(December 9, 2008 - Insidermedicine) On a recent trip to Atlanta, we caught up with Alan Platt, a clinical instructor in the Department of Family Medicine and Preventive Medicine Physician Assistant program at the Emory School of Medicine. Mr. Platt also serves as the program coordinator and a physician’s assistant at the Georgia Comprehensive Sickle Cell Center and has published many articles about sickle cell disease.
Is lower back pain a medical emergency
Acute lower back pain can be an emergency, as it can be life-threatening. One possibility is something called dissecting aortic aneurism, that gives very severe pain to the back and, and really needs to be seen immediately as it is life threatening. There can be some other serious causes. Back pain can be caused by metastatic disease to the bone from a cancer somewhere, so that needs to be investigated. There is something called multiple myeloma that could cause severe low back pain. The other thing is a nerve compression, or slip disk, and usually these heal on their own but there is a condition where it can actually interrupt the nerve supply to the bowel and bladder, and that could be a surgical emergency that needs to be immediately taken care of. Low back pain and loss of bladder control or loss of bowel control would be a definite warning sign of needing an immediate visit to an emergency room.
What diagnostic tests should be ordered?
For low back pain there are a series of basic tests to do, I think basically a blood count, looking for a high white blood count would indicate infection or something very abnormal going on, a urinalysis, again the kidneys are in the back and if the kidneys are inflamed or infected that would show up on a urinalysis, so those are some basic, fairly inexpensive tests. X-Rays are ok if there is a history of injury. If somebody fell off a ladder or fell down, you may see a fracture on an X-Ray. The best test however would be something like an MRI or CT scan but mainly the MRI would pick up a disk or something of that magnitude. Those usually aren’t done from the emergency room, as they are not emergency procedures, but if the back pain didn’t get better in a few days with conservative therapy that would be the next step. Usually most people will go on the history, the physical examination and if there are no signs of nerve compression or damage they will usually treat it conservatively, and it will get better.
How is the pain managed?
For the low back pain that doesn’t have any complications, you would treat it like any athletic injury – you would start with cold and maybe move to heat and that would increase blood supply. You would definitely not want to lay in bed all the time, and studies have shown that if you lay in bed the back pain actually persists longer, so getting up and moving, and there are some specific low back exercises that strengthen the abdominal wall that actually help the back get better more quickly – being active is better, it may hurt but it is still better. Basically the pain medicines to use in most people’s cabinets you would start with something like acetaminophen which is very easy on the stomach, has very few complications, you just can’t go over 4g per day because that can cause liver problems, and especially if you drink or have any liver injury, but that is by and far the safest medicine. The others are called non-steroidal anti-inflammatory agents, and the most common one I think would be ibuprofen, and taking 800mg usually three times a day gives an anti-inflammatory effect and a pain fighting effect, you just have to be careful about stomach injury, stomach bleeding. It also blocks platelets which prevents clotting problems which can lead to bleeding problems. So those are the downsides of the non steroidals. You can actually use acetaminophen and the NSAIDs (non-steroidal anti-inflammatory drug) together so you can alternate and a lot of people don’t know that, but it actually works because they work on two different pathways that you can get the maximal effect by using one from each class, the acetaminophen and something like ibuprofen.
Are there any methods to prevent lower back pain?
There are some very good preventative measures for preventing low back pain. One is weight loss. A second is strengthening the abdominal muscles, because these support the back; there are some excellent back exercises that will help keep it limber and keep it from spasming that can be found on the internet.
If I had severe low back pain…
If I did have severe low back pain that was excruciating, I would want to go see an emergency room doctor or my regular doctor, and the warning signs of it being very serious include loss of sensation, loss of bladder control, loss of bowel control, severe pain from the stomach radiating back to the back, those all need to be seen immediately. High fever would be another thing. Any pain that cannot really be relieved with home medication should be seen a physician.