Acute Lower Back Pain SUUUX!

I should know, I am currently suffering from it :(

Update: am 97% pain-free at time of posting here - total of 6 nurofen, lots of gentle exercise & movement & core strength (thanks to my Pilates instructor - Paddy Coary

Acute (severe / short duration) lower back pain is common in GP land, both in patients & likely us GPs too. Fortunately serious causes are rare, with tumours & fractures accounting for less than 1%. Most acute lower back pain, despite how debilitating & worrying it might seem initially, settles without special investigation, tests or fancy treatments. 70-80% of patients fully recover within 3 months & remain that way at 1 year. Knowing the natural history helps with recovery.

What causes acute lower back pain?

Usually there is no clear diagnosis for the underlying cause of the pain with the severity of pain & degree of immobility not pointing to any one culprit. There are joints, muscles, nerves & discs that can all contribute to the pain you are feeling but isolating the specific cause is usually not possible and not at all necessary for recovery.

Why doesn't my GP order an x-ray? I'm in so much pain!

Severe pain does not mean you need imaging such as an xray, CT or MRI more than someone with mild pain. Severity of the pain does not indicate how serious the cause is at all. In fact, if you have non-specific acute lower back pain that does not have any red flags (warning signs), performing imaging does not make you recover faster and, in fact, can make you do worse than someone who does not have an xray; not to mention the exposure to radiation. This is why the Royal Australian and New Zealand College of Radiologists recommends AGAINST imaging in non-serious lower back pain.

What are the red flags/ warning signs in acute lower back pain?

Features that may suggest that you have a more serious cause of lower back pain include: - age > 70 years - trauma/ accident - history of certain medications - history of or current cancer - fever - flu-like symptoms - recent dental work or operation - weakness in the lower limbs or loss of bladder function

If you have any of these, seek medical attention urgently. It is always a good idea to see your GP for any acute lower back pain for full assessment.

What can I do to recover?

See your GP for assessment and management. For non-serious acute lower back pain, light activity will not harm the spine and aids with recovery. Bed rest is NO recommended and normal activities should be resumed as soon as tolerated. Remaining active as possible is KEY for recovery. For example, I went for a run yesterday & today and despite some BAD grabbing moments of pain, I am already feeling the benefit of keeping the spine moving. I also like to do pilates for my back - for prevention. There is some evidence (low-moderate quality) that pilates is effective although it is similar to other forms of exercise, so your preferred exercise is best.

Should I take pain relief medications?

The evidence for pain relief in acute lower back pain is not strong. Pain relief can be used but should be for the least amount of time possible. See your GP to discuss appropriate pain relief medications for you. In the first 48 hrs, continuous low level heat wrap therapy has been shown to be more efficacious than over the counter medications. So try a heat pack - just don't burn yourself.

What about massage or spinal manipulation?

The evidence for spinal manipulation is conflicting and it is not clear that it is better than placebo in the short term for acute lower back pain. In the longer term, it has not been shown to be more effective than self rehabilitation. Massage therapy has similar pain relieving effects to exercise & education and is superior to placebo in the first 3 weeks.

When should I see my doctor again?

Most patients will be improving after a few days to weeks. You should check in with you GP if you are not improving after 4 weeks or sooner if worsening, urgently if you have any red flag symptoms listed above.

As for me, I am gradually improving. I might be a bit creaky for the next few days and might avoid crossfit until pain free but keeping active and positive is key to my recovery and yours.

- holly the gee pee Useful links:

Fact Sheet on Back Pain Evidence-base for different types of treatment for back pain:

Royal Australian & New Zealand College of Radiologists recommendations (see point 4)


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