Lower Back Pain

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Introduction

What is lower back pain?

Lower back pain is any type of pain or discomfort throughout the posterior (back) portion of your lower trunk area, extending down to your pelvis. The lower back is also referred to as the lumbar area or lumbar spine.

Most people will experience back pain at some point in their lives. Low back pain is the most common cause of job-related disability and absenteeism from work, according to the National Institute of Neurological Disorders and Stroke.

Pain in the lower back may be brief or chronic, which is defined as lasting more than three months. You may feel a dull, annoying ache or a sharp, bursting pain. Acute lower back pain often resolves with basic self-care measures within a few weeks, but it can become chronic and lead to more serious problems over time.

In addition to the lumbar spine, there are numerous nerves, muscles, tendons, and ligaments in the lower back. Any of these structures can become irritated or inflamed in response to a variety of different factors, such as trauma, muscle strain, arthritis, and bone cancer.

Lower back pain with other symptoms, such as loss of bladder or bowel control and numbness in your extremities (arms or legs), is a serious condition and should be evaluated as soon as possible or in an emergency medical setting. In addition, if your pain is extreme, persistent, or causes you concern, contact a medical professional.

Symptoms

What other symptoms might occur with lower back pain?

Lower back pain symptoms depend on the underlying disease, disorder or condition. Back pain due to infection or inflammation may be accompanied by a fever; whereas, back pain due to fibromyalgia may include symptoms such as insomnia and fatigue. The range of symptoms that may occur with lower back pain include:

  • Anxiety
  • Blood in the urine (hematuria)
  • Depression
  • Fatigue
  • Fever
  • Headache
  • Hip pain
  • Morning back stiffness
  • Pain through the buttocks and down one leg to below the knee (sciatica)
  • Paresthesias (stinging, burning, tingling, crawling sensations)
  • Redness, warmth, or swelling of the back
  • Sleep disturbances

Serious symptoms that might indicate a life-threatening condition

In some cases, pain in the lower back may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Symptoms that may indicate a serious or life-threatening condition include:

  • Chest pain
  • Abdominal pain
  • Difficulty breathing
  • Loss of bladder or bowel control
  • Progressive weakness and numbness in the legs

Causes

What causes lower back pain?

The lower back consists of the lumbar spine (bony structures called vertebrae surrounding the nerves of the spinal cord). Between the vertebrae are spongy sacs of cartilage called disks that act as a cushion and provide a range of motion to the back. Muscles, tendons and ligaments provide additional support. Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions.

A common cause of mild to severe lower back pain is a sudden movement during activities such as sports or home improvement projects. People who normally lead a relatively sedentary lifestyle are at increased risk for these types of strains and sprains. Lower back pain causes can also be more serious conditions, such as spinal trauma, disk herniation, and spinal cancer. A problem in another part of the body, such as the reproductive organs, can also radiate to the lower back. This is called referred lower back pain.

Structural causes of lower back pain

Lower back pain can be due to injury, inflammation, or infection of the bones and tissues including:

  • Herniated disk
  • Muscle spasm
  • Osteoarthritis
  • Osteomyelitis (infection or inflammation of the spinal bones)
  • Osteoporosis (metabolic bone disease)
  • Paget’s disease of the bone
  • Sciatic nerve damage and sciatica due to spinal stenosis or degenerative disc disease
  • Spinal degeneration (degenerative disc disease, also called spondylosis)
  • Spinal stenosis (a narrowing of the spinal canal that presses on the spinal cord or nerves)
  • Spine fracture
  • Spondylitis (infection or inflammation of the spinal joints)
  • Sprains and strains due to overuse or injury

Other possible causes of lower back pain

Body systems other than the neuromuscular system can lead to lower back pain, such as:

Life-threatening causes of lower back pain

In some cases, lower back pain may be due to a serious or life-threatening condition that should be evaluated as soon as possible or examined in an emergency setting. Possible life-threatening conditions that involve lower back pain include:

What are the risk factors for lower back pain?

Although anyone can experience lower back pain, there are certain risk factors that make you more likely to encounter back pain at some point in your life. Being older than 30 years of age and leading a sedentary lifestyle are the most common. The risk factors include:

  • Congenital (present at birth) or acquired back deformities (for example, scoliosis)
  • Family history of back pain or spine disease
  • Increasing age
  • Obesity
  • Poor posture
  • Sedentary lifestyle
  • Smoking
  • Stress and anxiety
  • Weak abdominal (core) muscles

What are the potential complications of lower back pain?

Lower back pain can lead to various complications depending on the underlying disease, disorder or condition. The good news is that most cases can be alleviated or minimized by physical therapy, basic self-care measures, and the treatment plan outlined by your doctor. However, your back pain may become chronic and overwhelming, affecting your quality of life. Research into the diagnosis and treatment of back pain is ongoing, so contact your health care professional for the most effective treatments.

Over time, lower back pain can lead to complications including:

  • Absenteeism from work or school
  • Chronic pain or discomfort
  • Permanent nerve damage (due to a pinched nerve) including paralysis
  • Permanent physical disability
  • Physiological and psychological response to chronic pain
  • Poor quality of life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 7
  1. Lower back pain fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
  2. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013
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