Lower back pain (LBP) is a prevalent condition affecting a significant portion of the population. It is characterized by discomfort or pain localized in the area below the ribs and above the legs.

Understanding the various facets of LBP, including its causes, symptoms, diagnosis, and treatment options, is crucial for effective management.

1. Epidemiology

• LBP affects approximately one in four individuals on a monthly basis.
• Around 80% of people will experience LBP at some point in their lives.
• Onset commonly occurs between the ages of 20 and 40, with recurring episodes more prevalent between 40 and 80 years old.

2. Classification

• LBP can be categorized based on duration:
  • Acute: Lasting less than 6 weeks.
  • Subacute: Lasting between 6 and 12 weeks.
  • Chronic: Persisting for more than 12 weeks.

3. Causes of Low Back Pain

• Mechanical Causes (97% of cases):
  • Lumbar spine strain or sprain.
  • Degeneration of discs or facets.
  • Disc herniation (herniation of the nucleus pulposus).
  • Spinal stenosis.
  • Spondylolysis.
  • Compression fractures.
  • Sacroiliitis and scoliosis.

4. Associated Symptoms

• Leg pain, often referred to as sciatica or lumbar radiculopathy.
• Referred lower back pain, originating from non-spinal sources such as abdominal pathologies.

5. Systemic Causes

• Inflammatory spondyloarthropathy (e.g., ankylosing spondylitis).
• Infections (e.g., dyskitis, osteomyelitis).
• Malignancy (e.g., lung, breast, prostate, thyroid cancers).

6. Red Flags

• Saddle anesthesia.
• Neurological deficits.
• Systemic features (weight loss, fever, night sweats).
• History of malignancy, trauma, or osteoporosis.

7. Diagnosis

• Clinical history and physical examination, including provocative tests.
• Laboratory tests (e.g., full blood count, CRP, ESR) for non-mechanical causes.
• Imaging (X-ray, MRI, CT scan) for patients with red flag symptoms or persistent pain after conservative management.

8. Treatment

Acute and Subacute LBP:

• Patient reassurance and encouragement of normal activity.
• Heat therapy.
• Medications (NSAIDs, paracetamol, opioids if necessary).
• Physical therapy, massage, acupuncture, spinal manipulation.

Chronic LBP:

• Emphasis on exercise and physiotherapy.
• Pharmacotherapy (NSAIDs, muscle relaxants).
• Interventional procedures (radiofrequency neurotomy, injection therapy).
• Surgery (for refractory cases).

Low back pain is a multifaceted condition with diverse etiologies and management approaches. A comprehensive understanding of its causes and appropriate diagnostic and therapeutic strategies is essential for optimizing patient outcomes and quality of life.

Additional Information For more in-depth knowledge on specific aspects of low back pain, including management algorithms, ongoing research, and patient education resources, consult reputable medical literature and healthcare professionals specializing in musculoskeletal disorders.