Causes of Lower Back Pain
- Bulging Or herniated (slipped disc)
- Sciatica - Herniated disc pressing over the nerve going to your leg causing sharp shooting pain the back & leg.
- Arthritis - It can lead to narrowing of the space around the spinal cord called spinal canal stenosis. This can cause back & leg pain.
- Structural irregularity - Your spine may have abnormal curvature either side to side or excessive curve in front/ back.
- Osteoporosis can cause vertebra fracture & can cause back pain. common in old age.
- Rare causes include Cancer, infection, cauda equina syndrome.
Contact your physician immediately when you have constant unrelieved pain, pain going in legs specially below knee, causing weakness & numbness, or loss of bowel / bladder control, follows fall or trauma, associated with abdominal pain or fever or associated with unexpected weight loss.
Lower Back Pain Symptoms - What are they?
Features, signs and symptoms in a patient with lower back pain which indicate serious spinal pathology,
Features
- Previous history malignancy (however long ago)
- Age 16< or >50 with NEW onset pain
- Weight loss (unexplained)
- Previous longstanding steroid use
- Recent serious illness\
- Recent significant infection
Signs
- Saddle numbness (around anus and testicals)
- Reduced anal tone
- Hip or knee weakness
- Generalised neurological deficit
- Progressive spinal deformity
- Urinary retention
Symptoms
- Non-mechanical pain (worse at rest)
- Thoracic pain
- Fevers/ rigors
- General malaise
- Urinary retention
When to investigate RED FLAGS-
Very Urgent - when red flags present, and in patients with non-red flag sign situation common investigations done are -
- Complete Blood Count,
- Erythrocyte sedimentation rate (ESR),
- C-reactive protein (CRP),
- Serum Calcium (Ca2+), Vit D levels
- Blood urea nitrogen
- serum Creatinine
- Prothrombine time / Partial Prothrombin Time, International normalised ratio (PT/PTT/INR)
- Plain xray particularly osteoporosis / infection
- MRI
- PET Scan
- CT scan
Special Investigations in pain clinics -
Diagnostic Injections in spine can be done to establish the cause of your pain. Few tests done are -
- Selective root or transforaminal Epidural steroid injections,
- facet joint or its nerve block, if positive then treated by radiofrequency ablation (RFA),
- Provocative discography, and if its positive than treated with Percutaneous Disc FX Discectomy, Dekompressor / ozone discectomy, Percutaneous endoscopic transforaminal discectomy.
Pain physicians at PCI are pioneer and leaders in these advanced minimally invasive techniques with more than 15000 procedures already being performed in last 19 years.
These procedures can cure patients and proven to be successful in avoiding surgery in almost 95% cases.
Surgery for spine pain is the last resort therapy and can be avoided in majority of patients with interventional pain procedures.
Surgery is only indicated when there are RED FLAG signs.
