Low Back Pain

We use our back for everything, so the chances of experiencing pain in our lower back at some point should be expected. Actually, four out of five people will definitely experience low back pain! Low back pain can make it feel impossible to do everyday activities, so don’t suffer with the pain. Instead, place your care in the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas who can get you out of pain as quickly and comfortably as possible. 

What is Low Back Pain? 

While you might not know exactly what caused your low back pain, you’ll certainly recognize the pain as soon as it begins. If you’ve ever picked up something too heavy, twisted too far, slipped and fell, or reached for something in an awkward manner, you could have damaged and irritated the muscles, tendons and ligaments in the back, causing pain. 

Pain can range from a widespread dull ache to a localized stabbing or shooting sensation, or even a tingling or burning sensation. The pain may be mild, but could also be severe enough that makes it unable to move, sleep or sit. Depending on the cause of the back pain, you might also feel pain and/or weakness in the legs, hip, or even feet, and experience sensitivity to pressure or touch.  

Overall, pain can be attributed to an injury or trauma, conditions or diseases, and can last for days or weeks (acute), or several weeks to months (chronic). While most low back pain can be remedied with rest, pain relievers and possibly physical therapy, there are instances where medical attention might be required, especially if the pain is chronic and dramatically interrupts a person’s lifestyle and quality of life. 

Additional symptoms of low back pain include: 

• Muscle spasms: after a strain in the back area, muscles in the lower back can spasm and contract uncontrollably, making it difficult and incredibly painful for a person to stand, walk or sit. 

• Posture issues: many people with back pain adjust their posture to combat the feeling of pain, which can make it difficult to stand up straight. Many people end up leaning or hunching over, or walking or standing crooked, which displaces the proper alignment of the spine and can possibly cause more pain in the long run. 

• Stiffness: low back pain can not only decrease a patient’s standard range of motion, but can also make it difficult to stand from sitting, or to get up from a reclined position. 

Patients can expect to have low back pain sensations fluctuate over time and during different activities. Some patients report that their pain is worse when they first wake up in the morning, while others report that it is worse when doing an activity. As to be expected, patients can experience an increase of low back pain if they lift, bend and twist. Some patients even report a stronger feeling of pain during changes in the environment. 

What Causes Low Back Pain?

There are several reasons why injury, medical conditions or certain diseases within the body can lead to low back pain. The structures of the lower back that could be responsible for a person experiencing back pain include: 

• Vertebrae: the spine is made up of 33 individual vertebrae that connect with the other bones in the spine, creating both a stable and flexible support for the spinal column. If any vertebrae are damaged or fractured, this could lead to pain.  

• Facet joints: these joints are the connection between the bones of the spine where nerve roots pass through, and also allow the spine to bend and twist. 

• Discs between the vertebrae: intervertebral discs act as cushions to minimize any impact the spinal column receives. Because they are always under wear and tear, they tend to break down over time (degenerative disc disease), which can also lead to greater chances of them bulging or slipping out of place (bulging disc disease). 

• Vertebral ligaments: ligaments attach to each vertebrae and help to provide mobility and strength to the spine, and have a tendency to become strained with heavy lifting, causing irritation to the nerves in the spinal column

• Muscles of the lower back: similar to ligaments, the muscles in the low back can be strained with use, leading to nerve irritation. Injuries to the myofascial system (muscle and connective tissue) and ligaments in the lower back account for the majority of low back pain patients experience. 

• Spinal cord: any damage to the nerves, tendons, ligaments, vertebrae in the spinal cord can lead to feelings of pain throughout the body, including the head, neck, arms, low back, legs and feet. 

• Peripheral nerves: most often, peripheral nerves (including the sciatic nerve) become damaged or dysfunctional after experiencing an injury, which causes hypersensitivity to pain.

•  Low back pain can be categorized as referred, acute or chronic. Referred pain means that the source of pain originates in the organs near the lower back, including the kidney, pancreas, spleen and liver, but is felt in the lower back itself. When these organs experience infection, inflammation, obstruction, enlargement, changes in blood supply, or cancer, pain will be experienced. Rest and relaxation will not help to resolve this source of pain, and seeing a medical professional is needed to help determine the proper diagnosis and the best course of treatment. 

Acute pain is most often attributed to a specific traumatic event, such as car accident, slip and fall, strenuous exercise, or more. Acute injuries can also be caused by a chronic problem, for instance, a patient is living with osteoporosis or spinal stenosis but the condition causes vertebral fractures and ruptured discs. 

Chronic back pain is pain that a person has experienced for three months or longer. Most often, the symptoms begin gradually but worsen over time. There are numerous reasons why a person could experience chronic back pain, and medical intervention is needed to determine the cause of pain and the best treatment option to help alleviate or mitigate the pain. 

The following conditions are the main reasons why back pain could occur in the aforementioned areas in and around the lower back:

• Strains and sprains: the most common cause of low back pain, there are no shortage of ways a person can injure their back, including lifting a heavy object, lifting a heavy object incorrectly, coughing, twisting, bending, etc. 

• Vertebral fractures: the bones in the spine can break, usually due to trauma but also by medical conditions

• Disc issues: whether it be degenerative disc disease, disc protrusion or extrusion, herniated disc or more, when discs become bulged, herniated or flatted because of use/age, this offers less protection and support for the spine

• Structural problems: spinal stenosis (narrowing of the spine), scoliosis (curving of the spine) cause nerve root irritation and compression, all of which lead to pain

• Arthritis: osteoarthritis is the most common type of arthritis to affect the low back, causing pain. Ankylosing spondylitis also causes stiffness and inflammation in the spine, which leads to pain. 

• Disease: tumors, kidney stones, infections and some types of cancers can also put pressure on the spine and also create referred pain. 

• Spondylolisthesis: this occurs when one vertebrae slips out of place and slides off another

• Spinal infections: some cases of low back pain can be attributed to diseases that infected the spine because bacteria is directly related to pain and inflammation

• Human conditions: lifestyle habits like poor posture, dietary choices, exercise habits and more can all lead to low back damage and low back pain. Additionally, psychological and emotional factors can not only make back problems worse, there is evidence of “stress-related” back pain

Due to the complex nature of the spine and the low back, there are several locations where damage and medical conditions can develop in the bony structures, intervertebral discs and spinal ligaments and muscles. This is what makes it so important to seek help from a pain management specialist who is expertly trained in how to best diagnose and treat low back pain. 

How is Low Back Pain Diagnosed and Treated?

The best way to diagnose the cause of low back pain is to seek help from a trained medical professional who is well versed in the complexities of low back pain causes, symptoms and treatments. The California Pain Consultants team is dedicated to helping their family of patients get out of pain as quickly and comfortably as possible, and will perform not only a comprehensive exam, but will also study the patient’s medical and family history, take X-rays, CT scans, MRIs, and possibly bone scans in an effort to diagnose and recommend treatment. Treatment recommendations ultimately depend on the cause and location, as well as the severity and duration, of pain. 

While most people think that rest is the best way to treat low back pain, it’s only the start. While this is a great option for slight strains and acute pain situations, serious and chronic back pain requires the care of a professional. The best case scenario is to treat low back pain with physical therapy, rest, alternative therapy and medication first, then minimally-invasive options second, with surgery as the final and last step. Below are some of the treatment options that best help to remedy low back pain: 

• Lifestyle changes: focusing on nutrition, including a healthy diet of anti-inflammatory foods and losing weight if need be, and exercise can help to strengthen the back muscles as well as reduce added stress the body and spine are enduring on a daily basis. Back braces are also a great option for helping to provide extra support if you’re healing from an acute injury. 

• Medications: nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription drugs have proven to provide pain relief, as well as reduce spasms and relax muscles

• Alternative therapy: chiropractic care, acupuncture and massages have all proven to provide pain relief, open up blocked channels in the spine allows nerve to behave properly, as well as help the body to release endorphins and decrease stress

• Epidural steroid injections: a minimally-invasive option that involves an injection of a local anesthetic and steroid medication with the goal to provide immediate pain relief and reduce inflammation so that the targeted nerves can heal

• Trigger point injections: an injection directed into the trigger point that may be irritating spinal ligaments and muscles, with a goal to reduce pain and inflammation

• Medial branch blocks (MBB): an injection used for arthritis-related neck and back pain that target whichever facet joints of the spine are causing pain and temporarily block the pain signal carried from the facet joints of the spine to the brain

• TENS units (Transcutaneous Electrical Nerve Stimulation): a device that delivers neurostimulation via patches placed on the skin, wherein the stimulation affects the nerves in the area under the patch, providing pain relief

• Spinal cord stimulation (SCS): an implanted device in the epidural space confuses the pain processing centers in the brain by replacing the feeling of pain with a slight tingling feeling that the patient controls

• Peripheral nerve stimulation: tiny electrodes are placed close the affected nerves that are believed to be the source of pain, releasing a low electrical current that blocks pain signals

• Botox injections: this toxin provides low back pain relief by blocking overactive nerve impulses and stopping the release of neurotransmitters that are involved in pain sensation

• Vertebroplasty: this minimally-invasive technique involves injecting medical-grade acrylic cement into the site of the fractured vertebrae, which eliminates compression caused by the fracture, and reduces pain 

• Peripheral nerve blocks and ablation: nerve blocks work by blocking the feeling of pain from being received by the brain. If a peripheral nerve block works, albating (heating) the affected nerves is generally the next best option in providing long-term pain relief. 

• Back surgery: generally the last possible option for pain management specialists, back surgery is recommended with conservation and alternative methods have failed to provide relief at all, or the amount and duration of relief that the patient was hoping for. Surgical procedures can include laminectomy, spinal fusion, and spinal instrumentation, all of which have significant risks of complications. 

If you are experiencing back pain and feel that you might need professional attention, please reach out to the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, Chula Vista areas to schedule an appointment. We are here to help decrease your pain and increase your quality of life, and look forward to the opportunity to serve you.