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      An Overview on Low Back Pain and Functional Disability: Associated Risk Factors and Management

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            Abstract

            Recently, low back pain (LBP) has been a major contributor to disability worldwide. Chronic LBP affects 80% of the population at some point. The incidence of LBP is on the rise, especially among the elderly, and it is more common in men than in women. The different aspects of one’s life, such as a history of mental illness, being overweight, smoking, not getting enough exercise, getting older, and leading a sedentary lifestyle, all increase the likelihood of developing LBP. According to research, there are a number of causes and contributing factors that add up to a hefty price tag for disabled people. Functional disability in chronic LBP can be caused in part by causes other than the disease itself, such as psychological and professional variables, and can put restrictions on one’s personal life, work life, and family life. According to a recent study, more than 80% of those with a functional disability were classified as having a moderate-to-severe impairment. Therefore, we have proposed this review to clarify the appropriate assessment and interventional modalities for LBP and reduce disability. The diagnosis of LBP may need physical examination as well as imaging procedures to rule out the possibility of other ailments, such as broken bones. There is more than one technique to treat the underlying causes of LBP. Interventions include several modalities, including medication, physical therapy, manual therapy, injections, and surgery. In terms of pain treatment, we could choose between over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and prescribed drugs. Back spasms can be treated with other medications that relax the muscles in the back. Physiotherapy can help an individual build up the core muscles that protect the spine. Physical therapy can help individuals to stay injury-free by doing more than just increasing the range of motion. Tense muscles can be relaxed, pain can be lessened, and posture and alignment can be enhanced through a series of sessions.

            Main article text

            INTRODUCTION

            Recently, low back pain (LBP) has been a major contributor to disability worldwide. Chronic LBP affects 80% of the population at some point. The incidence of LBP is on the rise, especially among the elderly, and it is more common in men than in women. The different aspects of one’s life, such as a history of mental illness, being overweight, smoking, not getting enough exercise, getting older, and leading a sedentary lifestyle, all increase the likelihood of developing LBP (Global Burden of Disease Study [GBD], 2016: Chenot et al., 2017).

            Although injuries to the back muscles and tendons are the most prevalent causes of LBP, many different conditions and accidents can trigger discomfort in the back as well. Injury to the back muscles or tendons is the leading cause of LBP. It is possible that people will experience discomfort to widely different degrees. Pain can make it hard, if not impossible, to do things like getting out of bed, going to work, or completing other routine tasks. In most cases, rest, anti-inflammatory medication, and physical therapy can alleviate lower back discomfort (Chenot et al., 2017).

            It has been suggested that cortisone injections, together with other forms of hands-on therapy such as manipulation by an osteopath or a chiropractor, can help alleviate pain and speed up recovery. Surgical intervention is the only option for treating or mending a variety of back problems and injuries. Back pain could indicate a serious medical issue. LBP affects over 80% of the population at a certain stage in their lives. It is a common reason for people to seek medical attention. Back discomfort is a common complaint, but it is more common in certain demographics (GBD, 2016; Smith et al., 2022).

            According to research, there are a number of causes and contributing factors that add up to a hefty price tag for disabled people. Functional disability in chronic LBP can be caused in part by causes other than the disease itself, such as psychological and professional variables, and can put restrictions on one’s personal life, work life, and family life. According to a recent study, more than 80% of those with a functional disability were classified as having a moderate-to-severe impairment (Hoy et al., 2014; Traeger et al., 2019). LBP is characterized by a decrease in physical activity and social engagement because of patient complaints of pain and functional restrictions. The extent to which a person is able to function normally is affected by their beliefs about their abilities to manage their discomfort. Specifically, individuals with severe functional impairment had more external event pain control beliefs, which have been linked to anxiety and depression. There are growing data that show that people with LBP experience increased levels of anxiety and depression in correlation with pain severity and functional impairment. However, it is not yet clear how pain control beliefs mediate the connection between psychological discomfort and functional limitations. According to available data, distress increases the likelihood of a negative outcome, increases health care usage, and worsens functional impairment. However, there has been no research on the role that suffering plays as a mediator between functional disability and psychological morbidity (Hoy et al., 2014; Traeger et al., 2019).

            CAUSES AND RISK FACTORS OF LBP

            Adults over the age of 30 have a significantly increased risk of experiencing back discomfort. With older age, the pliable and rubbery tissues that make up the disks in the spine begin to deteriorate, which can cause back pain. Disk degeneration can be the source of soreness and stiffness in the back. People who are overweight or obese, or who frequently carry additional weight on their bodies, are more likely to have discomfort in their backs. A typical side effect of being overweight is experiencing discomfort in the joints and disks. When the abdominal muscles are weak, there is a greater likelihood of experiencing back strains and sprains. People who smoke cigarettes, consume substantial amounts of alcohol, or maintain a sedentary lifestyle are more likely to suffer from chronic back pain. In the workplace, a larger risk of back injury is posed by activities that require heavy lifting and bending. Scoliosis and other conditions that change the natural curve of the spine, such as kyphosis, can be the source of acute back pain. People who have a history in their family of osteoarthritis, certain malignancies, or other disorders are at an increased risk for developing low back discomfort. Conditions such as depression and anxiety may play a role in the development of back pain (Chenot et al., 2017; To et al., 2021).

            Lower back discomfort can be caused by a wide variety of injuries, ailments, and diseases. Sprains and strains are the most prevalent causes of back discomfort. Injuries to muscles, tendons, and ligaments can result from improper lifting techniques or from lifting objects that are too heavy. Sneezing, coughing, twisting, or bending over can put extra strain on the spine for some people. Accidents such as vehicle wrecks and falls can cause vertebrae to fracture. The likelihood of breaking a bone increases in the presence of certain medical disorders. In between each vertebra lies a disk that provides support and acts as a cushion (small spinal bones). When disks in the spine expand, they can put pressure on nearby nerves. In addition, they can rip (herniated disk). Disks may become less protective as one becomes older due to age-related flattening (degenerative disk disease). When the spinal canal becomes overly constricted, a condition known as spinal stenosis develops. A pinched nerve in the spinal column is a common cause of both sciatica and pain in the lower back. Those who suffer from scoliosis (a lateral curved spine) may experience discomfort, inflexibility, and extreme pain. The majority of people who experience back discomfort from arthritis have osteoarthritis. Ankylosing spondylitis is a degenerative spine disorder that leads to stiffness and inflammation in the lower back. Cancers, infections, and tumors of the spine are all potential sources of discomfort in the back. Back pain is not exclusive to arthritis. Other causes include abdominal aortic aneurysms and kidney stones. Spinal vertebrae might slip out of place due to ankylosing spondylitis. When individuals have spondylolisthesis, they can experience pain in the lower back and possibly in the legs (Sany et al., 2021; To et al., 2021).

            SYMPTOMS AND DIAGNOSIS OF LBP

            In some cases, the symptoms of a lower back problem may develop gradually, while in others they may occur suddenly. The act of stooping down to pick something up, for example, can set off a chain reaction of painful events. Sometimes the source of the discomfort cannot be pinpointed. Pain might be severe or mild, radiate up or down the legs, and be felt anywhere from the hips to the feet (sciatica). When the back is strained, an unnatural click or pop may be heard. The pain may intensify in some positions (such as bending over) and lessen when the person lies down. The inability to bend down or stand up straight is a real possibility. Reduced mobility can make it difficult to rise quickly from a seated posture, making the patient feel the need to walk or stretch before standing up. People who suffer from back discomfort often have trouble maintaining an upright posture. The body may appear to be ‘crooked’ or ‘bowed’, with the body angled away from the spine. One or both of the natural curves in the lower back may be absent. Lower back muscles have a tendency to spasm or contract involuntarily after being strained. Muscle spasms often cause extreme pain and make it impossible to stand, walk, or move (Nicol et al., 2020).

            The diagnosis of LBP may need a physical examination as well as imaging procedures to rule out the possibility of other ailments, such as broken bones. These imaging studies make it possible to obtain a clear image of the spinal column as well as disks, muscles, ligaments, and tendons. Imaging techniques used in medicine include magnetic resonance imaging scans, computed tomography scans, and X-rays, among others. An electromyography test, often known as an EMG, can be used to diagnose peripheral neuropathy, which may be the cause leg numbness or tingling. In addition, the physician may decide to request blood and urine tests in order to assist in the diagnosis of the cause of pain. Blood tests can sometimes identify the genetic markers that are associated with specific types of back pain such as ankylosing spondylitis. The discomfort caused by kidney stones is frequently accompanied by nausea, vomiting, and weakness; a urinalysis can assist in making a diagnosis of this ailment in the lower side section of the back (Al Amer, 2020; Nicol et al., 2020).

            LBP MANAGEMENT

            Rest, ice, and over-the-counter pain relievers are common treatments for lower back discomfort. Following a period of rest, the patient may gradually resume their usual routine. Healing time can be reduced by staying active, as an increased blood flow brings more nutrients and oxygen to the injured area. There is more than one technique to treat the underlying causes of LBP. Interventions include medication, physical therapy, manual therapy, injections, and surgery. In terms of pain treatment, we can choose between over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and prescribed drugs. Back spasms can be treated with other medications that relax the muscles in the back (Major-Helsloot et al., 2014; Orrillo et al., 2022).

            Physical therapy can help an individual build up the core muscles that protect the spine. Physical therapy can help individuals stay injury-free by doing more than just increasing the range of motion (Hayden et al., 2019, 2021)

            Tense muscles can be relaxed, pain can be lessened, and posture and alignment can be enhanced through a series of sessions. Chiropractic adjustments or osteopathic manipulation may be necessary to help alleviate pain. Massage therapy not only helps alleviate back pain, but it also aids in restoring function (Hayden et al., 2019). The steroids might be injected directly into the area of concern. Subcutaneous steroid injections alleviate pain and reduce inflammation. Surgical intervention may be necessary for the repair of certain injuries and ailments. Many surgical procedures for treating LBP require only a little incision in the skin (Wong et al., 2017; Varrassi et al., 2021).

            CONCLUSION AND RECOMMENDATIONS

            The diagnosis of LBP may need a physical examination as well as imaging procedures to rule out the possibility of other ailments, such as broken bones. There is more than one technique to treat the underlying causes of LBP. Back spasms can be treated with other medications that relax the muscles in the back. On the other hand, physiotherapy can help an individual build up the core muscles that protect the spine. Physical therapy can help an individual to stay injury-free by doing more than just increasing the range of motion. Tense muscles can be relaxed, pain can be lessened, and posture and alignment can be enhanced through a series of manipulation sessions.

            ACKNOWLEDGMENTS

            The authors extend their appreciation to the King Salman Center for Disability Research for funding this work through their Research Group.

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            Author and article information

            Journal
            jdr
            Journal of Disability Research
            King Salman Centre for Disability Research (Riyadh, Saudi Arabia )
            29 November 2022
            : 1
            : 1
            : 19-22
            Affiliations
            [1 ]Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
            [2 ]Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
            [3 ]Department of Department of Radiological Sciences and Medical Imaging, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
            Author notes
            Correspondence to: Walid Kamal Abdelbasset, Mobile: +966561014872, E-mail: walidkamal.wr@ 123456gmail.com
            Author information
            https://orcid.org/0000-0003-4703-661X
            Article
            10.57197/JDR-2022-0004
            18e074ad-2ea6-49d4-aa40-32f88d7cfba1
            Copyright © 2022 The Authors.

            This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

            History
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            Pages: 4

            Social policy & Welfare,Political science,Education & Public policy,Special education,Civil law,Social & Behavioral Sciences
            disability,medications,low back pain,physiotherapy,lumbar vertebrae

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