Low Back Pain Case Study
This 29 years old patient’s main complaint is low back pain. Alex’s low back problem initiated 4 years ago and it has been bothering him since then. Low back pain is pain, muscle tension, or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain and is defined as chronic when it persists for 12 weeks or more (Chou, 2011).
Low back pain should be considered a symptom that is rarely attributable to a specific disease or pathologic lesion (Seller and Symons, 2012). It is most often caused by mechanical impact to include postural backache, acute lumbosacral strain, degenerative lumbosacral arthritis. Other causes include sciatica, lumbar spinal stenosis and chronic low back pain. Non-specific …show more content…
low back pain is pain not attributed to a recognisable pathology (such as infection, tumour, osteoporosis, rheumatoid arthritis, fracture, or inflammation).
Regardless of the cause, backache is most common in patients between 20 and 50 years of age (Seller and Symons, 2012). The condition affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back (National Institute of Clinical Excellence, 2009). Back pain currently costs the NHS and community care services more than £1 billion each year.
Alex describes his pain as constant, dull to moderate which did not happen after a specific incident, it rather developed slowly over a period of time. Previous rugby injuries might have caused micro tears in the tissues and contributed to the back problem. Alex does not have any pain in his legs or buttocks, no pins and needles, numbness or stiffness, therefore sciatica and spondylosis are unlikely. Spinal stenosis can also be excluded as it mostly occurs in those aged 60 or over (patient.co.uk, 2009). Degeneration of spinal discs is also unlikely to be the case for Alex because it is an age related disease, it takes decades of repeated daily stresses on the spine and occasional minor, unnoticed injuries, as well as major ones, to develop related symptoms.
Several lifestyle factors contribute to this patient’s chronic, non-specific lower back problem. First of all, the patient’s Body Mass Index (BMI) is 35.3 which is classified as obesity. BMI and height have been linked to the pathogenesis of low back pain (Hershkovich et al,2013). The worldwide prevalence of obesity has nearly doubled between 1980 and 2008 (Global Health Observatory, 2008). The key findings of the Health Survey for England (2011) show that in 2011, just under a quarter of men (24%) and just over quarter of women (26%) were obese, and 41% of men and 33% of women were overweight. In comparison 34% of men and 39% of women had a BMI in the normal range.
Meta-analysis of 33 studies indicated that overweight and obesity increase the risk of low back pain (Shiri et al, 2009). Overweight and obesity have the strongest association with seeking care for low back pain. Obesity not only contributes to the patient’s low back pain, but it also increases the risk of high blood pressure, heart disease and cancer.
Treatment of obesity involves most of all changes in diet, a reduction in calorie intake by 600 kcal is recommended (NHS Choices, 2012). Cutting down on fat and sugar, increasing fresh fruit and vegetable intake and introducing moderate-intensity exercise can help to loose excess weight. There are many anti-obesity medications available, but so far only Orlistat has been proved to be safe and effective (Drew et al, 2007). Orlistat reduces the absorption of undigested fat into the body by one - third. Orlistat could be the short term treatment for Alex to stop further weight gain. However permanent lifestyle changes (diet and exercise) would provide long term results.
Sedentary lifestyle and lack of exercise are another major contributors to non-specific low back pain. Study on the role of obesity and physical activity in non-specific and radiating low back pain found that both obesity and low level of physical activity are independent risk factors and moderate level of physical activity is recommended for the prevention of low back pain, especially in obese individuals (Shiri et al, 2013).
Alex spends most of his day at work on his feet and bends down, the repetitive work, the excess weight put more pressure on discs and joints resulting in pain and discomfort. Work related back problems are common especially in office workers and manual labourers. An above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather (Schneider et al, 2006).
Psychological wellbeing plays an important role in the occurrence of back pain. Pain and depression are closely related. Depression can cause pain — and pain can cause depression. There is some evidence demonstrating the link between back pain and depression, where individuals with chronic low back pain are at high risk to experience anxiety and depression (Sagheer et al, 2013).
Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments. For chronic back pain, several treatments are recommended. Lifestyle changes such as loosing excess weight and exercise can play major role in reducing back pain. Medical treatment of chronic back pain include painkillers and anaesthetic or steroid injections (NHS Choices, 2013). If the above treatments do not work, patients may be offered antidepressants or counselling, since how they think or feel about the condition can make it worse. Spinal surgery is considered in chronic pain, when all else has failed.
Alex’s life has changed from an active socialising and drinking with friends to a more sedentary life, he staying at home and drinks on his own in front of TV. The excess alcohol he has been consuming along with obesity have likely caused raised blood triglyceride level. Triglycerides are a type of fat found in the blood that body uses for energy. Some triglycerides are needed for good health, but high triglycerides – called hypertriglyceridemia (200 mg/dL and above) can raise the risk of heart disease, diabetes, stroke and may be a sign of metabolic syndrome (webmd.com, 2010). Hypertriglyceridemia is usually asymptomatic until triglycerides are greater than 1000-2000 mg/dL (Medscape, 2013). However some symptoms may occur (pain in the mid-epigastric, chest, or back regions; nausea, vomiting). Diet and lifestyle changes can help with lowering triglyceride level and those include staying at a healthy weight, limiting fats and carbohydrates in diet, being more active, reducing alcohol intake. Medications are recommended in those with high levels of triglycerides, with fibrates being recommended first (Berglund et al, 2012).
REFERENCES
Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, Stalenhoef ANH (2012).
Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97: 2969–89.
Chou R (2011) Low back pain (chronic). American family physician. 84: 437.
Drew BS, Dixon AF, Dixon JB (2007) Obesity management: Update on orlistat. Vasc Health Risk Manag. 3: 817–821.
Global Health Observatory (2008) [Online] Available at http://www.who.int/gho/ncd/risk_factors/obesity_text/en/ Accessed 10/12/13
Health Survey for England 2011 (2011). Health, social care and lifestyles. Summary of key findings. University College London.
Hershkovich O, Friedlander A, Gordon B, Arzi H, Derazne E, Tzur D, Shamis A, Afek A (2013) Associations of Body Mass Index and Body Height With Low Back Pain in 829,791 Adolescents. American Journal of Epidemiology. 178:603-609.
Medscape (rev. 05/11/13) Hypertriglyceridemia. [Online] Available at http://emedicine.medscape.com/article/126568-overview Accessed 10/12/13
National Institute for Health and Clinical Excellence (2009) Low back pain: Early management of persistent non-specific low back pain. [Online] Available at http://publications.nice.org.uk/low-back-pain-cg88 Accessed …show more content…
10/12/13
NHS Choices (rev.21/02/2013) Back pain. [Online] Available at http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx Accessed 09/12/13
NHS Choices (rev.05/03/12) Obesity. [Online] Available at http://www.nhs.uk/Conditions/Obesity/Pages/Treatment.aspx Accessed 11/12/13 Sagheer MA, Khan MF, Sharif S (2013) Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre.
J Pak Med Assoc. 63:688-90.
Shiri R, Karppinem J, Leino-arias P, Solovieva S, Viikari-Juntura E (2009) The Association Between Obesity and Low Back Pain: A Meta-Analysis. American Journal of Epidemiology.171:135-154
Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis and Rheumatism. 42:640–650
Seller RH, Symons AB (2012). Differential Diagnosis of Common Complaints (6th edition). Philadelphia: Elsevier Saunders.
Schneider S, Lipinski S, Schiltenwolf M (2006) Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany. Eur Spine J.15: 821–833.
Patient.co.uk (rev.11/12/2009) Lumbar spine stenosis. [Online] Available at http://www.patient.co.uk/doctor/lumbar-spinal-stenosis Accessed 10/12/13
Webmd.com (rev. 09/12/10) High Triglycerides – Overview. [Online] Available at http://www.webmd.com/cholesterol-management/tc/high-triglycerides-overview Accessed
07/12/13
Low back pain should be considered a symptom that is rarely attributable to a specific disease or pathologic lesion (Seller and Symons, 2012). It is most often caused by mechanical impact to include postural backache, acute lumbosacral strain, degenerative lumbosacral arthritis. Other causes include sciatica, lumbar spinal stenosis and chronic low back pain. Non-specific …show more content…
low back pain is pain not attributed to a recognisable pathology (such as infection, tumour, osteoporosis, rheumatoid arthritis, fracture, or inflammation).
Regardless of the cause, backache is most common in patients between 20 and 50 years of age (Seller and Symons, 2012). The condition affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back (National Institute of Clinical Excellence, 2009). Back pain currently costs the NHS and community care services more than £1 billion each year.
Alex describes his pain as constant, dull to moderate which did not happen after a specific incident, it rather developed slowly over a period of time. Previous rugby injuries might have caused micro tears in the tissues and contributed to the back problem. Alex does not have any pain in his legs or buttocks, no pins and needles, numbness or stiffness, therefore sciatica and spondylosis are unlikely. Spinal stenosis can also be excluded as it mostly occurs in those aged 60 or over (patient.co.uk, 2009). Degeneration of spinal discs is also unlikely to be the case for Alex because it is an age related disease, it takes decades of repeated daily stresses on the spine and occasional minor, unnoticed injuries, as well as major ones, to develop related symptoms.
Several lifestyle factors contribute to this patient’s chronic, non-specific lower back problem. First of all, the patient’s Body Mass Index (BMI) is 35.3 which is classified as obesity. BMI and height have been linked to the pathogenesis of low back pain (Hershkovich et al,2013). The worldwide prevalence of obesity has nearly doubled between 1980 and 2008 (Global Health Observatory, 2008). The key findings of the Health Survey for England (2011) show that in 2011, just under a quarter of men (24%) and just over quarter of women (26%) were obese, and 41% of men and 33% of women were overweight. In comparison 34% of men and 39% of women had a BMI in the normal range.
Meta-analysis of 33 studies indicated that overweight and obesity increase the risk of low back pain (Shiri et al, 2009). Overweight and obesity have the strongest association with seeking care for low back pain. Obesity not only contributes to the patient’s low back pain, but it also increases the risk of high blood pressure, heart disease and cancer.
Treatment of obesity involves most of all changes in diet, a reduction in calorie intake by 600 kcal is recommended (NHS Choices, 2012). Cutting down on fat and sugar, increasing fresh fruit and vegetable intake and introducing moderate-intensity exercise can help to loose excess weight. There are many anti-obesity medications available, but so far only Orlistat has been proved to be safe and effective (Drew et al, 2007). Orlistat reduces the absorption of undigested fat into the body by one - third. Orlistat could be the short term treatment for Alex to stop further weight gain. However permanent lifestyle changes (diet and exercise) would provide long term results.
Sedentary lifestyle and lack of exercise are another major contributors to non-specific low back pain. Study on the role of obesity and physical activity in non-specific and radiating low back pain found that both obesity and low level of physical activity are independent risk factors and moderate level of physical activity is recommended for the prevention of low back pain, especially in obese individuals (Shiri et al, 2013).
Alex spends most of his day at work on his feet and bends down, the repetitive work, the excess weight put more pressure on discs and joints resulting in pain and discomfort. Work related back problems are common especially in office workers and manual labourers. An above-average prevalence was identified for occupations associated with physically strenuous work involving one-sided postures, moving, carrying and holding heavy weights, and work typically performed in poor conditions or bad weather (Schneider et al, 2006).
Psychological wellbeing plays an important role in the occurrence of back pain. Pain and depression are closely related. Depression can cause pain — and pain can cause depression. There is some evidence demonstrating the link between back pain and depression, where individuals with chronic low back pain are at high risk to experience anxiety and depression (Sagheer et al, 2013).
Most cases of back pain that last no longer than six weeks can be treated with over-the-counter painkillers and home treatments. For chronic back pain, several treatments are recommended. Lifestyle changes such as loosing excess weight and exercise can play major role in reducing back pain. Medical treatment of chronic back pain include painkillers and anaesthetic or steroid injections (NHS Choices, 2013). If the above treatments do not work, patients may be offered antidepressants or counselling, since how they think or feel about the condition can make it worse. Spinal surgery is considered in chronic pain, when all else has failed.
Alex’s life has changed from an active socialising and drinking with friends to a more sedentary life, he staying at home and drinks on his own in front of TV. The excess alcohol he has been consuming along with obesity have likely caused raised blood triglyceride level. Triglycerides are a type of fat found in the blood that body uses for energy. Some triglycerides are needed for good health, but high triglycerides – called hypertriglyceridemia (200 mg/dL and above) can raise the risk of heart disease, diabetes, stroke and may be a sign of metabolic syndrome (webmd.com, 2010). Hypertriglyceridemia is usually asymptomatic until triglycerides are greater than 1000-2000 mg/dL (Medscape, 2013). However some symptoms may occur (pain in the mid-epigastric, chest, or back regions; nausea, vomiting). Diet and lifestyle changes can help with lowering triglyceride level and those include staying at a healthy weight, limiting fats and carbohydrates in diet, being more active, reducing alcohol intake. Medications are recommended in those with high levels of triglycerides, with fibrates being recommended first (Berglund et al, 2012).
REFERENCES
Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, Stalenhoef ANH (2012).
Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97: 2969–89.
Chou R (2011) Low back pain (chronic). American family physician. 84: 437.
Drew BS, Dixon AF, Dixon JB (2007) Obesity management: Update on orlistat. Vasc Health Risk Manag. 3: 817–821.
Global Health Observatory (2008) [Online] Available at http://www.who.int/gho/ncd/risk_factors/obesity_text/en/ Accessed 10/12/13
Health Survey for England 2011 (2011). Health, social care and lifestyles. Summary of key findings. University College London.
Hershkovich O, Friedlander A, Gordon B, Arzi H, Derazne E, Tzur D, Shamis A, Afek A (2013) Associations of Body Mass Index and Body Height With Low Back Pain in 829,791 Adolescents. American Journal of Epidemiology. 178:603-609.
Medscape (rev. 05/11/13) Hypertriglyceridemia. [Online] Available at http://emedicine.medscape.com/article/126568-overview Accessed 10/12/13
National Institute for Health and Clinical Excellence (2009) Low back pain: Early management of persistent non-specific low back pain. [Online] Available at http://publications.nice.org.uk/low-back-pain-cg88 Accessed …show more content…
10/12/13
NHS Choices (rev.21/02/2013) Back pain. [Online] Available at http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx Accessed 09/12/13
NHS Choices (rev.05/03/12) Obesity. [Online] Available at http://www.nhs.uk/Conditions/Obesity/Pages/Treatment.aspx Accessed 11/12/13 Sagheer MA, Khan MF, Sharif S (2013) Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre.
J Pak Med Assoc. 63:688-90.
Shiri R, Karppinem J, Leino-arias P, Solovieva S, Viikari-Juntura E (2009) The Association Between Obesity and Low Back Pain: A Meta-Analysis. American Journal of Epidemiology.171:135-154
Shiri R, Solovieva S, Husgafvel-Pursiainen K, Telama R, Yang X, Viikari J, Raitakari OT, Viikari-Juntura E (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis and Rheumatism. 42:640–650
Seller RH, Symons AB (2012). Differential Diagnosis of Common Complaints (6th edition). Philadelphia: Elsevier Saunders.
Schneider S, Lipinski S, Schiltenwolf M (2006) Occupations associated with a high risk of self-reported back pain: representative outcomes of a back pain prevalence study in the Federal Republic of Germany. Eur Spine J.15: 821–833.
Patient.co.uk (rev.11/12/2009) Lumbar spine stenosis. [Online] Available at http://www.patient.co.uk/doctor/lumbar-spinal-stenosis Accessed 10/12/13
Webmd.com (rev. 09/12/10) High Triglycerides – Overview. [Online] Available at http://www.webmd.com/cholesterol-management/tc/high-triglycerides-overview Accessed
07/12/13