The cause for chronic low back pain is multifactorial. The evaluation of chronic low back pain, the goal is to rule out any injuries or organic disease processes that place the patient at risk of further injury if not treated or addressed. In addition, a specialist will consider diagnoses that can be treated in order to reduce the pain. A good patient history and a thorough physical examination by a well-trained physician are the most important aspects of the evaluation. In most of the cases, the chronic low back pain is because of obesity, lack of exercise, less water intake, chronic tobacco chewing, chronic smoking and chronic alcohol consumption. If the treating physician feels based on the patient's history and physical exam findings, he may advise certain investigations which include blood tests, radiography (X-ray films), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), diagnostic injections, electromyography (EMG) and other specialised tests as required.
The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achy, burning, stabbing or tingling, sharp or dull and well-defined or vague. The intensity may range from mild to severe. Many times, the source of the pain is not known or cannot be specifically identified. In fact, in many instances, the condition or injury that triggered the pain may be completely healed and undetectable, but the pain may still continue to bother the patient. Nevertheless, even if the original cause of the pain is healed or unclear, the pain felt by the patient is real and the treating physician knows this.
Treatments for chronic back pain can vary greatly depending on the type and source of the pain. If a treatable source of the pain is found, then the underlying process can be addressed.
Conservative: When the underlying cause is either not specifically identifiable or not amenable to treatment, then the symptoms are treated. The goals of the treatment are to reduce pain, improve the quality of life and increase function. There are several different general categories of treatment that are usually recommended for chronic back pain. These categories include physical therapy, medications, coping skills, procedures and alternative medicine treatments. The treating physician will tailor a program involving a combination of these options to address the patient's needs. Physical therapy includes patient education, and patient training in a variety of stretching and strengthening exercises, manual therapies, and modalities (ice, heat, transcutaneous electrical nerve stimulation (TENS), ultrasound, etc.).
The treatment of low back pain needs more contribution from the patient side as compared to doctors as the main treatment of chronic low back pain is exercise and medicine cannot be given for a long time as they also have certain side effects on the body.
Surgical: If there is a definitive organic cause of pain such as lumbar canal stenosis, spondylolisthesis, chronic long standing infection then the pathology needs to be addressed surgically.
How to prevent chronic low back pain:
We at Shanta spine institute believes in prevention is better than cure, so we keep our main emphasis on prevention of the disease more than the treatment. The main cause of chronic low back pain is aging process and unhealthy lifestyle. So we aim to prevent the disease by certain lifestyle modifications which had to be followed regularly. This includes daily 1 hour of exercise, healthy diet which includes lots of fruits and salads, 4-5 litres of water daily and to maintain weight which is normal according to your height and age. The exercise program like swimming, yoga, walking jogging etc helps to develop core strength and allows us to maintain strength and flexibility of the spine. Lifestyle modifications such as quitting tobacco chewing, smoking cigarette and alcohol is also very important.
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- Vivek Madhukar Puradbhat
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