Chronic low back pain (CLBP) is a leading cause of pain and disability. Lower back pain accounts for 11% of total disability. Between 60% and 80% of individuals will experience lower back pain (LBP) at some point. While the prevalence of LBP has changed little over the years, the associated disability has increased fourfold. Various pain generators can cause CLBP, including the discs, facets, vertebral endplates, muscles, and ligaments. A few causes are listed below:
- Muscle or ligament strain
- Herniated or bulging discs
- Degenerative disc disease
- Facet joint arthropathy
- Sacroiliac joint dysfunction
- Spondylolisthesis
- Scoliosis or kyphosis
- Osteoarthritis or rheumatoid arthritis
- Poor posture
- Lack of exercise: weak core muscles
- Stress: can lead to muscle tension in the back
Assessment and Diagnosis:
To effectively understand and treat lower back pain, a thorough evaluation is essential for identifying the underlying cause. This includes the following components:
- A comprehensive history and assessment are vital
- Investigations: MRI, X-ray, CT scan, ultrasound
- Follow-up for a personalised multimodal management plan
- Review of the agreed-tailored pathway outcomes
Multimodal Treatment:
Treatment varies depending on the underlying cause and may include:
- Initiating oral analgesics
- Physiotherapy for strengthening core muscles
- Spinal injections to the medial branches of the facet joints and the sacroiliac joint
- Radiofrequency denervation or ablation of the medial branches of the facet joints and the sacroiliac joint
- Psychological support: stress management, cognitive behavioural therapy (CBT)
- Surgical consultation, if necessary
