What you’ve just read is one example of how lower back pain (LBP) can begin. If you’ve experienced it yourself, you may be able to identify with elements of this story. However, given the uniqueness of every episode, it’s unlikely you can relate to all of it.
Definition
LBP SUCKS! It is commonly defined as pain, muscle tension or stiffness between the bottom of your rib cage and the top of your legs (including your buttocks). This may sometimes be accompanied by leg pain (sciatica).1,2 Pain is usually the most significant symptom and may present as an aching, burning, throbbing or sharp quality. It can be confined to one area (localised), or spread out (diffuse). Other less common symptoms of LBP include tingling, numbness, and weakness in the legs.3–6
Demographics
LBP is extremely common (4 out of 5 people suffer from it at some stage in their lives3,6), is most prevalent in women and adults aged between 40-80 years old7,8, and can range in intensity from mildly annoying to severely disabling.4,9 It has been shown to be a major health problem in many countries around the world, and therefore represents a significant burden globally.7 The Global Burden of Disease 2010 found that LBP caused more disability than any other condition (291 were studied!).8
Specific vs Non-specific LBP
LBP can be classified as ‘specific’ or ‘non-specific’ based on whether it has an identifiable cause. Non-specific LBP consists of the vast majority of cases (95-99%), and derives its name from the fact it does NOT have a clear specific cause (pain of unknown origin).1 And while diagnostic tests and imaging continue to improve, they still cannot reliably determine what is causing this pain. However, it’s likely this type of LBP is caused by minor problems involving the muscles, bones, joints (ligaments), connective tissues and nerves of the lower back.3 The remaining cases are termed ‘specific LBP’ as they can be attributed to a specific medical condition. Some examples include disc injuries, fractures, arthritides (different types of arthritis), infections, or tumours.1 And while many of these conditions are pretty scary, keep in mind that they are also a lot rarer.10,11
**Please note that henceforth LBP will refer to non-specific LBP, unless specifically stated otherwise**
Acute vs Chronic LBP
Further to the classifications above, LBP can also be categorised in terms of its duration. ‘Acute’ complaints last from the initial onset of pain until 6 weeks; ‘sub-acute’ between 6 and 12 weeks; and ‘chronic’ for more than 12 weeks.12 Why 12 weeks? Because under normal circumstances we would expect even the slowest healing tissues in the body to have healed in this amount of time. This means that pain is only designated chronic once the original underlying injury has gone (healed). You have probably heard of chronic pain before. This condition is endemic to society and provides a significant global burden both socially and economically.13 It is a complex phenomenon that is still quite poorly understood, and therefore deserves its own separate discussion later.
Footnotes:
– Simple LBP is another term for non-specific LBP
– Lumbago is just a ‘fancy’ term for LBP (interchangeable)
Key points
• LBP is defined as pain, muscle tension or stiffness in your lower back (with or without leg pain).
• LBP is extremely common, especially in women and adults aged 40-80 years old.
• LBP can be divided into two types: non-specific and specific
• In non-specific LBP, we don’t know what causes the pain. This makes up the vast majority of LBP cases (95-99%).
• In specific LBP, we know a specific medical condition is causing the pain. This is rarer and tends to be more serious.
• LBP is further classified by its duration: Acute LBP (onset to 6 weeks); subacute (6-12 weeks); and chronic LBP (12+ weeks).
References
1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430-1434. doi:10.1136/bmj.332.7555.1430.
2. Choices N. Back pain guide. https://www.nhs.uk/Tools/Pages/Back-pain-guide.aspx. Accessed January 26, 2018.
3. Low Back Pain Fact Sheet | National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet#3102_3. Accessed August 17, 2017.
4. Delitto A, George SZ, Professor A, et al. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association Associate Professor in Physical Therapy and Orthopaedic Surgery, Program in Physical Therapy HHS Public Access. Man Ther. doi:10.2519/jospt.2012.42.4.A1.
5. NHS choices. Back pain – NHS.UK. https://www.nhs.uk/conditions/back-pain/. Published 2017. Accessed January 23, 2018.
6. Australian Institute of Health and Welfare. What are back problems? https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/what-are-back-problems. Published 2017. Accessed January 22, 2017.
7. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-2037. doi:10.1002/art.34347.
8. Manchikanti L, Singh V, Falco FJE, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014;17 Suppl 2:3-10. doi:10.1111/ner.12018.
9. Cassidy J, Carroll L, Spine PC-, 1998 undefined. The Saskatchewan health and back pain survey: the prevalence of low back pain and related disability in Saskatchewan adults. journals.lww.com. https://journals.lww.com/spinejournal/Abstract/1998/09010/The_Saskatchewan_Health_and_Back_Pain_Survey__The.12.aspx. Accessed February 18, 2018.
10. McLain RF. Prospective cohort study: Serious pathology in people presenting to primary care with acute low back pain is rare (0.9%), but high false-positive rates for some “red flags” may limit their diagnostic value. Evid Based Med. 2010;15(2):61-62. doi:10.1136/ebm1040.
11. Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60(10):3072-3080. doi:10.1002/art.24853.
12. Van Tulder M, Becker A, Bekkering T, et al. Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care On behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Eur Spine J. 2006;15:169-191. doi:10.1007/s00586-006-1071-2.
13. Landmark T, Romundstad P, Dale O, Borchgrevink PC, Kaasa S. Estimating the prevalence of chronic pain: Validation of recall against longitudinal reporting (the HUNT pain study). Pain. 2012;153(7):1368-1373. doi:10.1016/j.pain.2012.02.004.