Lower Back Pain Left Side – Causes, Symptoms, Treatment

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Lower Back Pain Left Side/Low back pain is a kind of pain, muscle tension, muscle spasm, or stiffness localized in right and left the inferior gluteal folds, with or without leg pain radiating pain (sciatica), It may be chronic when it persists for 12 weeks or more and acute that stay some and gradually decrease after rest. The specific or nonspecific low back pain is a pain attributed to a recognizable pathology (such as infection, tumor, osteoporosis, rheumatoid arthritis, fracture, or inflammation). For people solely with sciatica, it may be lumbosacral radicular syndrome and pain due to herniated discs, or both, are also may be included. People in this review have chronic low back pain (>12 weeks’ duration).

Types of Low Back Pain

Low back pain can be broadly classified into four main categories

In addition, symptoms of lower back pain are usually described by the type of onset and duration

  • Acute low pain  This type of pain typically comes on suddenly and lasts for a few days or weeks. It is considered a normal response of the body from where the pain arises and gradually decreases after rest or to injury that may be tissue damage. The pain gradually subsides as the body heals.
  • Subacute low back pain This types of pain lasting between 6 weeks and 3 months, this type of pain is usually mechanical (not inflammatory) in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered and it may be advised to take treatment if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working. You can take treatment from your doctor and Physiotherapist.
  • Chronic low back pain Usually defined as lower back pain that lasts over 3 months to sex month, this type of pain is usually severe, and may hamper your day to days activities does not respond to initial treatments, and requires a thorough medical workup to determine the exact source of the pain.

Causes of Lower Back Pain Left Side

The causes of lower back pain in the left side

Cauda equina syndrome – It is a medical condition that is caused by displacement infection inflammation in the lumber 4 vertebrae and sacrum. It may cause the problem are

  • Progressive motor/sensory loss, new urinary retention or incontinence, new fecal incontinence
  • Saddle anesthesia, anal sphincter atony, significant motor deficits of multiple myotomes

Fracture – Fracture in any vertebrae and pelvic region due to trauma, infection, displacement of vertebrae

  •  Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years
  • Contusions, abrasions, tenderness to palpation over spinous processes

Infection – It is another cause of lower back pain. It is caused by postoperative spine or failure back syndromes, direct injection push to the spine, foreign body, etc.

  • The spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery
  • Fever wound in the spinal region, localized pain, and tenderness

Malignancy – It is one kind of tumors and abnormal bone growth

  • History of metastatic cancer, unexplained weight loss
  • Focal tenderness to palpation in the setting of risk factors

Pediatric red flags are the same as adults with a few notable differences:

Malignancy

  • age less than 4 years, nighttime pain

Infectious

  •  age less than 4 years, nighttime pain, history of tuberculosis exposure

Inflammatory

  • age less than 4 years, morning stiffness for greater than 30min, improving with activity or hot showers

Fracture

  • activities with repetitive lumber hyperextension (sports such as cheerleading, gymnastics, wrestling, or football linemen)
  • Tenderness to palpation over spinous process, positive Stork test

Lumbosacral muscle strains/sprains

  •  follows traumatic incident or repetitive overuse, pain worse with movement, better with rest, restricted range of motion, tenderness to palpation of muscles

Lumbar spondylosis

  • The patient typically is greater than 40years old, pain may be present or radiate from hips, pain with extension or rotation, the neurologic exam is usually normal.

Disk herniation

  • usually involves the L4 to S1 segments, may include paresthesia, sensory change, loss of strength or reflexes depending on severity and nerve root involved.

Spondylolysis, Spondylolisthesis

  • similar to pediatrics, spondylolisthesis may present back pain with radiation to buttock and posterior thighs, neuro deficits are usually in the L5 distribution.

Vertebral compression fracture

  • localized back pain worse with flexion, point tenderness on palpation, may be acute or occur insidiously over time, age, chronic steroid use, and osteoporosis are risk factors.

Spinal stenosis

  • back pain which can be accompanied with sensory loss or weakness in legs relieved with rest (neurologic claudication), neuro exam normal.

Tumor

  • history of metastatic cancer, unexplained weight loss, focal tenderness to palpation in the setting of risk factors
  • 97% of spinal tumors are metastatic disease; however, the provider should keep multiple myeloma in the differential
  • vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess
    • The spinal procedure within the last 12 months, Intravenous drug use, Immunosuppression, prior lumbar spine surgery, fever, wound in the spinal region, localized pain, and tenderness
    • The granulomatous disease may represent as high as one-third of cases in developing countries.
  • Fracture

    • Significant trauma (relative to age), Prolonged corticosteroid use, osteoporosis, and age greater than 70 years, Contusions, abrasions, tenderness to palpation over spinous processes

Pediatrics

Tumor

  • fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • Osteoid osteoma is the most common tumor that presents with back pain – classically, the pain is promptly relieved with anti-inflammatory drugs such as NSAIDs.

Infection – vertebral osteomyelitis, discitis, septic sacroiliitis, epidural abscess, paraspinal muscle abscess

  • fever, malaise, weight loss, nighttime pain, recent onset scoliosis
  • The epidural abscess should be a consideration with the presence of fever, spinal pain, and neurologic deficits or radicular pain; discitis may present with a patient refusing to walk or crawl.

A herniated disk, slipped apophysis

  • Acute pain, radicular pain, positive straight leg raise test, pain with spinal forward flexion, recent onset scoliosis

Spondylolysis, spondylolisthesis, lesion or injury to the posterior arch

  •  Acute pain, radicular pain, positive straight leg raise test, pain with spinal extension, tight hamstrings

Vertebral fracture

  • acute pain, other injuries, traumatic mechanism of injury, neurologic loss

Muscle strain

  • acute pain, muscle tenderness without radiation

Scheuermann’s kyphosis

  • chronic pain, rigid kyphosis

Inflammatory spondyloarthropathies

  •  chronic pain, morning stiffness lasting greater than 30min, sacroiliac joint tenderness

Psychological Disorder (conversion, somatization disorder)

  •  normal evaluation but persistent subjective pain

Idiopathic Scoliosis

  •  positive Adam’s test (for larger angle curvature), most commonly asymptomatic
  • Of note, no definitive evidence that scoliosis causes pain, but patients with scoliosis have more frequently reported pain; therefore the provider should rule out other causes before attributing pain to scoliosis:


The Symptom of Lower Back Pain Left Side

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on

  • Pain in the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected and pain radiation.
  • In general symptoms of pain are clear up on their own within a short period.
  • Pain. It may be continuous, sudden, thunder pain, or only occur when you are in a certain position. The pain may be aggravated by coughing or sneezing, bending, or twisting.
  • Patients who have been taking steroids for a few months may increase the risk of pain
  • Drug abusers or the patient who taking drugs
  • Patients with cancer with previous cancer disease may cause pain.
  • Pain may be radiating to the whole back region
  • Patients with depressed immune systems and weak immune response.
  • Stiffness and increase pain in the morning
  • Pain may be decreased by elevating the leg in bed and sleeping

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

  • Weight loss and muscle spasm in the back rejion
  • Elevated body temperature (fever)
  • Inflammation (swelling) on the back
  • Persistent back pain – lying down or resting does not help
  • Pain down the legs
  • Pain reaches below the knees
  • A recent injury, blow, or trauma to your back
  • Urinary incontinence in some patients you pee unintentionally (even small amounts)
  • Difficulty in urinating passing urine is hard
  • Fecal incontinence you lose your bowel control (you poo unintentionally)
  • Numbness tingling sensation around the genitals
  • Numbness paresthesia around the anus
  • Pain and numbness around the buttocks
  • Dull ache,
  • Numbness,
  • Tingling,
  • Sharp pain,
  • Pulsating pain,
  • Pain with movement of the spine,
  • Pins and needles sensation,
  • Muscle spasm,
  • Tenderness,
  • Sciatica with shooting pain down one or both lower extremities
  • Additionally, people who experience severe pain symptoms after a major trauma (such as a car accident) are advised to see a doctor immediately. If low back pain interferes with daily activities, mobility, sleep, or if there are other troubling symptoms, medical attention should be sought as early as possible.

Pain may increase with

  • Biomechanical risk factors.
  • Sedentary occupations.
  • Gardening and other yard work.
  • Sports and exercise participation, especially if infrequent.
  • Obesity.
  • Exercises to strengthen lower back muscles.
  • Learn how to lift heavy objects.
  • Sit properly.
  • Back support in bed.
  • Lose weight, if obese.
  • Choose proper footwear.
  • Wear special back support devices.

Red flag conditions indicating possible underlying spinal pathology or nerve root problems

  • Non-mechanical pain (unrelated to time or activity)
  • Thoracic pain
  • Previous history of carcinoma, steroids, HIV
  • Feeling unwell
  • Weight loss
  • Widespread neurological symptoms
  • Structural spinal deformity

Indicators for nerve root problems

  • Unilateral leg pain > low back pain
  • Radiates to foot or toes
  • Numbness and paraesthesia in the same distribution
  • Straight leg raising test induces more leg pain you can observe
  • Localized neurology (limited to one nerve root) dee to nerve compression.

Diagnosis of Lower Back Pain Left Side

  • Straight leg raise (SLR) – It is a manual test performed by raising the patient’s leg to 30 to 70 degrees. Ipsilateral leg pain and one side leg pain in the right or left leg pain at less than 60 degrees is a positive test for lumbar disk herniation. It may be the likelihood ratio (LR) of 2, negative likelihood ratio (NLR) of 0.5. If the pain reproduction occurs contralaterally, it is a positive test for a lumbar disk herniation with LR of 3.5 and NLR of 0.72.
  • One leg hyperextension test/stork test – It a simple and manual or home test the patient can do it own have the patient stand on one leg and (while being supported by the provider) have them hyper-extend their back. Repeat this maneuver on both sides. If pain with hyperextension is the resulting increase positive for a pars interarticularis defect or associate abnormalities.
  • Adam test – Patient has to bend over with feet together and arms extended with palms together. The practitioner should observe from the front side of you. If a thoracic lump is present on one left side or the other right side lower back pain, it is an indication of scoliosis.There are numerous other examination techniques; however, they have mixed and anonymous evidence for inter-practitioner reliability and poor sensitivities or specificities lower back pain.
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Lab Test

  • Blood tests – CBC ,ESR,Hb, RBS,CRP, Serum Creatinine, Serum Electrolyte,
  • Bone scan – It is a bone scan that may be used for detecting bone tumors or compression of nerve root fractures caused by brittle bones and osteoporosis. The patient may receive an injection of a tracer (a radioactive substance) into a vein at the same time. The tracer collects or examiner in the bones and helps the doctor detect bone problems with the aid of a special camera.
  • Electromyography (EMG) – It one kind of test that helps assess the electrical activity in a muscle and nerve impulse velocity or nerve root compression and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body that are causing pain.
  • Evoked potential studies – It may involve two sets of electrodes are placed one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal that is transmitted to the brain.
  • Nerve conduction studies (NCS) – It also uses two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage for lower right and left side back pain.

Imaging

  • X-rays – These are very accessible at most clinics and outpatient offices. This imaging technique can be used to assess for any structural instability. If x-rays show an acute fracture, it needs to be further investigated using a computed tomogram (CT) scan or magnetic resonance imaging (MRI).
  • CT Scan – It is the preferred study to visualize bony structures in the spine. It can also show calcified herniated discs. It is a less accessible inpatient in office settings compared to x-rays. But it is more convenient and reliable than MRI. In the patients with lower right and left-back pain, that have non-MRI comparable implanted devices, CT myelography can be performed to visualize herniated disc.
  • CT myelography -It is a special kind when the patient has either a contraindication to having an MRI such as heart problem, open-heart surgery, or having a pacemaker device or defibrillator or be used when a standard CT or MRI is negative or equivocal. Myelography is a CT scan or an MRI with intrathecal administration of contrast for lower back pain. CT myelography visualizes a patient’s spinal nerve roots in their passage through the neuroforamina area. CT myelography can be used to assess the underlying root sleeve and nerve root compression. A CT is a poor test for the visualization of nerve roots, making it challenging to diagnose radicular disease.
  • Electromyography (EMG) – It is complete after three weeks of symptoms, not before the lower right and left back pain. Diagnostic tests such as EMG or nerve conduction studies are accurate only after three weeks of persistent symptoms of right or left lower back pain. The primary reason or why using an EMG or nerve conduction study is to identify the delayed three weeks or more time following the development of pain is because of fibrillation potentials after an acute injury in the brain and spinal cord lead to an axonal motor loss. These do not develop until two to three weeks following injury for the lower right and left back pain.
  • Cerebrospinal fluid analysis – It is a useful test for investigating the right and left lower back pain if there is an involvement of neoplasm or infectious cause or radiculopathy symptoms and radiating pain syndrome. The recommendation for lower right and left back pain in lumbar puncture is in the case of a patient with negative or nondiagnostic neuroimaging, without knowing primary cancer and its related condition, who has progressive neurological symptoms and has failed back syndrome to improve it properly.
  • MRI – It is the preferred and most sensitive study to visualize herniated disc, bulging disc, or sequestered disc. MRI findings will help to find the soft tissues, ligament, tendon, cartilage even spinal cord clearly to surgeons and other providers plan procedural for lower right and left side back pain care if it is indicated.
  • Bone scintigraphy – It is a special type of test that is done when some or above mention test failed to identify the causes of right and left lower back pain with single-photon emission computed tomography (SPECT) is more sensitive in detecting facet joint lesions and bony lesion, none spurs and allows more accurate anatomical localization of lower back pain. A recent study suggested that SPECT could help to identify patients with lower back pain who would benefit from facet joint intraarticular injections []. Facet joint block (FJB)injection is an indispensable diagnostic instrument in order to identify painful or painless back pain from painless facet joints and to plan the intervention strategy.
  • Foraminal nerve root entrapment test – It is best visualized on T1-weighted MRI where are used to identify the high contrast fat tissue and the nerve root sheath that is of great help for lower and right or left ba. In here usually, a combination of hypertrophic degenerative facets with osteophytes spurs posteriorly, and vertebral osteophytes and/or disc herniation anteriorly diminishes the anteroposterior diameter of the foramen and it associate condition. Foraminal height is erased by degenerative disc disease and subsequent disc height loss or not. In this case, the normal rounded (oval) appearance of the nerve root sheath is lost in combination with loss of the surrounding fat tissue, nerve root compression should be considered to identifying the lower right and left side back pain.


Treatment of Lower Back Pain Left Side

Not all treatments work for all conditions or for all individuals with the same condition treatment, and many find that they need to try several treatment options to determine what works best for the patients. The present stage of the condition (acute or chronic) is also helping to find a determining factor in the choice of treatment. Only a minority of people with lower right and left back pain (most estimates are 1% – 10%) require surgery and the rest may not surgery.

Non-medical

Treatment for back pain generally depends on how long your pain lasts

Acute (short-term) back pain – usually gets better on its own. Exercises or surgery are usually not recommended for this type of pain. There are some things you may try while you wait for your pain to get better. Simple you can take the medication are following-

  • Acetaminophen, aspirin, or ibuprofen will help ease the pain.
  • Get up and move around to ease stiffness, relieve pain, and have you back doing your regular activities sooner.

Chronic (long-term) back pain – is typically treated with non-surgical options before surgery is recommended.

Nonsurgical Treatments

  • Traction – It involves using pulleys and weights to stretch the back, which may allow a bulging disk to slip back into the right place. Your pain may be relieved while in traction, even pain returns once you aren’t in traction.
  • Practice healthy habits – such as exercise, relaxation, regular sleep, proper diet, and quitting smoking, drinking plenty of water.
  • Manipulation – Professionals use their hands to adjust or massage the spine or nearby tissues that may be injured to help in healing
  • Acupuncture This Chinese practice uses thin needles to relieve pain and restore health. Acupuncture may be effective when used as a part of a comprehensive treatment plan for low back pain. But it has a side effects and controversy of pain management.
  • Acupressure A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for right and left back pain. Move your body properly while you do daily activities, especially those involving heavy lifting, pushing, or pulling. Back pain is generally treated with non-pharmacological therapy first, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended.
  • Heat therapy –  It is useful for back muscle spasms or weakness or other conditions. A review concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.
  • Regular activity and gentle stretching exercises – It is encouraged in uncomplicated lower back pain and is associated with better long-term treatment outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended that are work surprisingly.
  • Outdoor exercises  – It is associated with better patient satisfaction, although it has not been shown to provide functional improvement in satisfaction level. However, one scientific study found that exercise is effective for chronic back pain, but not for acute pain. If used, they should be performed under the supervision of a licensed health professional.
  • Massage therapy – may give short-term pain relief, but not a functional improvement for lower back, for those with acute lower back pain. It may also give short-term pain relief and functional improvement for those with long-term (chronic) and sub-acute lower pack pain, but this benefit does not appear to be an effective result after 6 months of treatment. There has not appeared to be any serious side effects associated with massage.
  • Spinal manipulation Spinal manipulation for lower back pain is a widely-used method of treating back pain, although there is no evidence of long-term benefits.
  • Back school – It is an intervention that consists of both education and physical exercises. A 2016 Cochrane scientific review found the evidence concerning back school to be very high-quality effectiveness and was not able to make generalizations as to whether back school is how much effective.
  • Heat Or Ice Therapy – Applying heat pads, ice packs, or using both alternatively sometimes can help to relieve stiffness, inflammation, and muscle spasms related to right and left side of lower back pain. Cold compresses can be used to reduce swelling in the back muscle.
  • Braces – For patients with chronic lower back pain or a deformity in the spine due to trauma, the doctor may recommend wearing a brace to provide support to the spine. Back braces can help to maintain the right proper posture, limit strenuous movement, or unusual movement and the spine to provide relief from lower back pain.
  • Physical Therapy – The physical therapist may apply heat, ice, electrical stimulation, and other mechanisms to release muscle weakness and stiffness from the back muscles. He may also help the patient learn posture correction techniques to prevent the pain from recurring lower back pain.
  • Exercise – Your doctor may advise you to perform light stretching exercises to increase the flexibility of the muscles in the back. He may also recommend certainly or exercises to strengthen the core and improve the overall well-being of the patient.
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Medication

If non-pharmacological measures are not effective, medications may be tried.

  • Analgesics – It is with or without paracetamol may improve pain and function compared with treatment for lower right and left back pain. It is taken by mouth or applied to the skin. Examples include acetaminophen and aspirin. Your doctor may suggest steroid or numbing shots lessen your pain reliever to erase the lower back pain. However, long-term use of NSAIDs or opioids may be associated with well-recognized adverse effects.
  • Non-steroidal anti-inflammatory drugs – (NSAIDs) may be more effective than placebo at improving pain intensity in lower back pain and people with chronic low back pain. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include mainly or first choice etodolac, then tramadol, aceclofenacetoricoxib, ibuprofen, and naproxen. Nonsteroidal anti-inflammatory drugs were again the first-line pharmacologic agents recommended followed by tramadol in first-line and duloxetine as the second-line treatments.
  • Antidepressants  – It is used to decrease chronic low back pain or improve function compared with placebo in people with or without depression. The antidepressants such as tricyclic antidepressants and SNRI’s, muscle relaxers, N-methyl-d-aspartate (NMDA) receptor antagonists, and alpha 2 adrenergic agonists are also the most effective pharmacological therapies for the treatment of lower back pain.
  • Muscle Relaxant – Benzodiazepines may improve pain, but studies of non-benzodiazepine muscle relaxants have given conflicting results. Muscle relaxants, such as baclofentolperisoneeperisone, methocarbamol, carisoprodol, and cyclobenzaprine, may be prescribed to control muscle spasms and their associate low back pain.
  • Gabapentin – The initial stage of treatment for lower back pain, neuropathic pain, and chronic back pain are often treated with gabapentin or pregabalin It is Considere’s most effective treatments are in general recommended in chronic low back pain. They have also indicated for postherpetic neuralgia, diabetic neuropathy, and mixed neuropathy.
  • Tricyclic antidepressant (TCA) – It is a type of drug that can be used to treat back pain this use is different from its mode of action in treating depression, which usually requires a much higher dose. Examples include amitriptyline and imipramine that are used to treat the right and left side lower back pain.
  • Epidural corticosteroid injections – It is a type of injection or local injections with corticosteroids and a local anesthetic that are pushed in the joint space to reduce the nerve entrapment related to lower back pain to improve chronic low back pain treatment in people without sciatica. Facet-joint corticosteroid injections may be more effective than placebo at reducing pain.
  • Epidural glucocorticoid injections – are beneficial for up to three months in duration in patients with acute lumbar radiculopathy and lower back pain. This injection benefit is modest yet clinically significant in the short-term. If a patient has not improved after six weeks of conservative management, they would be eligible for an epidural glucocorticoid injection to treat the right and left side lower back pain.
  • Oral steroids tablets – These a very simple and are often prescribed for acute low back pain, and chronic low back pain although there is limited evidence to support their use. It is basically used to remove nerve-related inflammation, edema, hematoma. There is evidence that a single dose of steroids, such as dexamethasone, may provide lower back pain relief.
  • The serotonin-norepinephrine reuptake inhibitor (SNRI) – duloxetine is useful in treating chronic pain, osteoarthritis, and the treatment of fibromyalgia and associate pain. Furthermore, the efficacy of duloxetine in the treatment of comorbid depression is comparable to other antidepressants. Venlafaxine is an effective treatment for neuropathic pain, as well as another neuropathic agent. A TCA can also be utilized, such as nortriptyline. TCA medications may require time six to eight weeks to achieve their desired effect.
  • Topical lidocaine and ointment – is a useful treatment for neuropathic pain and allodynia as in postherpetic neuralgia. Separately, topical capsaicin cream and ointment is an option for chronic neuropathic or musculoskeletal pain unresponsive to other treatments for conservative management failed.
  • Opioids – are considered a second-line option; however, they may be warranted for pain management for patients with severe persistent pain, chronic or neuropathic pain secondary to malignancy. Opioid therapy should only start with extreme caution for patients with chronic back pain and musculoskeletal pain. The drug has the major side effects of opioids are significant and frequent and may include opioid-induced hyperalgesia, constipation, dependence, and sedation or its associate problem.
  • Epidural corticosteroid injection – (ESI) is a procedure in which steroid medications are injected into the epidural space of the spinal cord. Steroid medications help to reduce inflammation and thus decrease pain and improve functional mobility. ESI has long been used to both diagnose and treat back pain, although recent studies have shown a lack of efficacy in treating lower back pain.
  • Carisoprodol – This muscle relaxant was investigated in two high-quality studies on acute low back pain. The first scientific study compared carisoprodol with diazepam [. Carisoprodol was superior in performance on all the outcome parameters that are measured. A comparison of carisoprodol with cyclobenzaprine‐hydrochloride in the second scientific study revealed no statistically significant differences between the two treatments [.
  • Chlorzoxazone – This is an old muscle relaxant that was compared with tizanidine in one high-quality scientific study in a very small sample of patients with degenerative lumbar disc disease and low right or left side back pain[.
  • Cyclobenzaprine‐hydrochloride – Cyclobenzaprine was compared with diazepam in a low-quality trial on chronic low back pain, but no significant differences between the treatments were identified in this scientific study [. There was also no range of difference between cyclobenzaprine and carisoprodol in one high-quality study on acute lower back pain [.
  • Diazepam In comparison with carisoprodol, diazepam was found to be inferior in performance on muscle spasm, global efficacy, and functional status in a high-quality trial on acute or chronic low back pain [. In a very small high-quality comparing diazepam with tizanidine, there were no differences in pain, functional status, and muscle spasm after seven days of the study [.
  • Tizanidine This muscle relaxant was compared with chlorzoxazone and diazepam in two very small high quality [. Both trials did not find any significant differences in pain, functional status, and muscle spasm after 7 days of end result.
  • Pridinol mesylate – One low-quality trial showed no differences between this muscle relaxant and thiocolchicoside on pain relief and global efficacy for low back pain management.

Recommendations for the oral drug treatment of nonspecific low back pain, with evidence-based doses
Drug recommendation Dosage Recommendation*2 Recommendation grade
Nonsteroidal anti-inflammatory drugs
Ibuprofen
Diclofenac
Naproxen
1.2 g/d, at most 2.4 g
100 mg/d, at most 150 mg
750 mg/d, at most 1.25 g
Positive (“should”)
(“should”)
(“should”)
B
B
B
COX-2 inhibitors
(off-label use for acute low back pain)
Celecoxib 200 mg/d
Etoricoxib 60–90 mg/d
Open (“can”)
Paracetamol (acetaminophen) 500–1000 mg/d, at most 3 g Open (“can”)
Low-potency opioids
Tramadol
Tilidin N
Depending on the preparation
50–100 mg
50–100 mg
Open (“can”)

modified from [

The recommendations and grades listed here (positive [“should”] and open [“can”]) are derived from the German National Disease Management Guideline for Low Back Pain [,which employs the evidence classification of the Centre for Evidence-Based Medicine (CEBM) at the University of Oxford.

 

Surgery of Low Back Pain

Surgery for back pain is typically used as a last resort when the serious neurological deficit is evident. A 2019 systematic review of back surgery studies found that, for certain diagnostic criteria, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term.

Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome and when the conservative management failed. The major causes of neurological deficits can include spinal disc herniation, spinal stenosis, degenerative disc disease, tumor, infection, and spinal hematomas, all of which can impinge on the nerve roots around the spinal cord and not cure. There are multiple surgical options are offered by the surgeon to treat right and left side lower back pain, and these options vary depending on the cause of the pain and your doctors may refer to a surgeon for following a surgical procedure.

NIH’s National Institute of Neurological Disorders and Stroke (NINDS) lists the following as some of the surgical options for low back pain. But NINDS also cautions that “there is little evidence to show which procedures work best for their particular indications.”

  • Vertebroplasty and kyphoplasty These procedures are used to repair compression fractures of the vertebrae caused by osteoporosis. Both procedures include the injection of glue-like bone cement that hardens and strengthens the bone.
  • Spinal laminectomy/spinal decompression – This is performed when spinal stenosis causes a narrowing of the spinal canal that results in pain, numbness, or weakness and paresthesia. The surgeon removes the bony walls of the vertebrae and any bone spurs that are pinched in nerve or muscle, aiming to open up the spinal column to remove the access pressure on the nerves.
  • Discectomy – This procedure is used to remove a disk when it has a herniated disc or nerve entrapment and presses on a nerve root or the spinal cord disorder. Laminectomy and discectomy are frequently performed for lower back pain or right side or left side back pain together.
  • ForaminotomyIn this procedure the surgeon specially enlarges the bony hole where a nerve root exits the spinal canal for trauma or blunt trauma to prevent bulging discs or joints thickened with age from pressing on the nerve root compression for right and left side lower back pain.
  • Nucleoplasty also called plasma disk decompressionThis laser surgery and more secure and comfortable surgery uses radiofrequency energy to treat people with low back pain associated with a mildly herniated, prolapse, sequestrated disk problem. The surgeon inserts a needle into the disk that is a monitor in the c-arm machine. A plasma laser device is then inserted into the needle and the tip is heated, creating a field that vaporizes the tissue in the disk space, reducing its size and relieving pressure on the nerves that are causing it pain.
  • Spinal fusion The surgeon removes the spinal disk between two or more vertebrae, then fuses the adjacent vertebrae using bone grafts or metal devices secured by screws. It is a more safe treatment but its major complication that infection, postural problems, further displacement problems.  Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.
  • Artificial disk replacement – This is considered an alternative to spinal fusion surgery for the treatment of people with severely damaged disk pain and complicated fracture. The procedure involves the removal of the disk and its replacement by a synthetic disk or artificial disk that helps restore height and movement between the vertebrae.
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Some surgical treatments are not recommended by NINDS, which cautions, for example, that intradiscal electrothermal therapy is “of questionable benefit.” NINDS notes that radiofrequency denervation provides only temporary pain relief and that “evidence supporting this technique is limited.”


Lower back pain exercises

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A series of exercise routines you can do to help reduce any lower back pain (occasionally referred to as low back pain), including tension, stiffness, and soreness. These exercises from physiotherapists and BackCare expert Nick Sinfield help to stretch, strengthen and mobilize the lower back. When starting out, go gently to get used to the movements and work out how far you can go into each position without feeling pain.

Aim to do this routine at least once a day if the pain allows. You can complement this routine with walking, cycling and water-based activities. You are advised to seek medical advice before starting these back pain exercises and to stop immediately if you feel any pain.

Bottom to heels stretch

Stretches and mobilizes the spine

exercise-low-back-pain

Start position: Kneel on all fours, with your knees under hips and hands under shoulders. Don’t over-arch your lower back. Keep your neck long, your shoulders back and don’t lock your elbows.

Action: Slowly take your bottom backward, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position.

Repeat 8 to 10 times.

Tips:

  • Avoid sitting back on your heels if you have a knee problem.
  • Ensure correct positioning with the help of a mirror.
  • Only stretch as far as feels comfortable.

Knee rolls

Stretches and mobilizes the spine

backpain-knee-roll

Start position: Lie on your back. Place a small flat cushion or book under your head. Keep your knees bent and together. Keep your upper body relaxed and your chin gently tucked in.

Action: Roll your knees to one side, followed by your pelvis, keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position.

Repeat 8 to 10 times, alternating sides.

Tips:

  • Only move as far as feels comfortable.
  • Place a pillow between your knees for comfort.

Back extensions

Stretches and mobilizes the spine backward

backpain-exercise/Back extensions

Start position: Lie on your stomach, and prop yourself on your elbows, lengthening your spine. Keep your shoulders back and neck long.

Action: Keeping your neck long, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles as you arch backward. Breathe and hold for 5 to 10 seconds. Return to the starting position.

Repeat 8 to 10 times.

Tips:

  • Don’t bend your neck backward.
  • Keep your hips grounded.

Deep abdominal strengthening

Strengthens the deep supporting muscles around the spine

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Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: As you breathe out, draw up the muscles of your pelvis and lower abdominals, as though you were doing up an imaginary zip along your stomach. Hold this gentle contraction while breathing from your abdomen for 5 to 10 breaths, and relax.

Repeat 5 times.

Tips:

  • This is a slow, gentle tightening of the lower abdominal region. Don’t pull these muscles in using more than 25% of your maximum strength.
  • Make sure you don’t tense up through the neck, shoulders or legs.

Pelvic tilts

Stretches and strengthens the lower back

Low back pain

Start position: Lie on your back. Place a small, flat cushion or book under your head. Bend your knees and keep your feet straight and hip-width apart. Keep your upper body relaxed and your chin gently tucked in.

Action: Gently flatten your low back into the floor and contract your stomach muscles. Now tilt your pelvis towards your heels until you feel a gentle arch in your lower back, feeling your back muscles contracting and return to the starting position.

Repeat 10 to 15 times, tilting your pelvis back and forth in a slow rocking motion.

Tips:

  • Keep your deep abdominals working throughout.
  • Don’t press down through the neck, shoulders or feet.

Modification

  • Place one hand on your stomach and the other under your lower back to feel the correct muscles working

What are the risk factors for developing low back pain?

Anyone can have back pain. Factors that can increase the risk for low back pain include:

  • Age – The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
  • Fitness level – Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.
  • Weight gain – Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.
  • Genetics – Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine), have a genetic component.
  • Job-related factors – Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Working at a desk all day can contribute to pain, especially from poor posture or sitting in a chair with not enough back support.
  • Mental health – Anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.
  • Smoking – It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.
  • Backpack overload in children – A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.
  • Psychological factors – Mood and depression, stress, and psychological well-being also can influence the likelihood of experiencing back pain.

Can low back pain be prevented?

Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture.
Recommendations for keeping one’s back healthy

  • Exercise regularly to keep muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
  • Maintain a healthy weight and eat a nutritious diet with a sufficient daily intake of calcium, phosphorus, and vitamin D to promote new bone growth.
  • Use ergonomically designed furniture and equipment at home and at work. Make sure work surfaces are at a comfortable height.
  • Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. Put your feet on a low stool or a stack of books when sitting for a long time.
  • Wear comfortable, low-heeled shoes.
  • Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.
  • Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.
  • Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

References

Low back pain

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