LOWER BACK PAIN IN THE ELDERLY

The prevalence of low back pain is estimated to be more than 70% and is the most frequently reported musculoskeletal problem, in the population over 75 years of age. For 5 to 10% it can be a serious problem. Lower back pain can be acute or chronic in nature. Acute pain lasts less than 3 months and chronic may last for more than 3 to 6 months. Lumbar pain among senior citizens lasting more than week should be investigated and should not be neglected.

Symptoms

• A heightened pain in the mornings and in the evening in the Lower back pain and stiffness.
• Disrupted sleep due to pain.
• A tenderness when the area of the spine is pressed.
• Pain in the lower back that is increases on extended activity.
• Finding relief quickly after sitting down.
• loss of flexibility in the back.
• Developing leg pain while walking a small distance.
• Height loss.
• Deformity and disability.

Causes

• Facet joint osteoarthritis or degenerative arthritis or osteoarthritis of the spine, is a degenerative joint disease that due to the degradation of joints, articular cartilage and subchondral bone, as a result of mechanical stress on the area, over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine.
• Fever with back pain could mean possibly a serious infection, such as epidural abscess, septic diskitis, osteomyelitis, bacteremia, or bacterial endocarditis.
• Prolonged back pain with weight loss or anorexia could be an indication of the presence of a malignancy, particularly in people with a history of cancer.
• Low back pain could be a sign of Metastatic cancer too, which is a cancer that spreads to other parts of the body, starting from the part of the body where it started.
• Spinal compression fracture could be a cause of back pain, especially in post-menopausal women with osteoporosis. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.
• A bowel or bladder dysfunction raises the probability of spinal cord disease, and that could be a cause of lower back pain.
• Some medications too have Low back pain as an adverse effects. For example, if you are taking corticosteroid medications, the back pain may be related to a vertebral compression fracture. Anticoagulant drugs may also lead to low back pain caused by retroperitoneal hemorrhage.

Diagnosis

• Firstly, the Medical practitioner will initiate an Initial Observation. The location of the pain, its occurrence, its duration, etc. are firstly noted.
• The Physical Examination is the next step towards diagnosis. The goal of the examination is obtain key information to confirm or reorient the initial clinical impression.
• Diagnostic studies are conducted further, if the treatment resorted to with the initial diagnosis does not help. This would help to confirm if any injury is the cause of the back pain. This would be particularly useful to pinpoint the source and extent of the injury to assist in the diagnosis and development of an appropriate treatment plan for your back problems. This would include:
  • X-ray
  • CT Scan
  • CT Scan with Myelogram
  • Electromyography
  • Somatosensory Evoked Potentials
  • Discogram
  • Bone Scan
  • DEXA Scan

Treatment

Once your back pain cause is determined, the pain could be treated in three ways —

• with medications,
• therapeutic treatments or “physical medicine,” and
• surgery, either singly or in combination.

Medications for back pain relief include:

• Aspirin or acetaminophen
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
• Steroids, which can be injected or taken orally
• Narcotics such as codeine or morphine

Therapeutic Treatments or Physical medicine include:

• Rest or restricting certain activities
• Physical therapy, including active therapy (stretching, weight lifting, aerobics) and passive therapy (heat, ice, massage, ultrasound, electrical stimulation.)
• Braces, usually wrapped around the back and stomach
• Chiropractic or manipulation therapy
• Traction (although scientific evidence of its effectiveness is lacking)
• Stress relief such as Pilates, yoga, or meditation
• Alternative therapies like Ayurveda & Accupuncture.

Surgery options are:

• Spinal fusion to eliminate the motion between bone segments
• Disk replacement (similar to knee or hip replacement)

If you do experience back pain, even if you think the cause is aging, do not ignore it. It could be a sign of a serious, but a treatable disease. You don’t have to live with back pain. But please keep in mind that you run a higher-than-average risk of side effects from all drugs, including analgesics like nonsteroidal anti-inflammatory drugs (NSAIDs). There is also a risk that any medications may interact with those that you are already on. So please do consult your Doctor.