Back Pain — Know It All!

All you need to know about Back Pain.

Know your ailment well, so you can manage it better!!

Here we come with Back Pain today!

Overview:

One of the most common medical conditions in India is back pain. It can range from a sluggish, constant ache to an abrupt, sharp pain. Sometimes it can happen suddenly — from an accident, a fall, or something heavy lifting, or it can develop slowly due to age-related degenerative changes in the spine.

In certain cases, back pain is caused by inflammatory or other medical conditions.

Treatment varies depending on the cause and symptoms, but there are measures you can take to improve your health and decrease the risk of developing chronic or long-lasting backache.

Anatomy of the Back:

The back anatomy contains many different structures that work together to support your body. Problems with any of these structures could lead to back pain.

There are four regions of the spine:

• Cervical spine.
• Thoracic spine.
• Lumbar spine.
• Sacrum and coccyx.

Spine and back include the following parts:

• Vertebrae — small bones stacked on top of one another, which protect the spinal cord.
• Spinal cord — long bundle of nerves that run down the back through a canal in the vertebrae. Intervertebral discs — cushion-like pads between the vertebrae that act like shock absorbers and spacers for the spine.
• Ligaments — short bands of tough, flexible tissue that hold the vertebrae in place.
• Tendons — cord of tissue that connects muscle to bone.
• Muscles — a bundle of dynamic fibers that support your spine and upper body and help you move.

Who Develops Back Pain?

Anyone may have back pain but several factors increase the risk. Higher risk factors

You may experience back pain, which may include:

Fitness level: Back pain is more common among people who are not physically fit. For example, weak back and stomach muscles may not properly support the spine. Back pain is also more likely if you exercise too strenuously after being inactive for a while.

Weight gain: A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity. This can put stress on the back.

Job-related risk factors: Jobs that require heavy lifting, pushing, pulling, or twisting can injure the back. A desk job may also play a role, especially if you have poor posture or sit all day in an uncomfortable chair.

Age: Back pain becomes more common with age, particularly after the age of 45.

Heredity: Genetics play a role in some disorders that cause back pain.

Types:

The following are the different types of back pain we usually experience:

Acute back pain happens suddenly and usually lasts a few days to a few weeks.

Subacute back pain can come on suddenly or over time and lasts 4 to 12 weeks.

Chronic back pain may come on quickly or slowly and lasts longer than 12 weeks.

Causes:

A lot of different factors can cause back pain like mechanical or structural problems, thoracic disorders, inflammatory symptoms and other medical problems.

Mechanical / Structural Disorder

Back pain can occur when mechanical or structural problems arise in the spine, discs,

Muscles, ligaments, or rear tendons.

• Sprain: an injury to the ligaments that support the spine, often occurring from twisting or lifting improperly.
• Strain: an injury to a muscle or tendon. Degenerative disc disease: aging causes the discs between the vertebrae of the spine to break down.
• Herniated or ruptured discs: the discs compress and irritate nearby nerves. This often occurs at the lumbar level.
• Spondylolisthesis: a vertebra in the spine slips out of place.
• Spinal stenosis: a narrowing of the spinal column that puts pressure on the spinal cord and nerves. Fractured vertebrae. Scoliosis or other congenital changes to the spine. Inflammatory Conditions Ankylosing spondylitis, a specific type of arthritis of the spine.
• Other types of inflammatory arthritis of the spine.
• Other Medical Conditions like, Osteoporosis, which can lead to painful fractures of the vertebrae. Fibromyalgia, a condition of widespread muscle pain and fatigue. Kidney stones or infections. Endometriosis, which is the buildup of uterine tissue in places outside the uterus. Infections that involve the bones of the spine or the discs between these bones, which can cause pain. Tumors, in rare cases, that develop on the spine or other areas of the back. Pregnancy.

Common symptoms of Back Pain are as follows:

• Back pain can range from local pain at a particular spot to generalized back pain. Sometimes the pain is radiating away from the back to other areas of your body, like buttocks, legs, or abdomen. For each person, the severity of the back pain varies. You can experience: Depending on the type, cause, and location of back pain.
• Increasing pain with lifting and bending.
• Worsening pain when resting, sitting, or standing.
• Back pain that comes and goes.
• Stiffness in the morning when awakening and lessened back pain with activity.
• Pain that radiates away from the back into the buttocks, leg, or hip.

You should see a doctor if your pain does not improve after a few weeks or if any of the following symptoms happen with your back pain:

• Numbness and tingling.
• Severe back pain that does not improve with medication.
• Back pain after a fall or injury.
• Back pain along with: Trouble urinating.
• Weakness, pain, or numbness in your legs.
• Fever.
• Unintended Weight loss

How is it Diagnosed?

Doctors use various tools to help diagnose the possible cause for your back pain, which helps determine the best treatment plan.

Medical and Family History: Your doctor will ask questions about your medical and family history to help determine if an injury or underlying medical condition is the source for the back pain.

Some questions your doctor may ask:

• Can you describe your pain? (e.g. sharp, aching, burning)
• Where is the exact location of your back pain?
• When did the pain start and how long have you had the pain?
• What were you doing when you first noticed the pain?
• How severe or bad is the pain?
• What makes the pain worse or better?

Your doctor may ask you to rate your pain on a scale from 1 to 10 to gauge the severity of the pain and talk to you about your ability to perform activities of daily living.

Physical Exam:

Your doctor will likely perform a physical exam, which may include:

• Examining your spine and posture to look for changes in the bony structure.
• Asking you to bend or lift your legs to determine how movement affects your pain.
• Testing your reflexes, muscle strength, and sensation. Imaging and Blood Tests.

Most people do not need additional testing; however, sometimes doctors order tests to rule out a specific cause for your pain or to confirm a cause for your back pain.

Your doctor may order the following.

• X-rays only show bones and can help diagnose: Broken bones or fractures. Changes due to aging. Changes in the alignment of the spine.
• MRI (magnetic resonance imaging) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or “slices” are analyzed by a computer to produce an image of the back. MRI can help diagnose damage or disease of the soft tissues, such as the discs, ligaments, and nerve roots in and around the spine.
• Computerized axial tomography (CAT) uses a scanner to take images of the back at different angles. The images are analyzed by a computer to create three-dimensional views of the back. As with MRI, CAT scans help diagnose problems with the spinal canal and the surrounding tissues. Electrophysiological tests, such as electromyography or EMG, which helps measure the electrical activity in muscle. This test helps doctors check for problems with the muscles and nerves. Bone scans use small amounts of radioactive materials to help doctors see more details in the spine, such as fractures and infections. Blood tests help identify a possible cause for back pain, such as inflammatory or medical disorders.

Treatment Options:

Experts treat back pain with different methods like drugs, non-chirurgical therapies and

Surgical treatment.

• Medications: Over-the-counter pain relievers taken by mouth or applied to the skin. Anti-inflammatory drugs taken by mouth to relieve pain and inflammation.
• Muscle relaxants for some types of chronic back pain from muscle tension.
• Anti-inflammatory or numbing injections for certain types of back pain that radiates or travels due to nerve compression or irritation.
• Prescription pain relievers for severe acute back pain.
• Other Treatments Use cold packs to help relieve some back pain and hot packs to increase blood flow and promote healing in the muscles and tissues of the back.

Avoid bedrest; instead, limit activities or exercise that cause pain. Gradually increase physical activity as tolerated. Get physical therapy to help strengthen the muscles that support the back, which can improve mobility, posture, and positioning. Strengthening exercises can also help decrease pain. Check with your doctor or physical therapist before starting any exercise routine. Lifestyle changes teach you to: Move your body properly when performing daily activities, especially those involving heavy lifting, pushing, or pulling. Avoid any activities that cause or increase pain. Practice healthy habits such as exercise, relaxation, regular sleep, healthy diet, and quitting smoking. Complementary and alternative treatments may help relieve pain.

Some examples include the Manipulation of the spine and nearby tissues. Professionals use their hands to adjust and massage the spine and muscles.

Transcutaneous electrical nerve stimulation (TENS) sends mild electrical pulses to the nerves through a device and electrodes or pads that are placed on the skin. TENS treatments are not always effective for reducing pain.

Acupuncture is a Chinese practice that uses thin needles that may relieve pain in some patients.

Surgical Treatments:

Surgery for back pain may be suggested if all other treatments tried have not relieved your pain. However, not everyone is a candidate for surgery, even if the pain persists. The type of surgery your doctor recommends depends on the cause of your pain and your medical history. In addition, your surgeon will review the risks and possible benefits of the surgery or procedure. Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal column and remove the pressure on the nerves. Discectomy and microdiscectomy are surgeries that remove part of a herniated disc to relieve pressure on a nerve root or the spinal canal. The only difference between the procedures is a microdiscectomy uses a smaller incision than the discectomy. Doctors may also include a laminectomy. Spinal fusion is a surgery that helps treat degenerative disc disease and spondylolisthesis by joining two or more vertebrae in the spine that have slipped from their normal position. During this procedure, the surgeon removes the disc between the vertebrae and uses bone grafts or metal devices to secure bones together. Foraminotomy is a surgery that cleans out and widens the area where the nerve roots leave the spinal canal. By opening up this area, the pressure on the nerves from spinal stenosis can be relieved. Disc replacement surgery replaces a damaged disc with a synthetic one. This procedure is limited to patients who do not have complicating factors. Laser surgery uses a needle that produces bursts of laser energy to reduce the size of a damaged disc. This relieves pressure on the nerves. Radiofrequency lesioning of the affected nerves blocks inputs of the pain signals from entering the spinal cord. The recovery time from surgery depends on the type of procedure and your overall health. Research shows that surgery can be helpful for people with herniated discs, spinal stenosis, and spondylolisthesis.

References:

https://www.ncbi.nlm.nih.gov/pubmed?holding=flucfhghslib&term=25659245

“Prevention of Low Back Pain: A Systematic Review and Meta-analysis”. JAMA Internal Medicine. 176 (2): 199–208. doi:10.1001/jamainternmed.2015.7431. PMID 26752509.

https://www.niams.nih.gov/health-topics/back-pain/

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.