Low-back pain [LBP] in active patients is common and
often recurrent. The cause of LBP and other symptoms is
multi-factorial and diverse, and the precise
identification of the pain generators is often elusive.
Family practice physicians frequently diagnose
mechanical LBP in patients without a clear path of
evidence, including the US government sponsored AHCPR
meta-analysis, has indicated that 85-90% of LBP will
resolve within 6-12 weeks with only palliative
(symptomatic) care; therefore many physicians question
whether more specific intervention is really necessary
during this period.
However, recent longitudinal
studies suggest that back pain is typically recurrent in
nature, even if the original symptoms resolve, and many
patients suffer chronic, unremitting symptoms at
intervals. Studies indicate that over 60% of patients
with acute LBP, suffered at least one recurrence in the
following year. The high incidence of recurrence and
chronicity point to the inadequacy of current management
protocols, and warrants analysis and revision of our
current treatment algorithms (standards).
The medical community, despite
its appearance of being at the cutting edge of health
advancements, can often be quite conservative when it
comes to adopting new methods. If a patient does not
experience a spontaneous resolution of their back
problem within the first two months, an initial benign
problem may become a chronic situation. This is why it
is so important to institute early management that is
Lumbar disc degeneration is a common cause of low back
pain and leg pain. Patients with degenerative disc
disease frequently have LBP as the earliest symptom.
Often patients recall that
their back pain appears after periods of physical
activity or prolonged periods of sitting or standing.
Initially the pain may last a few hours or a few days
and usually subsides with a limitation of the patientís
activity and medication. The pain pattern at this time
is mechanical in nature, in the sense that it is usually
made worse by standing, lifting, twisting, and prolonged
sitting, and is often relieved by rest.
Since over 90% of clinically
significant lumbar disc herniations occur at the L4-L5
or L5-S1 levels, the most common neurologic impairments
are those of the L5 and the S1 nerve roots. Symptoms of
disc protrusion are leg pain in a root distribution
aggravated by lifting, coughing, laughing, sneezing and
movements that increase intradiscal pressure. Important
neurological signs are sensory deficits (tingling,
numbness) in the legs and feet [L5-S1], reduced ankle
reflexes [S1] and lower extremity weakness.
As the patient ages, painful
episodes become more frequent or intense in nature, and
may lead to more disability. The majority of these
patients are not ideal surgical candidates. Specific
therapy that targets disc pathology should be initiated
early for these patients.
If low back pain symptoms have
not resolved within four weeks, VAX-D should be
considered (in the absence of contraindications) for
those patients with a diagnosis of discogenic pain;
including those with radiculopathy.