Causes of Severe Low Back Pain
Back pain is an uncomfortable and debilitating condition. It is one of the common causes of people’s absence from duties. Severe low back pain can be caused by physical injuries, strenuous physical activities, and some serious medical conditions.
Back pain can occur at any age, but older people are at more risk of back pain. Some serious medical causes of low back pain include cauda equina syndrome, cancer of the spine, osteomyelitis of the vertebral bones, and abscess formation in the spinal epidural space. A detailed description of these serious medical causes of back pain is in the following section. Above all, these issues will cause severe low back pain and should be quickly addressed by a pain management specialist.
1: Cauda Equina Syndrome
Firstly, Cauda Equina is the bundle of nerves that arises from the terminal part of the spinal cord. Cauda Equina Syndrome is the condition of extreme pressure or swelling on the bundle of cauda equina. A lumbar herniated disc is the common condition that leads to cauda equina syndrome. Symptoms of the cauda equina syndrome may develop acutely as well as gradually.
In acute onset, there is severe pain in the back. This back pain can also extend to sensory and motor loss of the lower body. There is also acute impairment of bladder and bowel function.
In the gradual onset of cauda Equina symptoms, there is recurrent back pain. The associated symptoms of the gradually occurring back pain are the same as that of acute back pain of Cauda Equina. However, the associated symptoms occur over time in gradually occurring cauda equina syndrome.
The preferred treatment for cauda equina syndrome is surgical decompression of the cauda equina. A surgical decompression performed within 24-48 hours after symptoms’ onset gives the most satisfactory results.
2: Cancer of Spine
Did you know cancer could infect your spinal cord? Cancer of the spine can be of the spinal origin, but most cancers of the spine occur due to metastasis of other cancers such as myeloma. Cancer of the spine causes tumor formation. This tumor compresses the nerves originating from the spinal cord at that level. This leads to back pain in the region of the tumor. The pain can also radiate along the pathway of spinal nerves. The back pain caused by spinal cancer usually worsens at night.
The treatment options of spinal cancer are the same as that of any other cancer. These options include chemotherapy, radiation treatment, and surgical removal of the tumor.
3: Vertebral Osteomyelitis
Thirdly, Vertebral Osteomyelitis is the infection of the vertebral column. The infections of the vertebral column are rare, but blood and lymph can carry the infection to the vertebral column. However, the pain caused by vertebral Osteomyelitis is often severe and needs treatment immediately. When an inflection reaches the vertebral column, it causes inflammation. There is the release of prostaglandins, bradykinin, and other pain mediators. These pain mediators increase the pain sensitivity of spinal nerves.
The treatment of Osteomyelitis is the resolution of underlying infection. Antibiotics are given according to the type of infection.
4: Epidural Abscess
Lastly, there is a space between the dura mater (membrane covering the vertebrae) called epidural space. Epidural abscess is the severe pyogenic infection of this epidural space. An infection of this space can cause direct compression of vertebrae and nerves originating from the spinal cord at the point of infection. It can also cause local ischemia because the blood vessels of the spine are in the epidural space. This compression and ischemia of vertebrae and nerves cause severe back pain. It is necessary to treat this condition immediately. That is to say usual treatment is the combination of strong antibiotics to subside the infection as early as possible.
Diagnosis of Severe Low Back Pain
You may not know how severe low back pain is diagnosed if you haven’t gone to a specialist for your pain yet. When back pain is diagnosed it involves imagining techniques and spinal fluid cultures.
That is to say different imagining techniques such as X-ray and MRI are used to look for any tumor, disc slip, or other compressive mass. The culture of the spinal fluid is done to find out any infection.
Treatment
The specific treatments of each cause have been described above. However, general analgesics such as NSAIDs, and opioids, are often given to overcome the pain and specific treatment of the cause.
Conclusion
Back pain is a common condition that can be debilitating sometimes. There are different medical causes of back pain, such as cauda equina syndrome. These medical conditions cause back pain either by compression or ischemia of the vertebrae and spinal nerves. The diagnosis of the cause of back pain is made by imagining techniques and spinal fluid cultures. The treatment of back pain varies according to the specific type of cause. However, general pain killers are used irrespective of the type of cause.
References
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2: Bartleson J. D. (2001). Low Back Pain. Current treatment options in neurology, 3(2), 159–168. https://doi.org/10.1007/s11940-001-0051-4
3: Borenstein D. G. (1996). Chronic low back pain. Rheumatic diseases clinics of North America, 22(3), 439–456. https://doi.org/10.1016/s0889-857x(05)70281-7
4: Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ (Clinical research ed.), 332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430
5: Shemshaki, H., Nourian, S. M., Fereidan-Esfahani, M., Mokhtari, M., & Etemadifar, M. R. (2013). What is the source of low back pain?. Journal of craniovertebral junction & spine, 4(1), 21–24. https://doi.org/10.4103/0974-8237.121620
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