ACUTE LOW BACK PAIN

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DEFINITION
Acute low back pain is a kind of pain that occurs posteriorly in the region between the lower rib margin and the proximal thighs which lasts for a period less than 6 weeks.
It can also be defined as a common disorder involving the muscles, nerves, and bones of the back.

INCIDENCE
It is the fifth most common reason for physical visits which affects nearly 60-80% of people throughout their lifetime.

CAUSES OF LOW BACK PAIN
1.     Lumber strain
2.     Nerve irritation
3.     Lumber radiculopathy
4.     Bony encroachment
5.     Bone and joint condition
6.     Congenital bone conditions
7.     Degenerative bone and joint conditions
8.     Kidney problems
9.     Pregnancy
10.                        Tumor that originate in the bone of the spine

RISK FACTORS
1.     Heavy lifting
2.     Moving luggage
3.     Athletic activity
4.     Traumatic injury
5.     Aging
6.     Stress
7.     Poor posture
8.     Poor sleeping position
9.     Obesity

SIGNS AND SYMPTOMS
    Low back pain can cause a wide variety of symptoms depending on the precise cause of the back pain. They include;
1.     Numbness and tingling of the lower extremities
2.     Inability to walk without worsening pain
3.     Lower extremities weakness
4.     Fever
5.     Chills
6.     Weight loss
7.     Dizziness
8.     Joint pain
9.     Fatigue


DIAGNOSTIC TESTS
1.     History taking
2.     Physical examination
3.     X-ray
4.     MRI scanning
5.     Bone scanning
6.     Nerve test e.g. electromyograms (EMG) and nerve conduction velocities(NCV)

PATHOPHYSIOLOGY
The pathophysiology of acute low back pain is usually indeterminate. In fact, one of the defining features of this disorder is its nonspecific etiology. Pain can arise from a number of sites, including the vertebral column, surrounding muscles, tendons, ligaments, and fascia. Stretching, tearing, or contusion of these tissues can occur after sudden unexpected force applied to the spine from events such as heavy lifting, torsion of the spine, and whiplash injury. Whether muscle spasm is a significant etiology of lumbar spine pain, either as cause or effect of back injury, has not been proved.
The pathophysiology of radicular spine pain and lumbosacral radiculopathy is usually more obvious. Disk herniation through the annulus fibrosis does not in itself produce pain, but compression by disk of the dura lining around the spinal nerve root sleeve is one likely explanation for the back pain associated with acute disk herniation. This is also likely to contribute to the pain from spinal nerve root compression from arthritic spurs at degenerated facet and uncovertebral joints. Compression can directly stretch nociceptors in dura or nerve root sleeve tissues, but ischemia from compression of vascular structures, inflammation, and secondary edema is also likely to play a role in some cases.

MANAGEMENT
Medical management
Ø NSAID’S such as ibuprofen, diclofenac to relief pain.
Ø Analgesics such as paracetamol can also be prescribed. Opoids analgesics can also be given in case of more severe pain such as spinal pain and radiculopathy.
Ø Muscle relaxant to treat musculo-skeletal disorder e.g. diazepam
Nursing management
Ø Admit patient  to provide adequate rest
Ø Passive therapy such as use of traction, heat and ice
Ø Health educate client on the risk factors that can cause low back pain
Ø Adequate exercise such as flexibility exercise e.g. yoga
Ø Give prescribed medications

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