Grant Cooper

Lower Back Pain: An Overview of the Most Common Causes

When discussing the causes of lower back pain, it is important to make a distinction between acute, subacute, and chronic lower back pain. Acute lower back pain refers to lower back pain that lasts less than 4 weeks. Subacute lower back pain refers to lower back pain that lasts from 4 to 12 weeks. Chronic lower back pain is lower back pain lasting 12 weeks or longer.

Discogenic Lower Back Pain

The intervertebral disc is the most common source of chronic lower back pain accounting for approximately 40 % of all cases [1]. It is important to emphasize from the outset that discogenic lower back pain is not the same thing as a herniated disc. A herniated disc may (and then again may not) irritate a nerve root and cause radicular symptoms [2]. However, a herniated disc in and of itself will not cause isolated lower back pain. If a tear in the disc is also present, then it may cause back pain whether or not a herniation is present.

Clinical Case #5: Tania

Tania is a 52-year-old project manager with a 30-year history of chronic lower back and buttock pain. She recently changed primary care doctors and her new primary care doctor suggested that she come to this office. Tania reports that her pain began shortly after she had her first child at the age of 22. Since then, Tania has had another child and slowly over the last 30 years the pain in her lower back and buttock has gotten worse.

Clinical Case #3: Steve

Steve is a 22-year-old first-year graduate student in molecular biology who was referred by his friend. Steve has a 6-week history of right lower back pain, right buttock pain, and radiating right leg pain. The pain began without any particular inciting event that he can identify. The pain radiates from the right lower back and buttock into the right posterior thigh, lateral thigh, calf, and into the right dorsum of the foot. Steve’s right lateral lower leg feels numb to him.

Sacroiliac Joint Pain

Sacroiliac joint pain is the third most common cause of chronic lower back pain, accounting for approximately 10–15 % of cases [1]. Recall from chapter one that the sacroiliac joints are the tough, fibrous, stable joints, with some limited but important movement, that translate the forces from the spine to the pelvis and legs. Sacroiliac joint pain is more common in women and also more common in pregnant women and postpartum in particular. In pregnancy, the hormonal changes lead to increased laxity in the ligaments which is what is thought to make sacroiliac joint pain more common in this patient population.

Clinical Case #2: Ruth

Ruth is a 64-year-old married attorney who presents with a 7-month history of right-sided lower back and buttock pain. She is being referred to this office by her physical therapist. She had been sent to her physical therapist by her primary care doctor. After 15 sessions of physical therapy, her therapist told her that because she was not making any progress with therapy, she should see a specialist.

Red Flag Signs and Symptoms

Red flag signs and symptoms in the context of lower back pain are signs and symptoms that should prompt further investigation.

Clinical Case #10: Rebecca

Rebecca is a 34-year-old attorney and a mother of two who presents with an 18-month history of right lower back pain, buttock pain, and right lower extremity pain. The pain began insidiously without any specific identifiable inciting event 18 months ago when her youngest son was 2 years old. At first the pain she reports that the pain was mild. She tried to “just ignore the pain.” She initially attributed the pain to taking care of her kids, including lifting her 2-year-old son into and out of the car, working long hours, and generally not taking better care of herself. However, over following 3 months her pain gradually worsened to the point that she realized it was affecting her work performance and making it difficult for her to take care of her children. At that point, she went to see her primary care physician who sent her to a pain management doctor.

Epidural Steroid Injections: Dispelling Common Myths

Perhaps there is no source of confusion, contention, obfuscation, and general misunderstandings primarily among patients but also doctors as there is in regard to epidural steroid injections. This chapter is devoted to trying to dispel some of the more common myths.

Clinical Case #7: Natasha

Natasha is a 42-year-old homemaker and mother of three children, ages 12, 8, and 4. She presents with an 11-month history of lower back pain. Natasha is being referred to this office by her primary care doctor. Natasha’s pain does not radiate into the legs. She denies any numbness, tingling, or burning in the legs. The legs do not feel weak. The pain is described as “sharp” and is centralized around the L5–S1 level. The pain is worse with sitting. She says that going for long car rides is “very difficult” because the pain becomes extremely intense. Standing and walking around makes the pain better. In general, she feels that the more she moves, the better she tends to feel unless she does “too much.”