Back Pain and Sciatica
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Internet Sites
- Risk Factors
- Risk Reduction
- Treatment
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Back Pain and Sciatica
NIH - What Is Back Pain? “What Are the Causes of Back Pain? There are many causes of back pain. Mechanical problems with the back itself can cause pain. Examples are: • Disc breakdown • Spasms • Tense muscles • Ruptured discs Injuries from sprains, fractures, accidents, and falls can result in back pain. Back pain can also occur with some conditions and diseases, such as: • Scoliosis • Spondylolisthesis • Arthritis • Spinal stenosis • Pregnancy • Kidney stones • Infections • Endometriosis • Fibromyalgia Other possible causes of back pain are infections, tumors, or stress.”
NIH - Medical Encyclopedia Back pain - low "The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain: • Small fractures to the spine from osteoporosis • Muscle spasm (very tense muscles that remain contracted) • Ruptured or herniated disk • Degeneration of the disks • Poor alignment of the vertebrae • Spinal stenosis (narrowing of the spinal canal) • Strain or tears to the muscles or ligaments supporting the back • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens • Other medical conditions like fibromyalgia."
Highlighted Articles
Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial (BMJ 2008) “Conclusions Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year and these did not change during the second year.”
Evidence-informed management of chronic low back pain with watchful waiting (The Spine Journal 2008) "After the common cold and other upper respiratory issues, LBP is the most common reason why medical attention is sought in the United States. The lifetime prevalence of LBP is estimated at 60% to 80% in industrialized nations. However, the presence of LBP does not necessarily require medical attention. Most cases occur without an obvious or diagnosable cause, and are self-limiting. Absent certain red flags indicative of serious pathology, care for LBP should generally begin with the least invasive option, as there is no evidence that more invasive approaches are more effective for nonspecific LBP."
Treatment of acute sciatica. (Am Fam Physician. 2007) "Acute sciatica is lower back pain with radiculopathy below the knee and symptoms lasting up to six weeks. … caused by a variety of conditions: disk herniation, lumbar spinal stenosis, facet joint osteoarthritis or other arthropathies, spinal cord infection or tumor, or spondylolisthesis. … Clinical Commentary: An efficient clinical history and thorough physical examination of a patient with suspected sciatica is needed to rule out urgent conditions like cauda equina syndrome, infection, or cancer, and to determine the need for diagnostic tests. After the acute episode, emphasis is placed on activity, back exercises, behavioral techniques, ergonomics education, and close clinical monitoring. Educating patients on self-care and establishing reasonable expectations usually increase patient compliance with therapy and improve satisfaction."
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Notes
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Back Pain and Sciatica
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Drugs
Injection therapy for subacute and chronic low back pain: an updated Cochrane review. (Spine. 2009)
Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. (Pain Physician. 2009)
Exercise
Exercise More, Not Less, To Ease Aching Back, Study Suggests “A University of Alberta study of 240 men and women with chronic lower-back pain showed that those who exercised four days a week had a better quality of life, 28 per cent less pain and 36 per cent less disability, while those who hit the gym only two or three days a week did not show the same level of change. "While it could be assumed that someone with back pain should not be exercising frequently, our findings show that working with weights four days a week provides the greatest amount of pain relief and quality of life," said Robert Kell, lead author of the study and an assistant professor of exercise physiology at the University of Alberta, Augustana Campus. About 80 per cent of North Americans suffer from lower back pain.”
Low back pain: Exercises to reduce pain
Improving Low Back Pain With Exercise
General Information
What's the best approach to acute low back pain? (J Fam Pract. 2009)
Tackling persistent low back pain in primary care. (Practitioner. 2009)
An Introduction to an Evidence-Based Approach to Interventional Techniques in the Management of Chronic Spinal Pain (Pain Physician 2009)
Comprehensive Review of Neurophysiologic Basis and Diagnostic Interventions in Managing Chronic Spinal Pain (Pain Physician 2009)
Comprehensive Review of Therapeutic Interventions in Managing Chronic Spinal Pain (Pain Physician 2009)
Trial Results Raise Doubts About Vertebroplasty
Back Treatment for Elderly No Better than Fake One
Unspecific Back Pain - Basic Principles and Possibilites for Intervention from a Psychological Point of View. (Gesundheitswesen. 2009)
Muscle Rubs: Use For Pain Is Questionable, Review Finds
Systematic Review of Caudal Epidural Injections in the Management of Chronic Low Back Pain (Pain Physician 2009) “OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term = 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. RESULTS: The evidence showed Level I for short- and long-term relief in managing chronic low back and lower extremity pain secondary to lumbar disc herniation and/or radiculitis and discogenic pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back pain of post-lumbar laminectomy syndrome and spinal stenosis. “
Managing lower back pain: You may be doing too much
Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain. (Spine. 2009) “CONCLUSION.: A special interest in back pain is associated with back pain management beliefs contrary to the best available evidence. This has serious implications for management of back pain in the community.”
Managing lower back pain: You may be doing too much (APCToday 2009)
Overtreating Chronic Back Pain: Time to Back Off? (The Journal of the American Board of Family Medicine 2009)
Guidelines
AAN Guideline Recommends Against TENS for Chronic Low-Back Pain “A new evidence-based review from the American Academy of Neurology concludes that transcutaneous electric nerve stimulation (TENS) is not recommended for use in treating chronic low-back pain but adds that TENS should be considered to treat diabetic neuropathy.”
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Other
Other Treatments
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Acupuncture for lower back pain: a review. (Clin J Pain. 2010)
The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life. (Int J Immunopathol Pharmacol. 2009)
Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group. (Spine (Phila Pa 1976). 2009)
Actual or Simulated Acupuncture Therapy May Be Effective for Chronic Low Back Pain
Surgery
Minimally Invasive Surgery Not Better for Sciatica “Minimally invasive surgery for the excruciating back pain that can be caused by sciatica didn't work as well as the conventional procedure in a Dutch study. "The expected treatment benefit of a faster rate of recovery from sciatica after tubular diskectomy could not be reproduced by this double-blind study," according to a report in the July 8 issue of the Journal of the American Medical Association. Orthopedic surgeons at the Medical Center Haaglanden studied 328 people who underwent surgery for sciatic pain, and found that "the overall differences in pain intensity and recovery rates favored the conventional microdiskectomy." “
Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. (Eur Spine J. 2009)
Lumbar discectomy: a national survey of neurosurgeons and literature review. (Can J Neurol Sci. 2009)
Spinal Surgery Superior to Exercise, Medical Therapy at 4 Years
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