Pain in the low back / mid back region resulting in loss of function. Pain in the back is not only a very common complaint but also is only second to the common cold in sickness absenteeism. It is believed that about 85 % of the general population will have at least one episode of back pain in their lifespan.

The risk factors for low back pain can be:

Aging : as a part of the normal age related degenerative process.

Life style : Stress and emotional tension, poor posture -standing for long periods of time or sitting incorrectly—can cause back pain, heavy physical work, lifting or forceful movement, bending, or awkward positions can really hurt your back.

Injuries and Accidents : Injury to muscle, ligaments, or soft tissue can lead to back pain. Fracture in spinal bone in a fall or a car accident also is a common cause. If you have osteoporosis, a condition that weakens your bones, you’re much more prone to fracturing a bone.

Obesity : Being overweight puts pressure and stress on the back, especially the low back. Carrying excess weight aggravates other health conditions such as osteoporosis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

Back pain is also caused by a specific spinal condition like :

1. Slip disc
2. Spinal stenosis
3. Faceted arthritis
4. Spondylosis
5. Primary spinal tumors
6. Spinal Metastatic tumors
7. Infections
8. Tuberculosis
9. Spinal Fracture
10. Metabolic causes- Osteomalacia

Human Spine is made of up 33 bones (vertebrae) that are cushioned by discs. These vertebrae are divided by region: neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). At the lower end spine ends at the terminal bone of sacrum and the coccyx, which is commonly called your tailbone. Discs are present between these bones. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting. Each disk has two parts – a soft, gelatinous inner portion (nucleus pulp-ous) and a tough outer ring (annulus fibrosis). Facet joints are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help movement and are very important for flexibility. Together, the vertebrae and discs form a tunnel through which the spinal cords and nerve pass. The spine also has muscles, ligaments and blood vessels. Muscles are tissues that act as power generators for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together.

Low back pain – type character, duration, recovery and natural course depend on what is causing pain and where it is affecting your spine. The common complaints as-sociated with back pain are,

• Morning stiffness,
• Spasms,
• Pain in flanks
• Difficulty in sitting, forward bending,
• Pain with prolonged sitting or performing ground-level activities.
• Difficulty in walking and lying down also is a common presentation.
• Associated symptoms with back pain are leg pain,
• Numbness/ weakness in legs,
• Difficulty in passing urine or motion and difficulty in walking.

Most of the back pain patients shall improve with simple pain management measures. however one should Seek medical attention if your back pain persists and seek immediate attention if you have back pain with any of the following emergency signs (RED FLAGS ):

1. Pain is getting significantly worse
2. Pain affects everyday activities
3. Severe symptoms
4. Associated Fever or constitutional symptoms
5. Groin or leg weakness or numbness
6. Arm or hand weakness, tingling, or numbness
7. Loss of bowel or bladder control

There are different options to treat back pain depending on the severity and duration of symptoms .
They may comprise of one or many ;-

1. Drugs & Medications
2. Physical Therapy
3. Spinal Bracing
4. Spinal Injections
5. Spine surgery
6. Physiotherapy

Drugs, Medications, to Relieve Back Pain : Medication alone is not the ultimate solution to your back pain, however during emergency or during severe pain these medicines may help you curb the suffering.

Acetaminophen : Your doctor may call this an analgesic, but most of us refer to acetaminophen me-dications as painkillers. They don’t help reduce inflammation, though.

NSAIDs (non-steroidal anti-inflammatory drugs) : These will help reduce swelling (or inflammation) while relieving your pain; that’s how NSAIDs differ from acetaminophen. If an over-the-counter NSAID is an option for you, you have plenty to choose from. You can use ibuprofen, aspirin; however seek medical advice before you take any medicine.

Muscle Relaxants : If you have chronic back pain caused by muscle spasms, you may need a muscle relaxant, which will help stop the spasms

Anti-depressants : As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they block pain messages on their way to the brain. They can also help increase your body’s production of endorphins, a natural pain killer.

Opioids : In the most extreme cases, and only under careful supervision, you doctor may also prescribe an opioid, such as morphine or codeine.

Medication Warning : As with all medications, you must follow your doctor’s advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor.