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Fusion – two vertebrae are joined together, with a bone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.

Many researchers seem to believe that low back pain is a modern problem. For instance, Waddell writes, “Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic ….” In 2008, Martin et al found that, “The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7%… to 24.7% … 1997 to 2005,” which certainly shows that it is a growing problem and therefore likely to be worse now than in the past. A Spanish study (Jiménez-Sánchez et al) showed that “serious” musculoskeletal complaints (including a great deal of back pain, presumably) increased significantly from 1993 to 2001. Finally, Harkness et al did a nice job in 2005 of comparing rates of musculoskeletal pain (including low back pain) 40 years apart in the northwest of England, and found a large increase. In his books, Sarno also strongly portrays low back pain as a modern problem — though he doesn’t defend it . It’s hard to say if back pain actually is a modern problem, or whether it just tends to be described as such. Remember that human beings have a strong tendency to sensationalize and dramatize! Harkness pointed out in her study that the appearance of an increase “could be partly explained by the ‘worried well’. The ‘worried well’ are those patients who are concerned about their health, and attend their GP to seek reassurance about their well-being.” This is a great example of how hard it is to really be sure of anything! BACK TO TEXT

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A few cancers in their early stages can be hard to tell apart from ordinary back pain — a bone cancer in the vertebrae, for instance — and these create a frustrating diagnostic problem. They are too rare for doctors to inflict cancer testing on every low back pain patient “just in case.” And yet the possibility cannot be dismissed, either! It’s an unsolveable problem.

The Agency for Healthcare Research and Quality has identified 11 red flags that doctors look for when evaluating a person with back pain. The focus of these red flags is to detect fractures (broken bones), infections, or tumors of the spine. Presence of any of the following red flags associated with low back pain should prompt a visit to your doctor as soon as possible for complete evaluation.

Ankylosing spondylitis: A chronic inflammatory disease that first affects the spine and nearby structures. As the disease progresses, vertebrae will fuse together. This disease has a strong hereditary (runs in the family) tendency and primarily affects men under 30 years of age.

Future studies investigating the effect of different seating systems on patient postures and symptoms ought to include patients with higher pain levels, longer follow-up and female participants, so as to more realistically replicate the range of demographics and development of symptoms in those who work in seated environments.

2010 — Upgraded: Section now includes discussion of that bizarre and already infamous paper in the New England Journal of Medicine (see Berman). I also make important new point: exactly why acupuncture placebos are such a problem for low back pain patients in particular. [Section: The fascinating case of acupuncture, formerly a contender in low back pain therapy, but which has now miserably failed well-designed scientific tests.]

But how do you kow if you’re the exception? Can you recognize the early warning sign of cancer, infection, autoimmune disease, or spinal cord injury? These things often cause other distinctive signs and symptoms, and so they are usually diagnosed promptly. If you are aware of these red flags, you can get checked out when the time is right — but please avoid excessive worry before that.

I’ve previously recommended standing up and doing some exercises at your desk to counteract the negative effects of sitting. But after my discussion with Dr. James Levine, author of Get Up!: Why Your Chair Is Killing You and What You Can Do About It, I’m convinced that standing for 10 minutes for every hour of sitting is really the bare minimum, BUT it’s still far from ideal. What I was doing wasn’t enough; In fact, I really believe the answer is to stand up as much as possible.

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

Tumor. Most spinal tumors start in another part of the body and metastasize to the spine. The most common tumors that spread to the spine start from cancer in the breast, prostate, kidney, thyroid, or lung. Any new symptoms of back pain in a patient with a known diagnosis of cancer should be evaluated for possible spinal metastasis.

However, many people are uncomfortable sleeping on their back or find it causes them to snore. Everyone sleeps differently, so there is a variety of options for people who want to sleep better and reduce their back pain.

Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years. Experts say that back pain is associated with the way our bones, muscles and ligaments in our backs work and connect together.

Jump up ^ Momsen AM, Rasmussen JO, Nielsen CV, Iversen MD, Lund H (November 2012). Multidisciplinary team care in rehabilitation: an overview of reviews. J Rehabil Med. 44 (11): 901–12. doi:10.2340/16501977-1040. PMID 23026978. Archived from the original on 4 October 2013.

For subacute and chronic lower back pain, a thorough diagnosis is important to lay the foundation for appropriate treatment and rehabilitation. Lower back pain treatment reduces the likelihood of recurrent back pain flare-ups and helps prevent the development of chronic lower back pain.

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