Low Back Pain

Introduction

What is Acute Low Back Pain?

Acute low back pain is pain felt in the lower back that lasts for a short time (i.e. less than three months)

Most people have pain in their low back at some stage in their lives. In most cases, it will get better in several weeks even without treatment; however, this varies from person to person. Acute low back pain may happen again over time and may progress to chronic low back pain, which lasts for more than 3 months.

Causes

What Causes Acute Low Back Pain?

In around 95% of cases it is actually not necessary to know the specific cause and yet the pain can be managed effectively. Most of the time the pain is due to muscles strains. It is rare for the pain to be caused by a serious medical problem. 90% of patients recover from the pain in 6 weeks.

What Should I Do When I Have Acute Low Back Pain?

If your pain bothers you, it is important to see your doctor, to work with them to manage your pain, and to stay active.

Visiting The Pain Physician/Doctor

A history and physical examination are needed to assess for any serious medical conditions that may be associated with your pain, although these are rare.

They can provide you with information about your pain once they have assessed you.

Additional investigations such as x-rays and blood tests, are not needed in the majority of cases of acute low back pain. They do not help with your pain or your ability to move your back.

It is normal to worry about the cause of your pain and the impact it may have on you. Talking to your doctor or specialist about your concerns can be helpful. You will usually find there is no serious cause and that there are ways to relieve your symptoms.

The goal of the consultation is to help you find ways to manage your pain and return to your usual activities.

Most people find that the pain settles down over a short period of time as healing occurs. Pain-relieving measures may help you cope with your symptoms while nature takes its course.

Medications that you can be prescribed include paracetamol, anti-inflammatory medications, and muscle relaxants.

Stay active!

Your pain may make it difficult for you to carry out your usual activities, and you may even want to rest completely.

However, it is important to resume normal activities as soon as possible. Staying active helps to prevent long-term problems.

Symptoms

When Do I Need to See a Pain Physician?

  1. If the pain is not settling down or is getting worse.
  2. If the pain is associated with nerve root pain characterized by:
    • One-sided leg pain going to foot
    • Numbness in the leg
    • Leg pain worsened by bending over or coughing and straining


A Pain Specialist should be consulted with the above symptoms. Back pain, which persists for more than 3 months, is defined as chronic back pain. We will perform a complete initial assessment of the low back pain that typically includes a medical history and physical examination. By asking you certain questions and doing strength and movement tests, we can check for serious underlying conditions, such as fractures, tumours, infection and severe nerve damage and arrive at a diagnosis, sometimes with the help of other investigations.

Treatment

What Treatment Would I Receive?

The Pain Management Centre in Singapore General Hospital has a specialized team, working closely with the other specialties, which can help manage your pain. A multi-pronged approach will be needed to manage chronic back pain involving:

1. Medication

Many patients benefit from medication, which relieves low back pain and reduces inflammation or muscle spasms. Specific Medications maybe prescribed for the treatment of the nerve pain as well.

2. Physiotherapy

This will help relieve the pain using various treatment modalities and they can prescribe specific exercises to strengthen the back muscles. You will need to actively perform the exercises regularly to receive optimal benefits.

3. Interventional Therapy

Mainly in the form of injections, this is used to diagnose and treat the cause of the pain from the different spinal conditions in a procedure suite using guidance from x-rays. Such procedures last for about 30 minutes and are performed under local anaesthesia with mild sedation as a day procedure. You will be fit to go home after one to two hours after observation. You may be referred to an orthopaedic surgeon for a surgical assessment if necessary.