Back pain natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Natural history, Complications and Prognosis
Complications
Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:
- Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs. Patients with these symptoms should seek immediate medical care.
- Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition, such as cancer.
- Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a fracture or other injury.
- Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention.
In general, however, back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months.
A few observational studies suggest that two common diagnoses of back pain, lumbar disc herniation or degenerative disc disease may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.[1][2][3][4] Other studies suggest that for as many as 85% of cases, no physiological cause for the pain has been able to be specifically identified.[5][6]
A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.[7][8][9][10]
Prognosis
Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.
References
- ↑ Borenstein DG, O'Mara JW, Boden SD; et al. (2001). "The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study". The Journal of bone and joint surgery. American volume. 83-A (9): 1306–11. PMID 11568190.
- ↑ Savage RA, Whitehouse GH, Roberts N (1997). "The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males". European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 6 (2): 106–14. PMID 9209878.
- ↑ Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994). "Magnetic resonance imaging of the lumbar spine in people without back pain". N. Engl. J. Med. 331 (2): 69–73. PMID 8208267.
- ↑ Kleinstück F, Dvorak J, Mannion AF (2006). "Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain?". Spine. 31 (19): 2250–7. doi:10.1097/01.brs.0000232802.95773.89. PMID 16946663.
- ↑ White AA, Gordon SL (1982). "Synopsis: workshop on idiopathic low-back pain". Spine. 7 (2): 141–9. PMID 6211779.
- ↑ van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK (2004). "Evidence against the use of lumbar spine radiography for low back pain". Clinical radiology. 59 (1): 69–76. PMID 14697378.
- ↑ Burton AK, Tillotson KM, Main CJ, Hollis S (1995). "Psychosocial predictors of outcome in acute and subchronic low back trouble". Spine. 20 (6): 722–8. PMID 7604349.
- ↑ Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005). "Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain". The spine journal : official journal of the North American Spine Society. 5 (1): 24–35. doi:10.1016/j.spinee.2004.05.250. PMID 15653082.
- ↑ Hurwitz EL, Morgenstern H, Yu F (2003). "Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study". Journal of clinical epidemiology. 56 (5): 463–71. PMID 12812821.
- ↑ Dionne CE (2005). "Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings". Journal of clinical epidemiology. 58 (7): 714–8. doi:10.1016/j.jclinepi.2004.12.005. PMID 15939223.