
problem that causes people to seek medical serious reasons of back pain. Lumbar
attention. Every one experiences back pain radiculopathy, also called sciatica, refers to
at least one time in their entire life. back and leg pain caused by an irritated
Generally back pain occurs in the age group nerve in the lumbar spine. It is often
of 35-55. There are several reasons for back associated with numbness in the leg. It tends
pain. Various metabolic disorders, to affect one leg and the pain and numbness
autoimmune diseases and physiological can extend below the knee to the calf, foot,
conditions present back pain as a symptom. and ankle. It tends to affect people age 30
General back pain which have been and older. Spinal stenosis is another
generated due to stress will resolve on its condition that is related to lumbar
own without any treatment. Presence of degenerative disk disease. This tends to
back pain for more than six weeks indicates affect people that are 60 and older. It
serious health problem. The back pain which involves a combination of back and leg pain,
occurs at night time is more dangerous and often with numbness that tends to be worse
requires attention. Other symptoms are with standing and walking and is relieved by
fever, chills and night sweats. sitting down or flexing forward at the waist.
American Journal of Drug Delivery and Therapeutics www.pubicon.net
Sailaja ______________________________________________________ ISSN 2349-7211
Another cause of back pain is an acute Nerve irritation
vertebral compression fracture. These The nerves of the lumbar spine can
usually occur in elderly people with be irritated by mechanical pressure by bone
osteoporosis. or other tissues from their roots at the spinal
cord to the skin surface. These conditions
Function of the low back include lumbar disc disease (radiculopathy),
The low back serves a number of bony encroachment, and inflammation of the
important functions for the human body. nerves caused by a viral infection.
These functions include structural support,
movement, and protection of certain body Lumbar strain (acute, chronic)
tissues. While standing the lower back is A lumbar strain is a stretch injury to
functioning to support the weight of the the ligaments, tendons, and/or muscles of
upper body. In bending, extending lower the low back. The stretching incident results
back is involved in the movement. in microscopic tears of varying degrees in
Therefore, injury to the structures for weight these tissues. Lumbar strain is considered
bearing, such as the bony spine, muscles, one of the most common causes of low back
tendons, and ligaments, often can be pain. The injury can occur because of
detected when the body is standing erect or overuse, improper use, or trauma. If the
used in various movements. injury to soft tissue is present for more than
Protection of soft tissues of the three months this injury is commonly
nervous system and spinal cord as well as classified as "acute". If the strain lasts longer
nearby organs of the pelvis is a critical than three months, it is referred to as
function of the lumbar spine and adjacent "chronic."Lumbar strain occurs in people in
muscles of the low back. their 40s, but it can happen at any age. The
severity of the injury ranges from mild to
Risk factors for back pain severe, depending on the degree of strain
Following conditions are highly risk and resulting spasm of the muscles of the
factors for back pain. low back. The diagnosis of lumbar strain is
A mentally stressful job based on the history of injury, the location
Pregnancy of the pain, and exclusion of nervous system
A Sedentary life style injury. X- ray testing is helpful to determine
Age the bone abnormalities1.
Anxiety
Depression Lumbar radiculopathy
Lumbar radiculopathy is nerve
Gender- back pain is more common in
irritation caused by damage to the discs
women than men.
between the vertebrae. This damage to the
Obesity
disc may be because of degeneration of the
Physical work outer ring of the disc, traumatic injury, or
Common causes of low back pain
both. This rupture causes the "sciatica" pain
(lumbar backache) include nerve irritation,
of a herniated disc that shoots from the low
lumbar strain, lumbar radiculopathy, bony
back and buttock down the leg. This pain
encroachment, and conditions of the bone
commonly increases with movements at the
and joints.
waist and can increase with coughing or
sneezing. In more severe instances, sciatica
can be accompanied by incontinence of the
AJDDT[2][1][2015] 001-008Sailaja ______________________________________________________ ISSN 2349-7211
bladder. The sciatica of lumbar who are significantly affected by structural
radiculopathy typically affects only one side scoliosis may require treatment with bracing
of the body. Lumbar radiculopathy is and/or surgery to the spine. Adults
suspected based on the above symptoms. infrequently are treated surgically but often
Nerve testing (EMG/electromyogram and benefit by support bracing. Spina bifida is a
NCV/nerve conduction velocity) of the birth defect in the bony vertebral arch over
lower extremities can be used to detect the spinal canal, often with absence of the
nerve irritation. The actual disc herniation spinous process. This birth defect most
can be detected with imaging tests, such as commonly affects the lowest lumbar vertebra
CAT or MRI scanning. (See figure 1.) and the top of the sacrum.
Bony encroachment Injury to the bones and joints
Any condition that results in growth Fractures (breakage of bone) of the
of the vertebrae of the lumbar spine can limit lumbar spine and sacrum bone most
the space for the adjacent spinal cord and commonly affect elderly people with
nerves. Causes of bony encroachment of the osteoporosis, especially those who have taken
spinal nerves include foramina narrowing, long-term cortisone medication. For these
spondylolisthesis (slippage of one vertebra individuals, occasionally even minimal
relative to another), and spinal stenosis. stresses on the spine (such as bending to tie
Spinal-nerve compression in these conditions shoes) can lead to bone fracture. In this
can lead to sciatica pain that radiates down setting, the vertebra can collapse (vertebral
the lower extremities. Spinal stenosis can compression fracture). The fracture causes an
cause lower-extremity pains that worsen with immediate onset of severe localized pain that
walking and are relieved by resting. can radiate around the waist in a band-like
Treatment of these afflictions varies, fashion and is made intensely worse with
depending on their severity, and ranges from body motions. This pain generally does not
rest, and exercises to epidural cortisone radiate down the lower extremities12.
injections and surgical decompression by
removing the bone that is compressing the Degenerative bone and joint conditions
nervous tissue. (See figure 2.) As the age advances, the water and
protein content of the body's cartilage
Bone and joint conditions changes. This change results in weaker,
Bone and joint conditions that lead to thinner, and more fragile cartilage. Because
low back pain include those existing from both the discs and the joints that stack the
birth (congenital), those that result from wear vertebrae are partly composed of cartilage,
and tear (degenerative) or injury, and those these areas are subject to wear and tear over
that are due to inflammation of the joints time. Degeneration of the disc is called
(arthritis). spondylosis. Spondylosis can be noted on X-
rays of the spine as a narrowing of the normal
Congenital bone conditions "disc space" between the vertebrae. It is the
Congenital causes of low back pain deterioration of the disc tissue that
include scoliosis and spina bifida. Scoliosis is predisposes the disc to herniation and
a sideways (lateral) curvature of the spine that localized lumbar pain ("lumbago") in older
can be caused when one lower extremity is patients. Degenerative arthritis (osteoarthritis)
shorter than the other or because of an of the facet joints is also a cause of localized
abnormal architecture of the spine. Children lumbar pain that can be detected with plain X-
AJDDT[2][1][2015] 001-008Sailaja ______________________________________________________ ISSN 2349-7211
ray testing. These causes of degenerative back on whether or not the tumors affect the
pain are usually treated conservatively with nervous tissue. Tumors of these areas are
intermittent heat, rest, rehabilitative exercises, detected using imaging tests, such as plain X-
and medications to relieve pain, muscle rays, nuclear bone scanning, and CAT and
spasm, and inflammation10,11. MRI scanning.
Other causes of lower back pain Other symptoms and signs associated with
Other causes of low back pain include low back pain7,8
kidney problems, pregnancy, ovary problems, Symptoms that can be associated with
and tumors. low back pain include numbness, tingling of
the lower extremities, incontinence of urine or
Kidney problems stool, inability to walk without worsening
Kidney infections, stones, and pain, lower extremity weakness, atrophy
traumatic bleeding of the kidney (hematoma) (decreased in size) of the lower extremity
are frequently associated with low back pain. muscles, rash, fever, chills, weight loss,
Diagnosis can involve urine analysis, sound- abdominal pains, burning on urination,
wave tests (ultrasound), or other imaging dizziness, joint pain, and fatigue.
studies of the abdomen.
Diagnosis of lower back pain9
Pregnancy The diagnosis of low back pain
Pregnancy commonly leads to low involves a history of the illness and a physical
back pain by mechanically stressing the examination. Apart from abdomen and
lumbar spine and by the positioning of the extremity evaluations, rectal and pelvic
baby inside of the abdomen. Additionally, the examinations may eventually be required as
effects of the female hormone estrogen and well. Further tests for diagnosis of low back
the ligament-loosening hormone relaxin may pain can be required including blood and
contribute to loosening of the ligaments and urine tests, plain film X-ray tests, CAT
structures of the back. Pelvic-tilt exercises scanning, MRI scanning, bone scanning, and
and stretches are often recommended for tests of the nerves such as electromyograms
relieving this pain. (EMGs) and nerve conduction velocities
(NCVs).15
Ovary problems
Ovarian cysts, uterine fibroids, and Low Back Pain-Medications13,14
endometriosis not infrequently cause low Medicine can decrease low back pain
back pain. Precise diagnosis can require and reduce muscle spasms in some people.
gynecologic examination and testing. But medicine alone isn't an effective
treatment for low back pain. It should be used
Tumors along with other treatments, such as walking
Low back pain can be caused by and using heat or ice.
tumors, either benign or malignant, that
originate in the bone of the spine or pelvis and Medication choices
spinal cord (primary tumors) and those which There are several medicines your
originate elsewhere and spread to these areas doctor may recommend, depending on how
(metastatic tumors). Symptoms range from long you have had pain, what other symptoms
localized pain to radiating severe pain and you have, and your medical history.
loss of nerve and muscle function depending
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The medicines recommended most Role of Physical exercise in the treatment of
often are: back pain2,3
Here are a few stretching exercises, as
Acetaminophen (Tylenol) and nonsteroidal reported by the Times of India, which can be
anti-inflammatory drugs performed at the working place itself.
Nonsteroidal anti-inflammatory drugs
like ibuprofen and naproxen. These medicines Neck stretch
can be purchased without prescription. But Stand straight with the feet apart.
stronger doses require prescription. Entwine the fingers and hold the nape of the
neck. Look upwards toward the ceiling and
Muscle relaxants stretch your neck to release pressure.
These medicines can help to relief
muscle spasms along with low back pain. Shoulder shrugs
Side effects, such as drowsiness, are common. This exercise helps in releasing
stiffness in the neck and shoulders. Inhale
Opiate pain relievers deeply, grip the shoulders with the fingers and
These are very strong medicines that lift them up to the ears. Hold for five seconds
are sometimes tried to ease sudden, severe and release.
back pain that has not been controlled by
other medicines. They are usually taken for Arm raises
only 1 to 2 weeks. This exercise will be performed by
using a water bottle as a dumbbell, hold it in
Antidepressants the right hand. Bend the elbow, raise the arm
Some of these medicines, such as over the head and repeat with other hand.
amitriptyline and duloxetine, not only treat This exercise can be performed at the
depression but also may help with chronic working place itself.
pain.
Other medicines sometimes used for Hand circles4,5
low back pain are: Clench both fists and stretch the hands
out in front of you. Rotate the wrists, first
Anesthetic or steroid injections clockwise and then anti-clockwise for five
These have been prescribed for minutes each. This exercise can be performed
chronic low back pain. They may give short- at the working place itself.
term relief from leg pain related to a back
problem. Back hug
Cross the arms and place the right
Anticonvulsants hand on the left shoulder and the left hand on
These are sometimes used to treat low the right shoulder. Inhale and exhale deeply,
back pain, even though there isn't strong hold for five seconds and release.
evidence that they help.
Leg extension6
Botox injection While sitting, extend the legs straight
This is a shot into the back muscles. It out in front of you, so they are parallel to the
has not been well tested for chronic low back floor. Flex and point the toes downward in
pain. front of you. Repeat the exercise five
times. Beneficial for the abdomen and legs,
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practice leg extensions at work place twice a 6. Sherman KJ, et al. (2011). A randomized
day. trial comparing yoga, stretching, and a self-
care book for chronic low back pain.
CONCLUSIONS Archives of Internal Medicine, 171(22):
2019–2026.
In this review detailed discussion was 7. Chou R (2010). Low back pain (chronic),
made on the main causes, symptoms and search date April 2009. Online version of
diagnostic procedures for lower back pain. BMJ Clinical Evidence: http://www.
clinicalevidence.com.
The main reason for low back pain absolutely
8. Wilk V. Acute low back pain: assessment
depends on its precise cause. For example, and management. Australian Family
acute strain injuries generally heal entirely Physician. 2004; 33: 403-407.
with minimal treatment. On the other hand, 9. Deyo RA, Weinstein JN. Low back pain.
bony abnormalities that are irritating the New England Journal of Medicine. 2001;
spinal cord can require significant surgical 344: 363-370.
repair and the outlook depends on the surgical 10. Jenner JR, Barry M. ABC of rheumatology:
result. Different procedures are discussed for low back pain. BMJ. 1995; 310: 929-932.
the treatment of back pain. Long-term optimal 11. Devereaux MW. Low back pain. Primary
results often involve exercise rehabilitation Care. 2004; 31: 33-51.
programs that can involve physical therapists. 12. Anema JR, Steenstra IA, Bongers PM, et al.
Multidisciplinary rehabilitation for subacute
Physical exercise is always helpful for
low back pain: graded activity or workplace
controlling the different types of back pain. intervention or both? A randomized
controlled trial. Spine. 2007; 32(3):291-298;
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Figure 1. Cross-section picture of herniated disc between L4 and L5
AJDDT[2][1][2015] 001-008Sailaja ______________________________________________________ ISSN 2349-7211
Figure 2. Figure explaining about the disk herniation
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