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In the UK, up to 60% of the population will expect to have low back pain at some point in their life. Around 20% of the population will consult with their GP to seek a solution for their lower back pain. Low back pain is defined as pain in the region between the bottom of the ribs and top of the legs.
Sciatica describes symptoms of pain, tingling, numbness, and occasionally weakness arising from impingement of nerve roots as they emerge from the spinal canal. This is normally felt from the buttocks and radiating to behind the knee. It is thought that between 5-10% of patients with non-specific low back pain also have sciatica.
The symptoms associated with chronic low back pain will depend on the underlying cause for the pain. The pain may be mild or severe and continuous or sporadic.
Sciatica normally includes one or many of the following symptoms, in addition to low back pain:
Low back pain is not only a physical problem; it often has severe effects on psychological, social and economic health.
There are a wide range of causes of lower back pain. Often there is no clear cause of low back pain without sciatica, even with advanced imaging which is commonly referred to as nonspecific lower back pain. Other causes of low back pain include:
These conditions are usually diagnosed using a combination of listening to the patient in full and performing an examination of the back and related joints.
In addition to this imaging is often obtained in some, but not all cases. Imaging is more often obtained in cases which are refractory to physiotherapy and self-management advice.
Low Back Pain and Sciatica Treatment
A holistic approach is often needed to treat chronic low back pain with or without sciatica. Physiotherapy, modifications to work and home environment and psychological therapies are important aspects of patient care. It is also important to try and continue exercising as tolerated if advised by your clinician that it is ok to do so.
Medical therapy is dependent on the underlying cause of pain, as addressing the underlying cause is an important component of treatment.
For muscle and connective tissue pain simple painkillers are often first line treatment with stronger painkillers (e.g. codeine) used in conjunction in severe pain. For those with inflammatory arthritis they may be started on specialist medications that regulate their immune system by a rheumatologist.
Medicinal cannabis can be considered when first line therapies have not achieved adequate symptom control for their pain.
