There is a difference between acute and chronic LBP. Acute LBP is a pain that resolves within 6 to 12 weeks—no matter what treatment
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options are used (Hagan, Hilde, Jamtveldt, & Winnem, 2006). Treatment options for acute LBP include continued activity and the use of mild analgesics, whereas chronic LBP requires a multidisci-plinary approach that includes medications and physical therapy. If the patient with acute LBP does not improve within the 12-week period, the patient is considered to have chronic LBP (Von Korff & Saunders, 1996). The percentage of patients who fall into this category is reported as 15% of the acute LBP patients (Von Korff & Saunders).
Some acute LBP occurs when patients in poor physical conditioning undertake activities that exceed their physical abilities by lifting or moving heavy objects, through overuse, or by bending or stretching in the wrong position. These individuals, sometimes labeled "weekend warriors," try to perform all the planned tasks for the weekend with little consideration as to how their bodies respond or attempt a task that simply is beyond their capability. If an individual exerts too much pressure on a vertebral disc, for example, it can herniate the disc, creating a herniated nucleus pulposus (HNP). The HNP, in turn, can create pressure on the adjacent spinal nerves, resulting in acute LBP. The HNP can require medical attention and, in more severe cases, surgical treatment. If the LBP from an HNP lasts more than 12 weeks, it becomes chronic LBP.
Other patients with LBP have conditions that predispose them to LBP. These conditions include osteoarthritis, the normal wear and tear of aging, a malignancy, and spinal stenosis, which is a narrowing of the spinal canal that occurs over time. For these patients, the pain that they experience may limit activity, impair sleep, and seriously affect their ability to maintain normal social activity. One of the goals of treatment for LBP patients is to maximize functionality and to give the patient the opportunity for the best quality of life possible.
There are some identified risk factors that predispose patients to LBP. These include:
■ Poor physical condition with no regular exercise regimen
■ Age older than 55 years
■ Having to lift heavy loads and engage in daily hard physical labor over a period of their work lives
■ Reduced spinal canal dimensions (spinal stenosis)
■ Lower socioeconomic status and less access to health care (Dorsi & Belzberg, 2005)
As the baby boomer generation ages, it is expected that the prevalence of LBP will increase at the same time. Individuals who are at risk for LBP should be encouraged to maintain appropriate weight and to exercise regularly. Because inactivity and obesity are directly related to the occurrence of LBP, patients who are also at risk for spinal changes related to age should also be encouraged to develop and maintain a more active lifestyle to help improve their chances for better back health.
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