Back Pain

Back pain or dorsalgia is not a particular disease. Rather, it can originate from a variety of different processes. In spite of a thorough medical examination, no specific cause of the pain can be identified in about 80% of cases of lower back pain. The pain that is felt in the back generally emanates from the muscles, nerves, bones, joints or other structures in the spine.

Most severe back pain is caused by trauma to the lower back or a disorder such as arthritis. Pain from trauma may be due to sports injury, working around the house or in the garden, or a sudden jerk such as a car accident or other strain on spinal bones and tissues.

Low back pain appears only after the common cold as a reason for lost days at work. It is also one of the most common reasons to visit a doctor or a hospital\’s emergency department.

Back Pain Causes

It is essential to understand that back pain is an indication of a medical condition, not a diagnosis itself. Medical problems that can give rise to back pain include the following:

Mechanical problems:

Perhaps the most common mechanical cause of back pain includes a condition known as intervertebral disc degeneration, which plainly denotes that the break down of discs situated between the vertebrae of the spine with age. As they worsen, they lose their cushioning skill. This problem can produce pain if the back is stressed. Spasms, muscle tension, and ruptured discs, which are also called herniated discs, are some other reasons for back pain.

Injuries:

Spine injuries for example sprains and fractures can cause either transitory or chronic back pain. Sprains are breakages in the ligaments that hold up the spine, and such tears can happen due to twisting or lifting inappropriately. Fractured vertebrae often occur due to osteoporosis that causes weak, permeable bones. In rare cases, back pain may be caused by more severe injuries caused due to accidents and falls.

Acquired conditions and diseases:

Many medical problems can result in or contribute to back pain. The problems include scoliosis (It brings about curvature of the spine and does not usually cause pain until mid-life); spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis (a narrowing of the spinal column that exerts pressure on the spinal cord and nerves). While osteoporosis itself is not agonizing, it can cause painful fractures of the vertebrae.

Infections and tumors:

Infections and tumors are not really familiar causes of back pain. Infections can result in pain when they involve the vertebrae (osteomyelitis), or when they involve the discs that supports the vertebrae (discitis). Tumors, too, are comparatively unusual causes of back pain. Rarely, tumors begin in the back, but generally they appear in the back as an outcome of cancer that has spread from elsewhere in the body.

Although the causes of back pain are generally physical, it is imperative to know that emotional stress can play a part in determining how severe pain is and how long it persists. Stress can influence the body in many ways, such as causing back muscles to become tense and painful.

Other causes of back pain comprise pregnancy; kidney stones or infections; endometriosis (the formation of uterine tissue outside the uterus); and fibromyalgia, which results in fatigue and pervasive muscle pain.

The triggers of low back pain include combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine. It is rare that low back pain is caused by illness or spinal deformity. There are quite a few other common potential sources and causes of back pain including spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis, osteoarthritis (degenerative joint disease) and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.

Radicular pain also known as sciatica is distinguished from \’non-specific\’ back pain. This may be detected without invasive diagnostic tests.

A risk factor increases your chances of having back pain. More risk factors indicate higher chance of having back pain.

Risk factors that you cannot alter include:

Being middle-aged (risk drops after age 65)
Being male
Having a family history of back pain
Previous back injury
Being pregnant a woman\’s back becomes significantly stressed by carrying a baby
Having had compression fractures of the spine
Previous back surgery
Spine problems since birth (congenital spine problems)

Risk factors that you can alter with lifestyle changes or medical treatment include:

Not getting regular exercise
Doing a job or other activity that requires prolonged sitting
Lifting heavy objects
Bending or twisting
Repetitive motions, or constant vibration, like using a jackhammer or driving certain types of heavy equipment
Smoking: Smokers are more susceptible than nonsmokers to have low back pain
Being overweight: Excess body weight, especially around the waist, may put pressure on your back. But this is yet to prove. But being overweight often also indicates poor physical condition, with weaker muscles and less flexibility. These can cause low back pain.
Having poor posture is another risk factor. Slumping or slouching alone may not cause low back pain, but after the back has been stressed or injured, bad posture can worsen the situation.
Stress and other emotional factors are believed to play a prominent role in causing low back pain, especially chronic low back pain. Many people unconsciously stiffen their back muscles being under stress.
Prolonged depression
Long term use of medications that weaken bones, such as corticosteroids

Immediate relief

Heat therapy is important to relieve back spasms or other conditions. A meta-analysis of studies by the Cochrane Collaboration opined that heat therapy can lessen symptoms of severe and sub-acute low-back pain. In case of some patients moist heat works excellently (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours). Cold compression therapy (e.g. ice or cold pack application) may be useful at relieving back pain in some cases.

Use of medications, like muscle relaxant, opioids, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs) or paracetamol (acetaminophen), is also considered. A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that there are inadequate clinical trials to decide if injection therapy, usually with corticosteroids, helps in cases of low back pain. But a study of intramuscular corticosteroids found no profit.

Massage therapy under the supervision of an experienced therapist, can provide temporary respite. Acupressure or pressure point massage may be more helpful than typical (Swedish) massage.

Conservative treatments

Exercises can help reduce pain, but should be performed under supervision of a licensed health professional. Generally, some form of regular stretching and exercise is believed to be an essential component of most back treatment programs. However, a study reveals that exercise is also useful for chronic back ache, but not for severe pain. Another study found that back-mobilizing exercises in severe conditions are less helpful than continuation of ordinary activities as tolerated.

Physical therapy comprises manipulation and exercise, including stretching and strengthening (with particular focus on the muscles which cushions the spine). \’Back schools\’ have revealed benefit in occupational environment. The Schroth method, a specialized physical exercise therapy for scoliosis, kyphosis, spondylolisthesis, and related spinal disorders, has been proved useful in decreasing severity and frequency of back pain in adults with scoliosis.

A randomized control trial, brought out in the British Medical Journal, found the Alexander Technique providing lasting benefits for patients suffering from chronic back pain. A succeeding review expressed that “a series of six lessons in Alexander technique combined with an exercise prescription seems the most effective and cost effective option for the treatment of back pain in primary care.”

Studies of manipulation suggest that this approach has an advantage just as other therapies and superior to placebo.

Acupuncture has some sure benefit for back pain. However, a current randomized controlled trial suggested slight difference between real and sham acupuncture.

Education and attitude modification to focus on psychological or emotional causes, respondent-cognitive therapy and progressive relaxation therapy can curtail chronic pain.

Pregnancy and Back Pain

About 50% of women experience low back pain during pregnancy and it may be acute enough to cause serious pain and disability and pre-dispose patients to back pain in a following pregnancy. No major increased risk of back pain with pregnancy has been observed in relation to maternal weight gain, exercise, work satisfaction, or pregnancy outcome factors such as birth weight, birth length, and Apgar scores.

Prevention

There is no clear evidence of preventing low back pain. Almost everyone experiences it at some time. But you can follow some tips to help prevent low back pain. These can bring about faster recovery if you do have low back pain. Some of them also have additional health benefits.

Exercise regularly to keep your back healthy and strong. Exercise programs including aerobic conditioning and strengthening exercises can help decrease the recurrence of low back pain.

Give protection to your back while sitting. Standing posture is also vital because as you stand, your ears, shoulders, hips, and knees should be in line with one another.

Try different sleeping positions in order to protect your back. If you sleep on your side, try inserting a pillow between your knees. If you sleep on your back, place a pillow under your knees. You can also try rolling up a small towel and using it to support your lower back.

Wear low-heeled shoes

Maintain a healthy weight to avoid excess strain on your lower back.

If you\’re a smoker quit immediately as smoking increases the risk of bone loss (osteoporosis) and increases your sensitivity to pain. Smoking also affects blood circulation by tightening the arteries, which makes it difficult for blood to flow, and by decreasing the amount of oxygen the red blood cells can carry.

Spinal discs do not have their own blood supply, but receive nutrition partially from the blood supply to the vertebral bones located above and below them. Decreased circulation may accelerate the speed of degeneration and/or delay the healing of the discs. Follow a nutritious diet. Consuming plenty of calcium, phosphorus, and vitamin D may help prevent osteoporosis, which can cause compression fractures and low back pain.

Manage the stress in your life, both at home and at workplace.