Acute lower back pain, lower back complaints: pain in the lower back. People speak of low back pain when the pain is in the lower back. In more than 90% of cases there is no specific physically identifiable cause. The back pain may be caused by overloading the back or a (sudden) wrong movement. Lower back pain often occurs when lifting, reaching or digging in the garden from a twisted position. In rare cases, lower back pain is caused by an underlying condition. Self-care methods are helpful for the first 72 hours after pain begins. If the pain does not improve after 72 hours of home treatment, you should consult your doctor. Medical treatment for low back pain can include medications and physiotherapy. Occasionally surgery is necessary. There are many ways to prevent lower back pain. For example, training and strengthening the muscles in your abdomen and back, losing weight if you are overweight, lifting properly and adopting the correct posture.
- What is low back pain?
- Classification of low back pain
- Acute lower back pain
- Subacute low back pain
- Chronic low back pain
- Specific and non-specific back pain complaints
- Incidence of low back pain
- Low back pain is the number one cause of disability
- Symptoms of low back pain
- Causes of acute low back pain
- Mechanical causes
- Pain of the internal organs
- Women: pelvic inflammatory disease (PID) and enometriosis
- Kidney stones and gallstones
- Hernia
- Spinal column injury
- Back pain during pregnancy
- Joint disorder
- Arthrosis
- Osteoporosis or bone decalcification
- Osteomyelitis or bone infection
- Tumors
- Prostatitis
- Emotional stress
- Examination and diagnosis
- Self-care for lower back pain
- Rest briefly
- Keep moving
- Change of activities
- Applying heat or cold
- Over-the-counter painkillers
- Treatment of acute low back complaints
- Muscle relaxants
- Opioids
- Back brace
- Epidural corticosteroid injection in the lower back
- Physiotherapy
- Operation
- Prognosis and course of low back pain
- Prevention of low back problems
Low back pain / Source: Maridav/Shutterstock.com
What is low back pain?
There are many people who suffer from lower back pain for a shorter or longer period of time. Almost everyone suffers from back pain at some point in their lives. Typically, low back pain is caused by an unexpected movement, poor posture, performing the same action(s) over and over again, lifting heavy objects or weights, or a combination of these mechanical causes. Back pain is also common during pregnancy: about 50% of pregnant women suffer from it. However, sometimes back pain can be the result of a more serious problem. If pain persists or if low back pain is accompanied by other signs and symptoms, it is advisable to consult your doctor.
Classification of low back pain
A distinction is made between acute, subacute and chronic low back pain.
Acute lower back pain
Acute or short-term lower back pain generally lasts from a few days to a few weeks.
Subacute low back pain
Sometimes a distinction is also made between acute and subacute back complaints. Acute back complaints are said to last less than 6 weeks and subacute back complaints last 6 to 12 weeks.
Chronic low back pain
Chronic back pain is said to occur if the pain persists for more than 3 months. It is often difficult to determine the cause of chronic back pain.
Specific and non-specific back pain complaints
The specific structure in the back responsible for the pain is almost never identified. A distinction is often made between specific low back pain complaints and non-specific back pain complaints. Specific back complaints are back complaints involving a specific pathophysiological mechanism and/or a disorder in anatomical structures, such as an infection, inflammation, osteoporosis, hernia nuclei pulposi (HNP), a fracture or a tumor or a metastasis.[1] Non-specific back complaints are back complaints without an identifiable specific cause. This is the case for approximately 90% of people with lower back problems.[2] It is assumed that non-specific low back pain is related to overload of pain-sensitive structures in and around the spine.
Incidence of low back pain
It appears that 60-90% of the population will experience an episode of low back pain at some point in their lives.[3] 5% of the population suffers from low back pain every year. For an average general practice, this means an average of 3% of all patients per year.[4]
Absenteeism due to low back pain
Of all complaints of the musculoskeletal system, low back pain causes the highest costs in terms of absenteeism due to illness and disability. Low back pain complaints are common, especially in construction and nursing.
Low back pain is the number one cause of disability
A new study has shown that lower back pain is not only the number one cause of absenteeism, but also causes more disability around the world than any other condition. The jobs where many employees suffer from lower back pain are those that involve a lot of lifting, forceful movements, uncomfortable positions and where employees are frequently exposed to vibrations. The research shows that workers working in the agricultural sector are almost four times as likely to be permanently absent due to low back pain as workers in all other sectors combined. The research was published in the journal Annals of the Rheumatic Diseases . (March 25, 2014)
Symptoms of low back pain
Low back pain can include a wide range of symptoms. The pain can be mild and merely annoying or it can be severe and immobilizing. Low back pain can start suddenly, or it can come on slowly (and possibly come and go) and gradually worsen. Depending on the underlying cause of the pain, symptoms can be experienced in different ways. The symptoms of low back pain can include:
- pain that is dull or aching
- stabbing, burning pain that moves from the lower back to the lower back and thighs, sometimes in the lower legs or feet (sometimes even numbness or tingling)
- muscle spasms and tightness in the low back, pelvis and hips
- pain that worsens after sitting or standing for a long time
- difficulty standing upright, walking or from sitting to standing up
Back pain due to sedentary work / Source: Istock.com/AnaBGD
Causes of acute low back pain
Mechanical causes
As described above, low back pain is often due to mechanical causes. Examples of this include prolonged poor working posture at the desk, in the car or in construction or other work, suddenly lifting heavy weights or repetitive activities without variety or rest. Important symptoms of mechanical back problems are pain and reduced physical functioning. The patient experiences difficulty in performing daily activities and work. The pain is often localized in the lower back, but sometimes also higher. There may be radiating back pain. This causes stimulation of nerves that run to the legs. Back complaints do not always have to be accompanied by stiffness, strength and movement limitations.
Pain of the internal organs
Pain from the internal organs can sometimes also be felt in the back. For example, pain in the organs in the abdomen, the pelvis (pelvic pain), or chest pain can be felt in the back. This is called radiating pain. For example, in the event of an acute myocardial infarction (heart attack), pain may radiate to the back. And with Candida esophagitis (esophagitis caused by Candida), the patient may experience pain near the sternum, with the pain radiating to the back or shoulder blades. Many intra-abdominal disorders (i.e. disorders in the abdominal cavity), such as appendicitis (appendicitis), aneurysm (local widening of a blood vessel), pancreatitis (inflammation of the pancreas), kidney problems, bladder infection, renal pelvis infection and ovarian disorders, such as Inflammation of the fallopian tubes (salpingitis), which can lead to pain in the lower back.
Pelvic Inflammatory Disease / Source: Alila Medical Media/Shutterstock
Women: pelvic inflammatory disease (PID) and enometriosis
PID is a collective name for infections of the female reproductive organs: of the small pelvis (uterine mucosa, fallopian tubes and abdominal cavity) and abscesses in the ovaries or fallopian tube. Left untreated, these infections can spread and lead to recurring complaints. Major causes of PID are sexually transmitted diseases such as chlamydia and gonorrhea, but major events such as childbirth, abortion or surgery on the reproductive organs or the pelvis can also cause PID. PID may be associated with chronic, often severe lower abdominal pain, painful intercourse, unusual vaginal discharge, abnormal vaginal bleeding such as after sex or in the middle of the menstrual cycle, back pain cramps, fever, nausea, diarrhea, weight loss, and painful urination. However, it can also proceed without complaints.
Endometriosis is a condition in which the uterine lining spreads to other areas, usually the pelvis or abdominal cavity. This benign abnormality causes pain in many women (including abdominal pain and lower back pain), fatigue, disturbed bowel movements and problems or pain when urinating (dysuria).
Kidney stones and gallstones
Back pain can also occur with kidney stones and gallstones.
Hernia
The most common specific back complaint is hernia nuclei pulposi (abbreviated HNP). In 90-98% of cases, an HNP appears to be localized in the low back.[5] A hernia is a bulging intervertebral disc, one of the shock-absorbing discs that lie between the vertebrae. HNP occurs most frequently between the ages of 45 and 65. It affects as many women as men. Perhaps large height, overweight (obesity), heavy and persistent back strain and prolonged driving are risk factors. Heredity plays no significant role. The symptoms can occur quite suddenly or develop over several weeks and include: a sharp pain in the affected area with, for most patients, a radiating pain, which usually travels through the buttock along the back of the leg, sometimes even into the toes (sciatica). Furthermore, the patient may experience muscle spasm and stiffness around the affected area, making normal movement more difficult. If the nerve is severely pinched, symptoms may even occur, such as sensory disturbances and paralysis in the leg or problems with urination (urination) or defecation.
Spinal column injury
Low back pain can also result from spinal injuries: damage to the back (or neck) that involves the spinal cord. Injury to the spine due to an accident can damage the spinal cord.
Back pain during pregnancy / Source: Istock.com/kzenon
Back pain during pregnancy
About 50% of pregnant women suffer from lower back pain. This pain can arise as a result of a changed position of the woman due to the weight of the growing baby and hormonal changes that lead to weakening of ligaments and joints, including those of the spine.
Joint disorder
Persistent lower back pain can be the result of a joint disorder. In young people it may involve ankylosing spondylitis, also called ankylosing spondylitis. Ankylosing spondylitis is a rheumatic disease with, among others, the following symptoms: stiffness; backache; pain in the buttocks and/or pelvis. Symptoms worsen with rest and there are fewer complaints due to exercise.
Arthrosis
Persistent back pain in the elderly can be caused by osteoarthritis. In osteoarthritis, the quality of articular cartilage deteriorates. Over time it may even disappear completely. In osteoarthritis, the adjacent bone increases. Colloquially, this process is often referred to as ‘wear’. The condition is characterized by pain (joint pain), stiffness and loss of function.
Osteoporosis or bone decalcification
In osteoporosis, also called osteoporosis , the bones become more brittle because there is less calcium (limescale) in the bones. With osteoporosis, the vertebrae can be affected, which can cause back pain, which can manifest itself in various ways. In the event of an acute collapse of a vertebra, sudden severe pain occurs. The pain usually decreases or disappears when the patient lies down. In order to counteract the movements around the location of the vertebral collapse, the local back muscles can contract forcefully. In the worst case, this muscle cramping can last for days. This leads to stiffening of the back and intense muscle pain. In many cases, the acute pain resulting from the vertebral collapse disappears in four to six weeks. It is also possible for the pain to persist and become chronic.
Osteomyelitis or bone infection
Osteomyelitis is an infection in the bone, which causes inflammation. These inflammations can cause pain, among other things. Osteomyelitis can also occur in vertebrae or intervertebral discs. This is also called infectious spondylitis or septic spondylitis or spondylodiscitis. This can damage, deform or collapse the vertebrae.
Tumors
In rare cases, back pain comes from tumors that can arise from the vertebrae, the spinal cord, the nerve roots or from the spinal cord itself. Metastases or spreads of tumors elsewhere in the body to parts around the spinal cord are more common.
Prostatitis
For men, prostatitis (prostate inflammation) can also cause lower back pain complaints. Other complaints of a prostate infection are: a burning sensation or pain when urinating; problems urinating; frequent urination, especially at night; urgent need to urinate; pain in the groin, lower back, abdomen (abdominal pain), genitals.
Emotional stress
Finally, emotional stress can also cause lower back pain complaints.
Examination and diagnosis
Normally, a doctor is able to diagnose low back pain based on the information obtained from the interview about your complaints, the review of your medical history and a physical examination and no further examination is necessary.
Self-care for lower back pain
Depending on the diagnosis, some treatments may be more effective than others. Many people find that a combination of treatments is best. Self-care measures can be effective for treating mild or acute pain from muscle tension, as well as reducing the effects of persistent, severe pain.
Rest briefly
In the past, doctors often advised bed rest for back pain, but in 2023 it is well known that lying down is one of the worst things you can do. It can even worsen your back problems. Rest for a short period of time and no longer than one or two days. Too much inactivity makes healing more difficult.
Keep moving / Source: Halfpoint/Shutterstock.com
Keep moving
It is important to keep moving, but not to force anything. Exercise is one of the most effective ways to quickly recover from back pain, especially walking and swimming.
Change of activities
Keep moving, but avoid activities and positions that worsen the pain. If sitting in a car or at a desk for long periods of time makes the pain worse, set a timer to get up and walk around or gently stretch every 20 minutes. If standing makes the pain worse, avoid chores that require a lot of standing, such as washing dishes at the sink.
Applying heat or cold
Heat from a warm bath, a hot water bottle, an electric heating pad, or chemical or heat patches can relax tense muscles and improve blood flow. Increased blood flow brings nutrients and oxygen that muscles need to heal and stay healthy. If the low back is painful due to inflammation, ice or cold packs can be used to reduce swelling. It is important to protect the skin during the application of heat and ice to prevent tissue damage. So never apply ice directly to your back!
Alternating heat and cold can be especially useful when resuming activities: applying heat before performing certain activities helps relax the muscles. This improves flexibility and mobility. Applying cold after an activity reduces the chance of an area becoming irritated and swollen from exertion.
Ibuprofen / Source: Martin Sulman
Over-the-counter painkillers
The most common over-the-counter medications are paracetamol and NSAIDs such as ibuprofen and naproxen. Ibuprofen and naproxen are anti-inflammatory drugs that relieve lower back pain caused by swollen nerves or muscles. Paracetamol works by interfering with pain signals sent to the brain.
Treatment of acute low back complaints
The goal of medical treatments is to reduce pain and improve your mobility.
Muscle relaxants
Muscle relaxants are medications that reduce muscle tension. The most commonly prescribed muscle relaxant drug is diazepam, one of the benzodiazepines.
Opioids
Opioids are derived from opium from poppies (Papaver somniferum). These painkillers change the perception of pain by weakening the signals sent to the brain. Opioids have only a moderate effect on low back pain in the short term, according to a meta-analysis [JAMA Intern Med., epub May 23, 2016].
Back brace
A back brace or back bandage improves posture and reduces pain complaints. A back brace can also be useful after back surgery.
Epidural corticosteroid injection in the lower back
An epidural injection in the lower back is a form of pain relief that numbs a part of the body. It is also known as ‘epidural’. The purpose of the injection is to temporarily relieve pain by reducing the inflammation around a compressed nerve root.
Medical treatments are often used in combination with other methods. For example, an epidural corticosteroid injection may provide sufficient short-term pain relief to allow progress in physical therapy.
Physiotherapy / Source: Istock.com/KatarzynaBialasiewicz
Physiotherapy
Immediately going to a physiotherapist for lower back pain has few advantages, as the complaints usually go away on their own. However, physiotherapy can be useful if you need help staying active or starting to exercise.
Operation
When non-operative methods do not provide sufficient relief, spinal surgery may be considered. Back complaints where surgery is a possibility include hernia, scoliosis, spondylolisthesis and stenosis.
Prognosis and course of low back pain
The natural course of non-specific back complaints is favorable in most cases. Of the people with low back pain in the general population, approximately 80-90 recover spontaneously within four to six weeks.[6] Of the patients who visit the GP, approximately 65% are free of complaints after twelve weeks.[7] Low back pain complaints often recur. A recurrence is defined as when more than two back pain episodes occur within a year, the total duration of which is less than six months. In general, back complaints return more often and to a severe extent if the patient has suffered from frequent episodes of back pain in the past or from persistent, long-term back complaints.
The course of specific back complaints depends entirely on the underlying cause. No general statements can be made about this.
Preparing healthy food / Source: Gpointstudio/Shutterstock.com
Prevention of low back problems
You can reduce the chance of experiencing low back pain or lower back problems by making these positive lifestyle changes:
- Eat a healthy and varied diet so that you keep your body weight within a healthy range.
- Regular exercise to keep your back muscles fit and flexible.
- Strengthen the muscles of the back and abdomen with exercises.
- Avoid sitting for long periods of time.
- When you sit down, maintain good posture.
- Use proper lifting techniques (lift with your legs instead of your back).
- Avoid frequent bending and twisting. In particular, avoid bending, twisting and lifting at the same time (such as shoveling snow).
- Avoid situations where your spine is vibrated for long periods of time.
- Get enough sleep every day.
- Stop smoking.
- Losing weight if you are overweight.
- If you have depression and/or anxiety disorder (which is associated with physical symptoms), seek professional help.
Notes:
- Definition of pathophysiology: knowledge of disturbances in normal body functions that can cause diseases and symptoms of diseases. Anatomical structures refer to the parts of the body and their interrelationships.
- Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318:291-300.
- GE Bekkering. HJM Hendriks. BW Koes. RAB Oostendorp. RWJG Ostelo. J. Thomassen. MW van Tulder: KNGF guideline for low back pain.
- Ibid.
- Koes BW (Erasmus MC-GP), Tulder MW from (VU-EMGO). What are neck and back complaints and what is the course? In: Public Health Future Outlook, National Public Health Compass. Bilthoven: RIVM, <http://www.nationaalkompas.nl> National Public Health Compass Disease, quality of life and mortality Diseases and conditions Diseases of the musculoskeletal system and connective tissue Neck and back complaints, December 11, 2006.
- Waddell G. A new clinical model for the treatment of low-back pain. Spine, 1987; 12:632-644.
- Faas A, Chavannes AW, Koes BW, Hoogen JMM van den, Mens JMA, Smeele LJM, et al. NHG-Standaard Low Back Pain. General Practitioner Act 1996; 39:18-31.
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