Low back pain is extremely common, affecting 60-75% of people. It is defined as pain occurring in the area between the lowest rib and the crease of the buttocks. Mechanical causes such as muscle strains, herniated discs, and arthritis are responsible for 85% of back pain cases. Treatment depends on whether the back pain is acute or chronic. For acute pain, rest, analgesics, muscle relaxants and sedatives are used. For chronic pain, treatments include postural care, lifestyle modifications, exercises, analgesics, muscle relaxants, and physiotherapy. Surgery may be used for conditions like herniated discs, spinal stenosis, and scoliosis. Proper evaluation and a healthy lifestyle are

1. LOW BACK PAIN
DR SABYASACHI BARDHAN
Peerless Hospital

2. EPIDEMIOLOGY
• Extremely common
• 60 to 75% people
• 5 to 15% new cases
• 24 to 80% recurrence
• 35 to 55yrs

3. DEFINITION
Pain that occurs in an area
with boundaries
between the lowest rib
and the crease of the
buttocks

4. Why
Mechanical (85%)
Referred
Rheumatologic
Hematologic
Infectious
Neurologic
Neoplastic
Psychiatric
Endocrinologic
Miscellaneous

5. ANATOMY

6. MECHANICAL BACK PAIN
• Muscle, ligament,
tendon strain
• Discogenic disorders
including herniated
disc
• Apophyseal joint
arthritis
• Spinal stenosis
• Spondylolysis,
spondylolisthesis
• Scoliosis

7. LUMBAR STRAIN
Poor posture
Unaccustomed activity
Localised, nagging pain
Maximum in the morning
and forward bending

8. DISCOGENIC PAIN
Sudden onset severe pain,
shooting nature
Numbness, Weakness

9. SPONDYLOLYSIS
SPONDYLOLISTHESIS
SPINAL STENOSIS SCOLIOSIS

10. OTHERS
INFECTION NEOPLASTIC RHEUMATOLOGICAL ENDOCRINE VISCERAL
TB Spine
Pyogenic
Discitis
Pyogenic
Vertebral
osteomyelitis
Metastasis
Multiple
myeloma
Hemanfioma
Osteoblastoma
Ankylosing
Spondilytis
Rheumatoid arthritis
Low Vit D
High PTH
Renal
Pancreas

11. DIAGNOSIS
Clinical examination
Radiology: X ray, MRI
Blood test
Electrodiagnostic test

12. TREATMENT
ACUTE
• Rest (2 to 5 days)
• Analgesics
• Muscle relaxant
• Sedatives
CHRONIC

13. GENERAL TREATMENT FOR CHRONIC
LBP
• Postural care
• Lifestyle and activity
modification
• Exercise

14. GENERAL TREATMENT FOR CHRONIC
LBP
• Analgesic:
NSAIDS
COX 2 inhibitors
Opoids
• Muscle relaxants
• Pain modulators
• Physiotherapy

15. SPECIFIC THERAPY
DISCOGENIC PAIN
• Exercises
• Life style modification
• Medicines
• Epidural steroid
• Chemonucleolysis
• Surgery: Discectomy

16. SPECIFIC THERAPY
SPONDYLOLISTHESIS
SPINAL STENOSIS
• Conservative therapy:
Exercise, Medicines
Physical therapy
• Surgery

17. SPECIFIC THERAPY
SCOLIOSIS
• Bracing:
Early and mild cases
• Surgery

18. CONCLUSION
• Chronic Low back pain is almost as common as
cough & cold
• Most of them are harmless, but annoying
• Proper evaluation is necessary
• No substitute for healthy lifestyle