Low Back Pain – Could It Be An Aneurysm or Spinal Cord Compression?

Most people will experience some form of back pain sometime in their life. In fact, in the U.S, it’s known to be one of the most common reasons people visit the Emergency Room. According to back pain specialists, although there are numerous causes, low back pain usually is the result of benign condition.  Despite the fact that most people respond to conservative treatment, it is essential for health care providers to diagnose the potentially serious condition, that is spinal cord compression or AAA(Abdominal Aortic Aneurysm).

A.Spinal Cord Compression

In the lumbar region, the spinal nerves pass well above the disks and exit below their respectively named vertebrae; for example, spinal nerve L4 passes between vertebrae L4 and L5. Herniation of the disk between these two vertebrae typically does not compress spinal nerve L4, but rather nerve L5, because it crosses the posterolateral aspect of the disk, as a result, individuals with spinal cord compression may experience loss of sensation and motor function below the level of compression and with some degree of bowel and/or bladder dysfunction. According to one emergency medicine text, the causes of acute cord compression include the following:

  • Tumors: Due to primary or secondary tumors (e.g., lung, breast, prostate, lymphoma, multiple myeloma).
  • Infections: Resulting from epidural Abscess
  • Trauma: Causing dislocation of the vertebra or vertebral body collapse
  • Disk Injury: Due to raptured intervertebral disk or compression of disk or as a result of severe central herniation
  • Spinal cord hematoma: Due to trauma or one that occurs naturally.

B. Abdominal Aortic Aneurysm

Usually when an individual older than 50 years of age shows up at the Emergency Room complaining of lower flank or back pain, especially if he is hypertensive, there is a possibility that he might have had an abdominal aortic aneurysm. According to emergency medicine experts, in most patients, a detailed History and Physical(H&P) is sufficient to rule out serious pathological conditions. X-rays of the lumbosacral spine may need to be done in the following circumstances:

  • If the person have had recent significant trauma
  • Anyone with evidence of malignant disease anywhere in the body
  • Age extremes: Individuals younger than 18 and older than 50).
  • A person with unresolved back pain for more than 30 days
  • A person who have been experiencing fever, weight loss, adenopathy, or signs of systemic illness
  • An individual with history of IV drug abuse or alcohol abuse
  • Individuals with history of tuberculosis (Pott’s disease).
  • A person with neurologic deficits

NSAIDs or acetaminophen provide sufficient pain relief for most patients with acute low back pain, with acetaminophen(Tylenol) being considered the safest of these. Muscle relaxants are felt to be no more effective than NSAIDs for treating low back symptoms, and using them in conjunction with NSAIDs has no demonstrated benefit. Opiods seems to be no more effective than safer analgesics in patients with LBP, and it is felt that they generally should be avoided in the treatment of back pain.

When necessary, they should be used only for a short time due to possible addictive effect. Back stretching exercises and also self application of heat or cold may provide some temporary symptomatic relief. To date, there is no evidence that stretching the back causes the symptoms to get worst. Although NSAIDs(Non-steroidal, Anti-inflammatory Drugs)can be effective, potential side effects include gastrointestinal, renal, and allergic manifestations. Acetaminophen(Tylenol)may be used safely in combination with NSAIDs, especially in otherwise well patients, according to Emergency Medicine Text.

In 1994, the Agency for Health Care Policy and Research (AHCPR) published guidelines regarding the assessment of adults 18 years and older with low back pain. These can be found at http://www.ahcpr.gov

P.S Finding reveals that large doses Acetaminophen(Tylenol) may cause liver damage such as hepatic necrosis. However, with normal therapeutic doses it’s side effects are insignificant. Always speak to your doctor in regards to possible side effects of all medications.

See also other article on Back Pain help @

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