Back Pain and Sciatica
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Internet Sites
- Risk Factors
- Risk Reduction
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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
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Back Pain - Sciatica
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis (The Lancet 2010)
Device Therapy
Drug Side-Effects and Interactions
Drugs
Exercise
For Acute Low Back Pain, Staying Active May Be Better Than Bed Rest
The treatment effect of exercise programmes for chronic low back pain. (J Eval Clin Pract. 2010)
The effectiveness of walking as an intervention for low back pain: a systematic review. (Eur Spine J. 2010)
Exercises for prevention of recurrences of low-back pain. (Cochrane Database Syst Rev. 2010)
General Information
Injection Therapy for Persistent Low Back Pain: When, Where, Why?
Low back pain symptoms show a similar pattern of improvement following a wide range of primary care treatments: a systematic review of randomized clinical trials. (Rheumatology (Oxford). 2010) “Conclusions. NSLBP symptoms seem to improve in a similar pattern in clinical trials following a wide variety of active as well as inactive treatments.”
Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica (Cochrane Reviews 2010)
Glucosamine no better than placebo for back pain
The truth about treating low back pain
Overtreated: Pain in the Back Widely Overtreated “The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren't even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks. Yet a study last year found nearly one in three aching Medicare patients get some kind of back scan within that first month. Why is that a problem? Those scans can be misleading. By middle age, most people who don't even have pain nonetheless have degeneration of their disks, those doughnut-looking shock absorbers between vertebrae. So in someone who does have pain, pinpointing that a particular black spot or bulge on a scan is the true cause is tricky. “
Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults (JAMA. 2010) “Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.”
Unneeded, riskier spinal fusion surgery on rise “A study of Medicare patients shows that costlier, more complex spinal fusion surgeries are on the rise — and sometimes done unnecessarily — for a common lower back condition caused by aging and arthritis. What's more alarming is that the findings suggest these more challenging operations are riskier, leading to more complications and even deaths.”
Low Back Pain and Best Practice Care (Arch Intern Med. 2010) “It is clear from this study that the usual care provided by GPs does not align with best practice recommendations. The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”
Guidelines
Quality of Low Back Pain Guidelines Improved (Spine. 2009)
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
The Role of Exercise and Alternative Treatments for Low Back Pain (Physical Medicine and Rehabilitation Clinics of North America 2010)
A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. (Eur Spine J. 2010)
Surgery
Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature. (Eur Spine J. 2010)
The Truth About Back Surgery “Of the 56 million Americans who have back pain, only 5 percent need surgery. Here's how to protect yourself and find relief that really works.”
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