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Back pain and sciatica - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of back pain, including sciatica.

Alternative Names

Herniated disk; Sciatica

Highlights:

Statistics:

According to the Bureau of Labor Statistics, in 2006 back pain was responsible for 62% of cases of people missing work due to pain involving the upper body.

Overview:

Back pain can be acute, subacute, or chronic.
- Acute back pain develops suddenly and lasts up to several weeks. Acute pain is the most common type of back pain.
- Subacute back pain is pain that lasts up to three months.
- Chronic back pain can begin abruptly or gradually, but it lasts longer than 3 months.
Back pain can occur in any area of the back, but it is more common in the lower part, which supports most of the body's weight.

Diagnosis:

Although most episodes of new back pain, as well as flare-ups of chronic back pain, clear up or return to a previous level of discomfort, a medical history and a brief physical examination is always necessary.
The main goal of a physical exam is to try and determine the source of the pain and the limits of movement.
Because most patients with back pain are on the mend or completely recovered within 6 weeks, imaging techniques such as x-rays or scans are rarely recommended in the first month unless the health care provider suspects a tumor, fracture, infection, cauda equina syndrome, or progressive neurological disease.

Treatment:

The most commonly prescribed medications for the treatment of back pain are nonsteroidal anti-inflammatory drugs (NSAIDs)
Injections of corticosteroids (commonly called steroids) are sometimes used to treat low back pain caused by nerve impingement.
Spinal manipulation may sometimes be useful for acute back pain that persists beyond 2 - 3 weeks.
Patients should always try all possible non-surgical treatments before opting for surgery.

Resources

www.niams.nih.gov -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.aaos.org -- American Academy of Orthopaedic Surgeons
www.arthritis.org -- Arthritis Foundation
www.spine.org -- North American Spine Society
www.apta.org -- American Physical Therapy Association
www.ampainsoc.org -- American Pain Society
www.theacpa.org -- American Chronic Pain Association
www.iasp-pain.org -- International Association for the Study of Pain

References

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Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505-514.

Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 147(7):492-504.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007;(2):CD003010.

Curlee PM. Other Disorders of the Spine. In: Canale ST, Beatty JH. (eds.) Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007.

Erdogmus CB, Resch KL, Sabitzer R, et al. Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial. Spine. 2007;32(19):2041-2049.

Freeman BJ, Davenport J. Total disc replacement in the lumbar spine: a systematic review of the literature. Eur Spine J. 2006;15 Suppl 3:S439-47.

Freeman BJ. IDET: a critical appraisal of the evidence. Eur Spine J. 2006;15 Suppl 3:S448-457.

Freeman BJ, Fraser RD, Cain CM, et al. A randomized, double-blind, controlled trial: intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine. 2005;30(21):2369-77; discussion 2378.

Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167(17):1892-1898.

Hancock MJ, Maher CG, Latimer J, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet. 2007;370(9599):1638-43.

Hayden JA, van Tulder MW, Malmivaara AV, et al. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142(9):765-775.

Johnson RE, Jones GT, Wiles NJ, et al. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine. 2007;32(15):1578-1585

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Luo X, Pietrobon R, Sun SX, et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 20041;29(1):79-86.

Martell BA, O'Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116-1127.

Pneumaticos SG, Chatziioannou SN, Hipp JA, et al. Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology. 2006;238(2):693-698.

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Smeets RJ, Vlaeyen JW, Hidding A, et al. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain. 2008;134(3):263-276.

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U.S. Department of Labor, Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2006. News Release USDL 07-1741, November 8, 2007.

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kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009;373(9668):1016-24.

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Reviewed last on: 5/13/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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