The low back pain, sometimes also called lumbago are general terms that refer to lower back pain, and the two terms are used interchangeably.
The underlying causes of low back pain can be complex and are not always obvious.. When looking to determine the underlying cause of lower back pain, two main factors help guide the doctor to make a preliminary diagnosis:
- The type of lower back pain – lo que significa una descripción de cómo se siente el dolor, what makes it better or worse, When it occurs, and
- The area of pain distribution – es decir, where do you feel the pain, if it is limited to the lower back, or if the accompanying leg pain is worse than the lower back pain, or if the pain radiates to other parts of the body.
This article is intended to help patients understand how physicians assess the area of pain distribution to help diagnose the source of a patient's low back pain and determine initial treatment options..
Index
Principles of low back pain
Before discussing the specific types of lower back pain, it is important to understand some important principles.
Pain does not always reflect the magnitude of the damage. The severity of pain from back problems, often unrelated to the extent of physical damage present.
For instance, a simple tear in a lower back muscle can cause excruciating pain that can limit the ability to walk or even stand, while even a great herniated disc can be totally painless.
Diagnosis is often difficult. There are many anatomical structures in the lower back that can cause severe back pain and / or pain that radiates to the legs and / or feet.. These include:
- The soft tissues, as well as the muscles, ligaments and tendons.
- Bones, that provide the structural building blocks of the spine.
- The joints facet, that allow spinal movement
- The discos (the outer edge of the disc, the ring, can be a source of significant lower back pain due to their rich innervation and tendency to suffer damage)
- The nerves that branch from the spinal cord into the lumbar region and innervate the legs and feet
All the above structures are intertwined to form the structure of the spine.
During embryological development there is a high degree of innervation overlap of all these structures, making it almost impossible for the brain to distinguish between the problems of one specific structure versus another..
For instance, a herniated or ruptured disc can feel identical to a bruised muscle or torn ligament.
Diagnostic accuracy is important
Obtaining an accurate diagnosis of the underlying cause of pain, es importante si hay signos de alarma o “banderas rojas” presentes.
These include weakness in the legs, significant numbness, loss of bowel or bladder control, fever or chills or unexplained significant weight loss.
If these symptoms are not present, then conservative treatment can be started without the need for immediate diagnosis with an MRI.
Finally, es importante tener en cuenta que – a diferencia de muchos otros problemas de salud – la experiencia del dolor lumbar tiende a ser diferente para muchas personas.
For instance, two people can have the exact same status, but for one it can be disabling and for the other it is a simple annoyance.
In fact, for most people a spinal abnormality (like a degenerated disc that can be seen on an MRI image) it is painless.
What's more, there are other factors: psychological, emotional and even financial that often contribute to and influence a person's experience of back pain.
Diagnosis and treatment of low back pain
When determining the underlying cause of lower back pain, both in the type of lower back pain (a description of what the pain feels like) and the area of pain distribution (where do you feel the pain) help guide the physician in making a preliminary diagnosis and determining the appropriate treatment plan.
Obtaining an accurate diagnosis of the cause of low back pain is often more difficult than many expect and, will often involve a combination of a thorough history and physical examination, as well as diagnostic tests.
The history and physical examination are used to help determine if a patient's lower back pain is more likely to be caused by soft tissue. (muscle , ligament or tendon ) problem that is likely to heal itself or a more serious underlying medical condition, like a fracture, infection or tumor.
At the moment a doctor will order the diagnostic tests, such as an X-ray or MRI, as they usually have a strong suspicion about the probable cause of the patient's low back pain and the diagnostic test is used to confirm and provide more details.
It is important to note that patients with the following symptoms could have a serious medical condition and should be evaluated immediately:
- Fever and chills
- History of cancer with recent weight loss (or unexplained weight loss)
- severe trauma
- Significant weakness of one or both legs
- Incontinencia intestinal repentina y/o de la vejiga – ya sea dificultad para orinar o defecar, or loss of control of urination or bowel movement
- Severe ongoing abdominal pain combined with back pain.
