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Low Back Pain (LBP)

Low back pain (LBP) is the most common pain condition seen in pain clinics. Approximately 60% to 80% of the Unites States population will experience back pain at some point time during life. It is critical for clinicians to appropriately examine the patients and make a diagnosis before treatment is rendered.

Common Causes of Low Back Pain

Common causes of LBP include muscle strain, lumbar disc herniation, lumbar radiculopathy (sciatica), lumbar facet joint syndrome, sacroiliac joint syndrome and lumbar spinal stenosis.

Patients with acute muscle strain in the low back often have histories of acute injury. Physical examination may reveal tenderness or muscle spasms. Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, massage therapy, physical therapy or acupuncture often provide effective pain relief. However, many times muscle pain in the low back is secondary to injuries in deeper tissues such as lumbar disc herniation or lumbar radiculopathy.

Acute lumbar disc herniation after injury may cause severe low back pain. Patients often complain of severe, shooting, or stabbing pains in the low back with frequent radiating pain down the dorsomedial part of the foot when the L5 nerve root is involved, or the lateral part of the foot or the small toe when the S1 nerve root is involved. Straight leg raising test is often positive. Detail neurological examinations may find decreased sensation to pin prick in the area innervated by L5 and/or S1 nerve root(s). Patient may also have mild weakness on the tibialis anterior (L5), or peroneous longus and brevis muscles (S1). These patients usually have severe tenderness and spasm over the lumbar paraspinal muscles.

Lumbosacral MRIs may find disc herniation at L4-5 and/or L5-S1 level(s). EMG/NCV tests may not detect a lumbar radiculopathy. NSAIDs, muscle relaxants, and physical therapy may help some of patients with acute disc herniation and lumbar radiculopathy. If patients fail these treatments, lumbar epidural corticosteroid injections may offer fast and effective pain relief if the nerve roots are not severely mechanically compressed. Open surgeries are suggested for those with severe focal weakness of relevant muscles or incontinence. Surgery may also be indicated for severe pain that lasts for more than 3 months and does not respond to aggressive pain management if disc herniation is demonstrated by MRI or CT studies.

Lumbar facet joint syndromes are found in up to 35% of patients with LBP. It is frequently associated with arthritis or injuries in lumbar facet joints. Patients may complain of pain in the low back, often on one side only. Pain may radiate down the back or front of the thigh. Physical examination may find positive tenderness over the lumbar paraspinal muscles and facet joints. Back extension and lateral rotation to the side of the pain often increases the back pain. Results of a straight leg raising test should be negative. Neurological examination should be normal unless there is a coexistent lumbar radiculopathy or other neurological condition.

Diagnosis of facet joint syndrome is clinical. MRI and CT reports of facet joint arthropathy are not well correlated with clinical findings. Often, these changes are age-related. NSAIDs should be tried for those with lumbar facet joint syndromes before the patients are considered for diagnostic medial branch blocks or intra-joint corticosteroid injections.

Sacroiliac (SI) joint syndrome is another major source of low back pain. The patient may have pain in one side of the low back with pain radiation down to the hip or thigh. Pain is often increased when the patients try to walk upstairs. Physical examination may find tenderness over the SI joint. Patrick’s test or single leg standing test often exacerbates the SI joint pain. NSAIDs are the first line mediation for SI joint inflammation. SI joint corticosteroid injection can provide temporary pain relief. Radiofrequency lesions to denervate the SI joint have been reported to be effective, however, more studies are needed to confirm this.

Lumbar spinal stenosis is a common age-related change. The majority of senior citizens over 60 years old have varying degrees of spinal stenosis due to disc herniation, disc bulging, osteophytes or degenerative spondylolisthesis. Pre-existing congenital lumbar canal stenosis predisposes to the development of this syndrome.

Fortunately, less than 30% of those with spinal stenosis have clinical pain. Patients often have pain in the low back with pain radiation down the back of both legs. Standing or walking may make the pain worsen. Patients often walk with a hunched back and sit down after walking a short distance to relieve pain (neurogenic claudication). The pain usually takes minutes to disappear, compared to the seconds with vascular claudication. On physical examination, patients often have no tenderness over the lumbar spine. A straight leg raising test may be normal. The condition must be separated from vascular claudication.

Patients may try NSAIDs first. Lumbar corticosteroid injections may provide pain relief for this group of patient for weeks or to months. If a patient has severe pain and does not wants surgery, chronic narcotic treatment often provides adequate pain control, but runs a risk of the development of tolerance and addiction.

Meet the FLPNR Team

  • YiLi Zhou, M.D., Ph.D
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Kirstie Nicol, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Neurologist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Neurologist in Ocala, FL

YiLi Zhou, M.D., Ph.D.

Harvard-Trained, Board-Certified Pain Specialist and Neurologist.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Physician in Ocala, FL

Kirstie Nicol, P.A.

Kirstie has been serving as a physician assistant at Florida Pain and Rehabilitation Center, Lake City since September 2016. She is board certified by the National Commission on Certification of Physician Assistants (NCCPA). She received her master of science in physician assistant studies, at Clarkson University in Potsdam, NY.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.

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