Back Pain

Back Pain

Back pain, sometimes referred to as dorsalgia, is one of the most common ailments amongst people all over the world. The vast majority of the population will experience back pain and one point or another in their lifetimes.

Approximately 90% of all adults will suffer from back pain in their lifetime, and nearly 50% of the working adult population claims to deal with back pain on an annual basis. Low back pain, sometimes referred to as lumbago, ranks amongst the top five reasons for doctor visits annually in the United States and is one of the most common reasons for absenteeism in the work place.

The spine is a column made of 33 different bones which runs the length of the body from the skull to the pelvis. The bones comprising the spine, known as vertebrae, are surrounded by a casing of nerve tissue called the spinal cord.

A layer of cartilage exists between each vertebra and acts as a cushion to help protect the bones. Each of these components, in addition to the muscles, tendons, and ligaments in the back, are susceptible to injuries, strains, and accidents; all of which can lead to mild back pain ranging from mild to severe.

Symptoms of Back Pain

The severity, type, and location of back pain will vary depending upon the root cause of the pain.

Different ailments and conditions can result in similar symptoms.

• Low back pain may progress over time or may happen suddenly. Acute back pain is generally very intense, but rarely lasts more than a few weeks depending on the cause of the discomfort. Chronic back pain is the term used for any back pain that lasts longer than three or four months. At times, lower back pain may also radiate down into one or both legs.
• Pain from injuries, sprains, and strains to the muscles and ligaments of the back are generally localized to the injured area of the back and do not pass along to other areas of the body. Often times, the pain from one of these ailments can be amplified by bending the back.
• A herniated disc can apply pressure to the sciatic nerve, amongst others, causing a number of problems, such as: pain or tingling in the hip or leg, pain that increases when sneezing or coughing, pain that increase when sitting or standing for extended periods of time, pain that radiates down one leg, and sharp pains in one leg accompanied by numbness of the same leg.

Risk Factors of Back Pain

There are a number of risk factors that can lead to back pain. Some of these can be controlled or prevented, but some are a matter of genetics and cannot be controlled effectively.

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Some of the most common risk factors include:

• Physically strenuous work, exercise, and activities
• Stress
• Depression
• Family history of back pain
• Obesity
• Smoking
• Old age
• Pregnancy
• Congenital spinal problems
• Poor posture
• Long term use of certain medications, such as corticosteroids
• Lack of exercise

Prenention Tips for Back Pain

There are no sure fire ways to guarantee the prevention of back pain because there are so many different factors that can lead to the problem.

There are, however, some preventative steps that can be taken to help reduce your risk of certain types of back problems.

• Regular exercise can help to strengthen the muscles in your back and your core and can provide additional protection to help prevent injury.
• Be sure to lift properly. The correct steps to lifting heavy items are to bend at the knees, keep your back and head straight, and lift by extending your legs. Bending at the hip and lifting with the back muscles can lead to serious injury.
• Quit smoking. Smoking tightens the arteries and interferes with blood circulation. This leads to a decrease in the amount of oxygen carried by red blood cells which can lead to an increased risk of bone loss and degeneration as well as slow healing for damaged areas of the back.
• Eat a diet rich with protein, calcium, vitamin D, and phosphorous. These nutrients can help to prevent or slow osteoporosis, thus reducing the risk for serious fractures and breaks.
• Try to manage the level of stress in your life the best you can, both at home and at work. In addition to a myriad of other health problems caused by stress, people tend to tense up and tighten their back muscles when they are tense, thus leading to soreness and cramping.
• Maintain a healthy weight through proper diet and exercise. Obesity places additional stress on the back which can often lead to back pain.
• Make an effort to sleep in a position that keeps your spine properly aligned. If you sleep on your back, use a towel or pillow under your knees to relieve your pressure points. If you sleep on your side, place a pillow or a towel between your knees.

Diagnosis and Testing for Back Pain

Some of the methods used to test and diagnose back pain are very similar to those used to test and diagnose a wide array of medical problems. As long as the problem is not crippling, a doctor will generally test a patient’s range of motion and conduct a visual inspection of the area in pain. Blood and urine tests may also be administered to check for infection.

A series of questions aimed at identifying the source, severity, and cause of the problem will often be asked. Some of the more common questions that may be asked are:

• When did the pain start
• Where is the pain located? Is it concentrated in one area, or is it radiating down into the hips and legs?
• Was there an injury, accident, or incident which can explain the onset of the back pain?
• Is there anything that makes the pain seem either worse or better?

A few common, preliminary diagnostic tests include:

• Testing the patient with the straight leg and bent leg tests. When straightening the leg, a pain shooting down the straightened leg is often indicative of a pinched root nerve. When crossing legs, pain going down the non-crossed leg often indicates a herniated disc
• Reflex tests can help identify nerve pressure if certain reflexes are absent
• Weakness in the lower extremities can help identify other nerve pressure and/or damage. The doctor may be able to isolate the location of the problem based on the patient’s discomfort when walking on their toes or in their difficulty raising their big toe.

Testing for the cause of back pain can include a wide array of differing tests to try and identify the root cause of the problem.

• X-rays are one of the most commonly thought of tests when it comes to identifying issues that exist inside the body. X-rays, however, are not very commonly used in the identification of back pain unless the patient has experienced significant trauma, has prolonged steroid use, or suffers from osteoporosis.
• Nerve tests are accomplished by placing small needles into the muscles in the back. The electric activity transferred through the needles is monitored to try and determine if there is nerve root damage or muscle disease. This test is generally reserved for extreme, chronic pain that has been evident for at least several months.
• Magnetic Resonance Imaging (MRI) and Computed Tomographic Scanning (CT scan) are often considered for patients that are likely candidates for surgery as a result of their root back problems. MRI technology is useful for imaging soft tissue, such as herniated discs and tumors, and CT scans are better used for imaging of bone. CT scanning is less expensive and also less sensitive to patient movement, making it much easier for the patient to deal with, both physically and financially.

Causes of Back Pain

Back pain can occur in people for a number of different reasons.

A few of the more common reasons are listed below:

• Spondylosis occurs when there is a stress fracture within the spine. Vertebrae are often moved from their natural position when this happens which is called spondylolisthesis.
• Osteoporosis is a condition which causes a person’s bones to weaken, making them more susceptible to breaks and fractures. Someone suffering from osteoporosis is much more likely to suffer a spinal injury than an otherwise healthy person.
• Spinal stenosis is caused by a narrowing of the area surround the spinal cord or the spinal nerves. Nerves transmit information from the body to the brain and the brain back to the body.
• Lumbar strains and lower back sprains are the most common cause of back pain in adults. A strain occurs when muscle fibers are abnormally stretched and/or torn.
• Herniated discs occur when the cartilage between vertebras slips out from its normal location and protrudes from one side of the spine more than the other. This disc is soft and pliable in young age, but as with most parts of the human body, can become rigid and less elastic with age. When this happens, the disc can rupture, causing the disc to be herniated.
• Discogenic back pain is caused by the gradual wearing out, or degeneration, of the lumbar discs. This is a natural byproduct of the aging process and sometimes does not produce any symptoms at all. One of the positives of discogenic back pain is that patients generally report diminishment of the pain as time passes, even with minimal treatment.
• Lumbar spine arthritis is most commonly seen in older patients, but it can affect all age groups. Arthritis is an affliction of the joints that surround the vertebrae. Vertebrae are connected with the spinal disc in the front of the spinal cord and with two different facet joints behind the spinal cord.

Treatment Options for Back Pain

The options for treatment for back pain can change dramatically based upon the root cause of the problem, the patient’s wishes, and the medical professional that recommends the treatment. Options for treatment can include home and herbal remedies, pharmaceutical remedies, and in extreme cases, surgical remedies.

Home and Herbal Remedies

Home remedies for back pain are extensive and seemingly everyone has an option to offer. One of the basics shared amongst many groups is regular exercise which strengthens the back and allows for a better supply of nutrients to the back. Proper lifting and moving, getting enough rest, sleeping on a quality mattress with proper support, and avoiding sitting for prolonged periods of time are all preventative measures as well as natural remedies for addressing a problem once it has already begun.

Herbal remedies are a popular option for treating back pain as well. The juice of one lemon, mixed with common table salt, taken twice daily as part of a daily routine has proven to be effective for some. Others have stated that the application of garlic oil directly to the source of the problem has helped to relieve back pain. Consumption of garlic on a daily basis, two to three cloves at a time, has also proven to be an effective remedy for some. Chamomile has long been thought to have a soothing effect on smooth muscle tissue and can be taken as a tea, as an extract mixed with water or some other liquid, or in capsule form.

Pharmaceutical Remedies

Prescription drugs are a popular choice used to address back pain. Most often, pain killing, muscle relaxing, and anti-inflammatory pharmaceuticals are prescribed to treat and relieve back pain. Pain killers are available in both over the counter varieties as well as prescription drugs. Aleve, Tylenol, and Advil are amongst the most popular choices for OTC medication. Felxeril, OxyContin, and Percocet are some of the most popular prescription medications used for back pain relief, and should only be used as directed by a qualified physician.

Surgical Remedies for Back Pain

In the most extreme cases, surgery may be the last available option for a patient to consider when trying to manage their back pain. It is not an option that is taken lightly as the complications and possibility for worsening a patient’s condition are very realistic.

A discectomy is performed to remove a herniated disc from the spinal canal. The area of the disc that is removed is the section which is creating pressure on the spinal nerves, causing severe pain for the patient. A small incision in the back allows the surgeon to remove the herniated section of the disc, and once inside, the decision to remove additional sections of discs may take place to prevent future herniations from taking place.

Spinal fusion is an option that may be recommended for those that have abnormal curvature of the spine, injury to the spinal vertebrae, or weak spines as a result of infection or tumors. The procedure consists of fusing two or more vertebrae together to prevent motion from occurring between the individual bones.

In severe cases, a cordotomy may be performed during which bundles of nerve fibers are intentionally severed to prevent the transmission of pain signals to the brain.