Скачать или смотреть Low Back Pain Explained: Causes, Treatment, and Patient Advice

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Instructions and education for patients with low back pain. About 85% of people will experience low back pain during their lifetime. It is very common, occurring equally in males and females. It affects all age groups but is most frequent between the ages of 35 and 50. It occurs across all ethnicities and socioeconomic classes. Acute low back pain is usually temporary and resolves within a few weeks. Most patients recover quickly without long-term loss of function. Patients should be educated about the natural history and favorable outcome of acute low back pain. They should also understand that by the age of 50, nearly 90% of people show degenerative changes in the lumbar discs.

It is important to distinguish between acute and chronic low back pain. Their natural history, treatment, and prognosis differ. Acute low back pain lasts up to 12 weeks, while chronic low back pain persists beyond 12 weeks and often recurs. Most patients with acute low back pain recover quickly without lasting deficits, and about 90% return to work within 12 weeks.

Acute pain is most often caused by muscle or ligament strain. In many cases, no specific cause is identified, and treatment focuses on reducing pain and improving function. When evaluating a patient with acute low back pain, always rule out red flags that may suggest serious underlying conditions: radiation of pain, systemic symptoms, trauma, neurological deficit, bladder or bowel dysfunction, infection, tumor, or abnormal reflexes suggesting spinal cord involvement.

Other possible causes of low back pain include discogenic pain, herniated discs, facet joint arthritis, spinal stenosis, and spondylolisthesis. Patients should also learn that MRI can sometimes be misleading—many people have positive MRI findings but no symptoms (false positives). In otherwise healthy patients with acute, non-traumatic low back pain, diagnostic imaging is not needed before treatment.

Risk factors for low back pain include heavy lifting, occupational vibration exposure, prolonged driving, smoking, depression and anxiety, sedentary lifestyle, job dissatisfaction, certain sports, and pregnancy. Patients should be advised to:

Stop smoking, as it impairs circulation and disc nutrition and may have toxic effects on discs.

Maintain ideal body weight to reduce spinal load. A dietary consult may help.

Stay physically fit with aerobic activities such as walking, cycling, or swimming, gradually increasing duration and frequency. Aerobic exercise improves disc nutrition and muscle strength.

Medications: Avoid narcotics because they are addictive and interfere with rehabilitation. There is strong evidence supporting aspirin, NSAIDs, and appropriate use of muscle relaxants.

Mobility and therapy: Patients should remain active, avoid prolonged bed rest, and minimize long sitting. Active physiotherapy has limited benefit for acute pain but strong benefit for chronic cases. Avoid exercises that worsen symptoms. Heat or hot showers may relieve spasm.

Epidural injections have weak evidence in acute low back pain, provide strong short-term relief in chronic pain, but limited long-term benefit. Facet injections, orthoses, traction, magnets, and dry needling lack strong evidence. There is moderate evidence supporting spinal manipulation, especially for acute pain.

Patients should be taught proper body mechanics for sitting, standing, lifting, and lying down. Disc pressure is lowest when lying supine and highest when sitting, leaning forward, and carrying weight. Always keep loads close to the body.

In general, if there are no red flags, conservative treatment with NSAIDs and physiotherapy is sufficient. Cognitive behavioral therapy combined with non-surgical management can improve function and reduce pain and disability.
QUIZZES
1) Disc pressure is lowest in which position?
A) Sitting
B) Standing
C) Supine
D) Forward bending
Answer: C) Supine
Explanation: Lying flat reduces intradiscal pressure, relieving mechanical stress.

2) Which factor increases spinal load the most?
A) Leaning back
B) Supine rest
C) Sitting forward with weight
D) Standing upright
Answer: C) Sitting forward with weight
3) Which medication should be avoided in back pain management?
A) NSAIDs
B) Aspirin
C) Muscle relaxants
D) Narcotics
Answer: D) Narcotics
Explanation: Narcotics are addictive and hinder rehabilitation, so they should be avoided.
4) Which lifestyle factor contributes to disc degeneration?
A) Swimming
B) Smoking
C) Stretching
D) Balanced diet
Answer: B) Smoking
Explanation: Smoking impairs circulation and has toxic effects on spinal discs.
5) Which symptom is a red flag in low back pain?
A) Local pain
B) Morning stiffness
C) Bladder dysfunction
D) Pain relieved by rest
Answer: C) Bladder dysfunction
Explanation: Bladder or bowel dysfunction may indicate cauda equina syndrome, a surgical emergency.