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36 WWW.UNWLA.ORG “НАШЕ ЖИТТЯ”, ЛЮТИЙ 2018 OH MY ACHING BACK by Ihor Magun, M.D., FACP Lower back pain is ubiquitous, and because it is so common, i t is a costly issue , both from the stan d - point of lost time and productivity and as a burden on the health care system in general . An estimated eighty percent of the population will experience at least one episode of lower back pain that will be evaluated by a physician . I n many cases, the prob- lem will recur. In fact, f or individuals younger than 45, lower back pain ranks as the leading cause of disability. All of this may sound disheartening, but in most cases, lower back pain is not chronic. So what exactly is lower back pain? A clear definition is tricky because the condition is truly a conundrum. It can include one or more of the fol- lowing symptoms : pain, stiffness, numbness or spasm. It can happen suddenly or as a gradual, in- termittent progress ion. It can also be localized or may ra diate to other parts of the body. In the med- ical profession, lower back pain is charac terized only as a symptom , but one that harbors numerous possible causes. The major complicating factor can be explained by basic back anatomy. The back is complex ; it i s composed of bones, disks, nerves, muscles, ligaments, tendons, blood vessels, joints and the spinal cord. It is because of these multiple parts and components that diagnosis is challeng- ing . The d ifficulty of proving an anatomic correla- tion with symptoms makes diagnosis frustrating. Most cases of lower back pain are so non - specific that no identifiable cause can be unequivocally given. So w here do we start? The best place to begin is with time classification. Lower back pain is usually characterized by a time frame . It can be acute — lasting less than six weeks ; subacute — last- ing six to twelve weeks ; or chronic — lasting longer than twelve weeks. • Acute lower back pain is the most common back pain . It is mainly caused by unusual exertion or un- customary activity. Most symptoms occur at the time of injury , but back pain may present itself hours or even a n entire day after an activity that causes it . • Chronic back pain can arise from a range of rea- sons that slowly, but progressively br ing on symp- toms. It can be caused by poor posture, slouching, bulging disks, spondylitis ( inflam mation of the spinal joints), spinal stenosis and even fibromyal- gia. The list of additional potential causes is long and beyond the scope of this article. • Subacute back pain fa lls into a category that is purely a time - frame issue (i.e., just the time asso- ciated with the pain). Once the time classification is established, t he first step in diagnosis is obtaining a good his- tory. Did the pain arise suddenly after a specific ac- tivi ty or was it slow and progressively more symp- tomatic? O ne important note on the issue of back pain is to watch for “red flags” — signals that prompt medical attention is required. These sig- nals can include loss of bladder or bowel con trol, neurological symp toms of numbness anywhere in the groin area, unexplained weight loss , or any pre- vious history of a cancer because cancer of the prostate, breast, colon , lung and other areas of the body can spread to the spine . Imaging (x - rays) ha s no role in diagnosis because of the poor association between symptoms and anatomical findings. Only certain “red flag” cases warrant radiological confir- mation. The risk factors for developing back pain are multidimensional and include both medical and ps ychological health, socioeconomic status, and work related issues. Moreover, p erception of pain is quite complex and frequently reflects indi- vidual patients’ belief system s . This can play a ma- jor role in the duration of pain as well as in the pro- gression o f disability. Manag ing back pain requires patient co op- eration. It includes staying active and judiciously using appropriate medications. Obviously, these recommendations are solely based on conditions that are not “red flag” related issues and apply only once m edical conditions that warrant targeted treatments have been eliminated . The recommen- dations range from specific exercise routines, like yoga, to biofeedback and localized pain manage- ment interventions. A final caveat is that w e should all do our b est to prevent back issues. I’m sure your mother told you to s tand up straight and avoid slouching. She was right. But you should also mak e sure your mattress is not too soft, make certain the height of your chair and computer keyboard is optimal , and take care to lift heavy objects only when you bend your knees and not by bending over . One final piece of advice is to engage routinely in some form of exercise. This will not only contribute to good back health but will a lso improve your overall health.
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