Lower Back Pain(LBP)

Lower back pain is a prevalent condition with various management strategies depending on the underlying cause and severity. Here are some key points from recent guidelines and evidence-based practices for managing lower back pain:

Non-Pharmacological Management

1. Exercise Therapy: Regular physical activity and specific exercises are recommended for both acute and chronic low back pain. Exercise helps improve function and reduce pain.

2. Cognitive Behavioral Therapy (CBT): CBT can be beneficial, particularly for chronic low back pain, by addressing psychological factors that may contribute to pain perception and disability.

3. Physical Therapy: Techniques such as manual therapy, spinal manipulation, and other physical modalities can be effective in managing symptoms.

4. Education and Self-Management: Educating patients about the nature of low back pain and encouraging self-management strategies are crucial components of care.

5. Staying Active: Patients are encouraged to remain active and avoid bed rest, as prolonged inactivity can worsen symptoms.

Pharmacological Management

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are commonly used for pain relief in both acute and chronic low back pain.

2. Antidepressants: Certain antidepressants may be prescribed for chronic low back pain, particularly when there is a component of neuropathic pain.

3. Opioids: Generally not recommended for chronic low back pain due to limited benefit and potential for harm. They may be considered in specific cases where other treatments have failed.

Interventional and Surgical Options

1. Interventional Procedures: Options such as epidural steroid injections or radiofrequency ablation may be considered for specific cases, particularly when there is a neuropathic component.

2. Surgery: Reserved for patients with specific pathologies (e.g., herniated disc with nerve compression) who do not respond to conservative treatments.

Multidisciplinary Approach

A comprehensive approach involving multiple healthcare professionals, including physiotherapists, psychologists, and pain specialists, is often necessary for optimal management of chronic low back pain.

These guidelines emphasize a multimodal and individualized approach to treatment, considering the biopsychosocial model of pain. For the most current and specific recommendations, clinicians should refer to the latest clinical practice guidelines from reputable organizations such as the World Health Organization (WHO) and other professional bodies.

Lower back pain itself does not directly cause ocular manifestations. However, certain conditions that involve both lower back pain and ocular symptoms can be considered. Here are a few examples:

1. Ankylosing Spondylitis: This is a type of inflammatory arthritis that primarily affects the spine and can lead to chronic lower back pain. It is also associated with uveitis, an inflammation of the eye that can cause redness, pain, and blurred vision.

2. Reactive Arthritis: This condition can cause inflammation in various parts of the body, including the eyes (conjunctivitis or uveitis) and the lower back. It often follows an infection and can present with both ocular and musculoskeletal symptoms.

3. Autoimmune Diseases: Some autoimmune conditions, such as lupus or rheumatoid arthritis, can cause both joint pain, including lower back pain, and ocular manifestations like dry eyes or uveitis.

4. Infections: Certain infections that cause systemic symptoms, including lower back pain, may also have ocular manifestations. For example, ocular syphilis can present with eye pain and changes in vision alongside other systemic symptoms.

Author

Paddy Kalish OD, JD and B.Arch