Low back pain (also called lower back pain) is a common condition. Low back complaints cause many limitations, so treatment is therefore desirable. However, in the majority of cases the cause of low back pain cannot be identified, which is referred to as non-specific low back pain.
Lower back pain
Low back pain, also called lower back pain, is the most common musculoskeletal complaint. Almost every adult has experienced lower back pain at least once in their lives. For most people, back problems go away at some point – with or without treatment. However, approximately 5 to 15 percent of people with lower back pain have chronic lower back pain .
In practice, a distinction is often made between three forms of low back pain , subdivided according to the duration of the complaints:
- Acute low back pain: complaints last less than six weeks
- Subacute low back pain: complaints last six to twelve weeks
- Chronic low back pain: complaints persist for more than twelve weeks or keep recurring
Cause of lower back pain
In approximately 95% of cases, no direct cause of the low back complaints can be identified. Specific causes of low back pain include compression fractures, spinal canal stenosis and spondylitis. Because these causes are not obvious and the complaints usually disappear on their own, it is often decided not to investigate the low back complaints extensively. However, there are so-called “red flags” where further investigation is wise. Such red flags include a history of tumor, pain that increases significantly at night, fever, and recent unexplained weight loss.
Risk factors developing lower back pain
There are several factors that increase the chance of developing low back pain. These are also called risk factors. The most important risk factor for developing low back pain is a previous episode of low back pain. Other risk factors include:
- With age, the risk of low back pain increases significantly from the age of 60
- Lower socio-economic status
- Obesity
- Stress, anxiety and depressive complaints
Treatment of low back pain
If no direct cause of the pain can be identified and there is therefore a non-specific cause of the low back complaints, treatment in the first six weeks of the back complaints is not useful. According to studies, physiotherapy does not appear to cause significant improvement. In the first weeks after the onset of the complaints, the so-called acute phase, waiting seems to be the best treatment method. If necessary, a painkiller such as paracetamol can be used to combat the symptoms.
When the back complaints are subacute (duration 6-12 weeks) or chronic (duration >12 weeks or recurring), a different approach is useful. In such cases, the use of physiotherapy, electrotherapy (TENS) and injections in or in the peripheral or central nervous system can be considered. A visit to an outpatient clinic for pain management or a rehabilitation center with a multidisciplinary approach is recommended.
TENS
TENS is the abbreviation for transcutaneous electrical neurostimulation and is a form of electrotherapy . With TENS, the nerves are stimulated by means of electrodes applied to the skin. The underlying mechanism of action of this form of pain relief is not yet completely clear. TENS appears to reduce complaints for some people and not for others. It is not yet known why this happens. It is certain that TENS is a safe option for pain relief.
Injections
Injections with substances such as lidocaine and novocaine appear to provide relief for some people with lower back problems . An advantage of these injections is that they can be used very locally (only those body areas with pain complaints are addressed). However, the injections do not appear to be entirely without risk, so the pros and cons of such a treatment must be carefully weighed against each other.
Medication
In a number of cases, the use of medication appears to be useful. For example, antidepressants such as amitriptyline and clomipramine are sometimes prescribed. However, these medications can have unpleasant side effects and sometimes interact with other medications, so caution is advised.
