The Many Faces of Low Back Pain


Have you experienced low back pain lately? There are many causes of low back pain (LBP) which need to be properly and thoroughly evaluated in order for treatment to lead to a satisfactory result. The obvious cause may be attributed to a specific activity, especially one that has not been performed in quite some time. This may include a sports injury, gardening- or yard work-related injury, or it may result from the accumulation of multiple smaller activities that you are not used to doing. Sometimes, the cause of low back pain can be obscure and difficult, if not impossible, to determine. In these cases, a thorough history is important. For example, Lyme’s disease can create the classic low back pain presentation and its diagnosis is dependent on a blood test. Don’t be fooled by the fact that the patient may not be an outdoors type of person, “…and couldn’t possibly have been in contact with a tic.” Pets can carry the deer tic larva into a home and transfer it to a sedentary, non-outdoorsy person. If the cause of LBP is difficult to determine, Lyme’s disease may be worthy of investigation.


Another cause of low back pain can arise from certain medications. In a July 2009 journal article, muscle fiber damage was found in 57% of patients taking drugs associated with lowering cholesterol, referred to as statins. Typically, healthcare providers rely on a blood test that is supposed to detect the breakdown of muscle tissue called CPK (creatine phosphokinase) when statin-related muscle damage is suspected. However, in this study, only one in 44 patients with muscle damage caused by statin drugs had abnormal results on their blood test! According to the researchers, muscle pain associated with statin drug treatment has been dismissed as a “minor” side effect by both doctors and patients. In fact, the American College of Cardiology and the American Heart Association have published guidelines recommending continuing statin therapy, “…as long as circulating levels of CPK do not exceed 10 times the upper limit of normal (1,950U/L).” To see if that is was a good recommendation, CPK was tested in 10 healthy volunteers who had never taken statins, 10 control subjects matched by age, 15 patients with clinically diagnosed myopathy from statins but had stopped the statin therapy at least 5 weeks prior to the study, 29 patients with a history of statin-associated myopathy who remained on statin therapy, and 19 patients with long-term statin therapy but no muscle complaints. Significant muscle damage (>2% of the biopsied muscle sample) was NOT seen in any of the control patients who were not taking statins. However, it was seen in 1 of the 19 patients on long-term statin therapy who reported no muscle symptoms as well as 25 of the 44 with myopathy (57%). More importantly, all but 3 patients who quit statin therapy because of related muscle pain reported their symptoms disappeared within days of quitting the statin medication. Also, the rate of significant muscle damage was about equal in those with myopathy still taking the statin meds (55%), and those who had quit the medication (60%). The severity of muscle damage was not related to the length of time the statin med was used or with higher doses of statins.


The point of this discussion is that low back pain may be related to causes other than an injury or trauma to the back and that a thorough history from the patient must be obtained, especially when the patient is non-responsive to typical care for low back pain.

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