What is Back Pain?
Back pain is a musculoskeletal condition in which short-term, recurrent, or long-term pain is experienced in any area along the back and spine.
Back pain is a very common complaint. According to the Mayo Clinic, approximately 80% of all Americans will have low back pain at least once in their lives.
Back pain is a common reason for absence from work and doctor visits. 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 together. A 2010 a study, ranking the most burdensome conditions in the U.S. in terms of mortality or poor health as a result of disease put back pain in third place, with only ischemic heart disease and chronic obstructive pulmonary disease ranking higher.
Causes of Back Pain
There are many causes of back pain.
- Muscle strain
- Ligament injuries
- Degenerative joints (e.g. osteoarthritis)
- Disc disease
- Spinal injuries
- Fragile or brittle bones (e.g. osteoporosis)
- Vertebral fractures
- Tumor or cancer
- Infection (e.g. fever or urinary tract infection)
- Inflammatory arthritis
Red flags for back pain include: muscle weakness, mobility problems, loss of bladder or bowel control, urinary retention, and vertebrae that are tender to the touch. If these conditions are present, immediate medical attention may be necessary.
Additional risk factors such as excessive weight gain, lack of exercise, smoking, consuming excessive amounts of alcohol, improper lifting, poor posture, stress, depression, an injury caused by a fall or vehicle crash, a suspected spinal infection, and a history of cancer can increase the occurrence of back pain.
A physical examination as well as a review of an individual’s medical history is typically utilized to diagnose back pain. Neurological examinations may also be performed in order to determine whether nerve damage may be causing the pain.
Treatments of Back Pain
Once diagnosed, treatment often involves pain medicine or physical therapy as well as educating the patient about ways to relieve pain (e.g. proper lifting techniques or correcting poor posture) and improve range of motion. Back pain treatment aims at reducing, relieving, and preventing chronic pain.
Common forms of treatment include:
- Medication (e.g. muscle relaxants, nonsteroidal anti-inflammatory drugs, or pain relievers)
- Rehabilitation (e.g. physical therapy)
- Alternative therapy (e.g. acupuncture or massage therapy)
- Spinal manipulation
- Spinal injection therapy
Acute pain may be treated with medication, physical therapy, or a combination of both methods. Medication usually helps relieve pain by reducing inflammation or relaxing tense muscles, while physical therapy involves specific techniques and exercises that strengthen the back and improve range of motion. Strengthening the back can reduce recovery time and prevent future injuries.
Massage therapy focuses on the soft tissues and muscles in the back and can improve blood flow, which helps relieve both pain and tension. Acupuncture is an alternative form of therapy that involves placing needles in specific regions of the back where the symptoms originated as well as distant areas that may be contributing to the pain. The appropriate combination of needle placement has the ability to reduce pain, stiffness, and muscle spasms in some patients.
Spinal manipulation is the application of single, rapid, and controlled movements to the spine through the hands or a special device. This procedure is also referred to as high-velocity thrust, and is different from repetitive movements or sustained stretches that may be applied during physical therapy. Spinal manipulation is most effective in patients experiencing acute low back pain when it is utilized during the first month that the symptoms began.
Direct spinal injections are also an option to alleviate back pain. Epidural injections are performed to deliver long-lasting steroids, sometimes combined with local anesthetics. Other steroid injections, given to the facet joints connecting the bones of the spine, are recommended for back pain. Injection therapies give prolonged relief from lower back pain, spinal stenosis and pain resulting from degenerating and herniating (bulging) discs.
Back pain is not typically treated by surgery unless nerve damage or a herniated disc has been diagnosed. There are different types of surgeries that can be performed on the back such as discectomy and laminectomy for spinal stenosis. Discectomy entails removing herniated disc tissue, and a laminectomy can be performed to relieve pressure on the spinal cord. Surgery is sometimes considered when back pain is causing decreased mobility or other serious health conditions. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility.Patients considering surgical approaches should be fully informed of all related risks. Surgical options include: Vertebroplasty and kyphoplasty are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity. Spinal laminectomy (also known as spinal decompression) is performed when spinal stenosis causes a narrowing of the spinal canal that causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae, along with any bone spurs, are removed. The aim of the procedure is to open up the spinal column to remove pressure on the nerves. Discectomy or microdiscectomy may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain. Microdiscectomy is similar to a conventional discectomy; however, this procedure involves removing the herniated disc through a much smaller incision in the back and a more rapid recovery. Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur. Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve. Intradiscal electrothermal therapy (IDET) is a treatment for discs that are cracked or bulging as a result of degenerative disc disease. The procedure involves inserting a catheter through a small incision at the site of the disc in the back. A special wire is passed through the catheter and an electrical current is applied to heat the disc, which helps strengthen the collagen fibers of the disc wall, reducing the bulging and the related irritation of the spinal nerve. IDET is of questionable benefit. Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves. Several channels may be made depending on how tissue needs to be removed to decompress the disc and nerve root. Radiofrequency denervation is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals). Using x-ray guidance, a needle is inserted into a target area of nerves and a local anesthetic is introduced as a way of confirming the involvement of the nerves in the person’s back pain. Next, the region is heated, resulting in localized destruction of the target nerves. Pain relief associated with the technique is temporary and the evidence supporting this technique is limited. Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. The fusion can be performed through the abdomen, a procedure known as an anterior lumbar interbody fusion, or through the back, called posterior fusion. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine. Artificial disc replacement is considered an alternative to spinal fusion for the treatment of people with severely damaged discs. The procedure involves removal of the disc and its replacement by a synthetic disc that helps restore height and movement between the vertebrae.
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Back pain, especially in the lower back, is a common musculoskeletal condition that may be caused by several factors such as muscle strains, injures, fractures, disc disease, infection, brittle bones (e.g. osteoporosis), tumor, or cancer.
Risk factors such as a lack of exercise, obesity, poor posture, improper lifting, smoking, and consuming excessive amounts of alcohol can also lead to back pain. This condition can be aggravated by standing, sitting, or walking and additional pain may even be experienced in the arms, legs, or pelvic region.
Doctors often diagnose back pain through a physical examination, a review of a patient’s medical history, or through a neurological examination when nerve damage is suspected.
Approaches to treatment generally entail:
- Determining whether the pain is acute or chronic
- Educating the patient about ways to relieve pain (e.g. proper lifting techniques or correcting poor posture)
- The utilization of medication, physical therapy, or a combination of both methods
- Alternative therapies (e.g. spinal manipulation, massage therapy, or acupuncture)
- Surgery for serious conditions related to back pain (e.g. discectomy)
When acute back pain is diagnosed, common treatment methods are those which can be followed at home such a taking pain medicine, using heat or ice pads, and avoiding excessive lifting. If chronic back pain or a serious underlying condition is diagnosed, more intensive treatments such as rehabilitation therapy, spinal manipulation, or surgery may be utilized. The ultimate goal of back pain treatment is to reduce, relieve, and prevent chronic pain and the optimum form of treatment may involve identifying the right combinations.