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Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move.
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Low back pain is one of the most common reasons people see a doctor or miss days at work. Even school-age children can have back pain. Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain.
There are two types of back pain. Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases, a few months are required for the symptoms to disappear. Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases, pain continues despite medical and surgical treatment.
CAUSES OF LOW BACK PAIN
Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of congenital mechanical causes of low back pain include skeletal irregularities and spina bifida. Skeletal irregularities include scoliosis, lordosis, kyphosis, and other congenital anomalies of the spine. Spina bifida involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis. Another common cause of low back pain is injuries. Sprains, strains, and spasms are common injuries. Low back pain can also result from a traumatic injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate. Degenerative problems also cause low back pain. Examples include intervertebral disc degeneration and spondylosis. Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability. Spondylosis is the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
TREATMENT FOR LOW BACK PAIN
Acute back pain usually gets better on its own. Acute back pain is usually treated with medications designed to relieve pain and/or inflammation, such as analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, and topical pain relief. Heat and/or ice may help ease pain, reduce inflammation, and improve mobility for some people. Gentle stretching upon advice by your healthcare professional. Exercising, bed rest, and surgery are typically not recommended for acute back pain.
Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain. Medications may include analgesics and NSAID, opioid drugs, anticonvulsants, and antidepressants such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain. Forms of self-management include hot or ice packs and exercise. Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them, which may cause the body to release naturally occurring painkilling chemicals. Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions. When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include vertebroplasty and kyphoplasty, spinal laminectomy, discectomy and microdiscectomy, foraminotomy, nucleoplasty, radiofrequency denervation, spinal fusion, artificial disc replacement, and interspinous spacers.
The table below includes the most commonly used ICD-10 codes for low back pain:
| ICD-10 Chapter | Codes | Code Description |
|---|---|---|
| 13 | M54.30 | Sciatica, unspecified side |
| 13 | M54.31 | Sciatica, right side |
| 13 | M54.32 | Sciatica, left side |
| 13 | M54.40 | Lumbago with sciatica, unspecified side |
| 13 | M54.41 | Lumbago with sciatica, right side |
| 13 | M54.42 | Lumbago with sciatica, left side |
| 13 | M54.5 | Low back pain |
Author: Tonoya Ahmed
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