Back Pain

Back pain, particularly low back pain, remains a prevalent condition affecting a large proportion of Americans [1]. It often manifests as discomfort in the lower back, buttocks, hips, or legs. This pain can range from sharp and excruciating to dull and constant, possibly appearing intermittently or linked with certain activities [1].

The lumbar spine, composed of five vertebrae and cushioned discs acting as shock absorbers, is a common source of this discomfort. Typical causes of low back pain include sprains and strains, traumatic injury, herniated discs, and sciatica [1]. In some instances, however, the specific cause remains unidentified [3].

Diagnosis primarily relies on patient history, symptoms, physical examination, and certain diagnostic studies [1]. A comprehensive history should include age, symptoms, and how the pain impacts daily life, while physical examination assesses reflexes, sensation, muscle strength, pulses, and flexibility [3]. Laboratory tests and radiographs may be necessary when infection, malignancy, rheumatologic diseases, or neurologic disorders are suspected [3].

Treatment typically starts with conservative management, including physical therapy, adjuvant treatments like shockwave therapy, low level laser therapy (PBM), medication, and limited activity [1]. Acute low back pain may benefit from bed rest for two to three days, particularly in case  of acute radiculopathy [3]. However, half of patients experience recurring episodes within a year, and if conservative treatment fails to provide relief or neurologic symptoms worsen, surgical intervention might be necessary [1][2].

Patient education is vital in managing this condition. It is important for patients to understand that most cases improve with conservative management, but recurrences and functional limitations are common [3]. If symptoms persist or worsen, or if changes in bowel or bladder function occur, seek medical assistance promptly [1].

In summary, back pain is a multi-faceted condition requiring a comprehensive approach in diagnosis and treatment. While conservative treatments often suffice, more invasive treatments, such as surgery, may be considered in severe or unresponsive cases [1][2][3].