Herald Café: In your estimate, what percentage of
adults has Low Back Pain?
Dr Sambprassad Nadkarni: Low Back Pain (LBP) is a very common presentation to orthopaedic
OPDs. It is estimated that about 80-85% of adults experience LBP at some point in
their lifetime. About 30% of patients visiting ortho OPDs are either due to
back or neck pains.
HC: What are the causes
for back pain?
Dr SN: Causes for back pain
include minor sprains and strains; lumbar spondylosis; prolapsed disc (slip
disc); degenerative spinal disease; scoliosis; infections like tuberculosis
(not uncommon in India); osteoporosis; tumours; metabolic bone diseases
(deficiency of Vitamin D, diabetes, hypothyroidism, etc); fractures; referred
pain from kidneys, bladder, ovaries, uterus, gut and other pelvic organs and
psychological / stress.
Back pain is also
sometimes associated with patients having length discrepancies or arthritis of
joints of lower limbs.
HC: Has LBP become more
common lately? If so, what are the reasons?
Dr SN: Yes, LBP is on the
rise. This is mainly due to increase in geriatric population, increase in
metabolic conditions like diabetes, hypothyroidism etc. Obesity sedentary
lifestyle and work stress also contribute to the recent increase in cases of
LBP.
HC: Does long driving or
lifting heavy weights cause / worsen back pain?
Dr SN: Long distance
driving, especially heavy vehicles and earth-moving machinery are associated
with LBP. Lifting heavy weights, travelling long distances and bending can
aggravate pre-existing back pain.
HC: When should one
consult doctor?
Dr SN: Any back pain lasting
more than a couple of weeks; severe and capacitating back pains; presence of
night pains; back pain at rest; low back pain in children; pain associated with
weakness in lower limbs; urinary disturbances need immediate medical
consultation.
HC: Which are the
dangerous signs?
Dr SN: Back pain associated
with weakness of lower limbs, urine retention, rest pain and that associated
with constitutional symptoms like fever, weight loss, should be investigated.
Any pain in mid back
or any back pain in children always needs to be viewed seriously.
HC: How would you
diagnose LBP?
Dr SN: Low Back Pain is
diagnosed on the basis of clinical history and detailed clinical examination.
Besides, blood tests and radiological investigations like X rays, CT scans and
MRI help in confirming the diagnosis. MRI is considered the gold standard in
diagnosing causes of back pain.
HC: What are the various
remedies for LBP?
Dr SN: Most back pains can
be managed with rest, avoiding strenuous activities, application of heat/ ice
and mild painkillers with muscle relaxants. Some may require physiotherapy,
correction of posture, core strengthening exercises and lumbar supports. Still
others may need epidural pain blocks and psychological counselling. A small
proportion of patients, especially those who have signs of spinal cord or nerve
compression, require surgical intervention.
HC: Do traction, massage
and alternative therapies have any role?
Dr SN: Light massage and
traction can help relieve pain due to spondylosis or muscle spasms.
HC: Can a surgery be
avoided in ‘slipdisc’?
Dr SN: Most of us are under
the impression that low back pain is synonymous with a slipped disc. However,
classical slipped disc is the cause for LBP only in a small proportion of
patients. Contrary to belief, more than 90% of patients settle down with
conservative management over a period of 4-6 weeks. However, patients who
present with neurological deficit (weakness of muscles of the leg or bladder
paralysis) are more likely to benefit from surgical decompression.
HC: How can one prevent
the recurrence of LBP?
Dr SN: A healthy diet, regular aerobic exercises,
core strengthening exercises, maintaining BMI, proper posture, adequate sleep
is the mantra for a strong and healthy back.
