What Is Back Pain? What Causes Back Pain?

[Guest guest]

What Is Back Pain? What Causes Back Pain?

http://www.medicalnewstoday.com/articles/172943.php

Back pain is a very common complaint. According to the Mayo Clinic, USA,

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, or visiting the

doctor's.

According to the NHS (National Health Service), UK, back pain is the largest

cause of work-related absence in the United Kingdom. Although back pain may be

painful and uncomfortable, it is not usually serious.

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.

Pain in the lower back may be linked to the bony lumbar spine, discs between the

vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower

back muscles, abdomen and pelvic internal organs, and the skin around the lumbar

area. Pain in the upper back may be due to disorders of the aorta, tumors in the

chest, and spine inflammation.

What are the risk factors for back pain?

A risk factor is something which increases the likelihood of developing a

condition or disease. For example, obesity significantly raises the risk of

developing diabetes type 2. Therefore, obesity is a risk factor for diabetes

type 2. The following factors are linked to a higher risk of developing low back

pain:

A mentally stressful job

Pregnancy - pregnant women are much more likely to get back pain

A sedentary lifestyle

Age - older adults are more susceptible than young adults or children

Anxiety

Depression

Gender - back pain is more common among females than males

Obesity/overweight

Smoking

Strenuous physical exercise (especially if not done properly)

Strenuous physical work

What are the signs and symptoms of back pain?

A symptom is something the patient feels and reports, while a sign is something

other people, such as the doctor detect. For example, pain may be a symptom

while a rash may be a sign.

The main symptom of back pain is, as the name suggests, an ache or pain anywhere

on the back, and sometimes all the way down to the buttocks and legs. In most

cases signs and symptoms clear up on their own within a short period.

If any of the following signs or symptoms accompanies a back pain your should

see your doctor:

Weight loss

Elevated body temperature (fever)

Inflammation (swelling) on the back

Persistent back pain - lying down or resting does not help

Pain down the legs

Pain reaches below the knees

A recent injury, blow or trauma to your back

Urinary incontinence - you pee unintentionally (even small amounts)

Difficulty urinating - passing urine is hard

Fecal incontinence - you lose your bowel control (you poo unintentionally)

Numbness around the genitals

Numbness around the anus

Numbness around the buttocks

According to the National Health Service (NHS), UK, the following groups of

people should seek medical advice if they experience back pain:

People aged less than 20 and more than 55 years

Patients who have been taking steroids for a few months

Drug abusers

Patients with cancer

Patients who have had cancer

Patients with low immune systems

What are the causes of back pain?

The human back is composed of a complex structure of muscles, ligaments,

tendons, disks and bones - the segments of our spine are cushioned with

cartilage-like pads. Problems with any of these components can lead to back

pain. In some cases of back pain, its cause is never found.

Strain - the most common causes of back pain are:

Strained muscles

Strained ligaments

Lifting something improperly

Lifting something that is too heavy

The result of an abrupt and awkward movement

A muscle spasm

Structural problems - the following structural problems may also result in back

pain:

Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk

ruptures there will be more pressure on a nerve, resulting in back pain.

Bulging disks - in much the same way as ruptured disks, a bulging disk can

result in more pressure on a nerve.

Sciatica - a sharp and shooting pain that travels through the buttock and down

the back of the leg, caused by a bulging or herniated disk pressing on a nerve.

Arthritis - patients with osteoarthritis commonly experience problems with the

joints in the hips, lower back, knees and hands. In some cases spinal stenosis

can develop - the space around the spinal cord narrows.

Abnormal curvature of the spine - if the spine curves in an unusual way the

patient is more likely to experience back pain. An example is scoliosis, when

the spine curves to the side.

Osteoporosis - bones, including the vertebrae of the spine, become brittle and

porous, making compression fractures more likely.

Below are some other causes of back pain:

Cauda equina syndrome - the cauda equine is a bundle of spinal nerve roots that

arise from the lower end of the spinal cord. People with cauda equine syndrome

feel a dull pain in the lower back and upper buttocks, as well as analgesia

(lack of feeling) in the buttocks, genitalia and thigh. There are sometimes

bowel and bladder function disturbances.

Cancer of the spine - a tumor located on the spine may press against a nerve,

resulting in back pain.

Infection of the spine - if the patient has an elevated body temperature (fever)

as well as a tender warm area on the back, it could be caused by an infection of

the spine.

Other infections - pelvic inflammatory disease (females), bladder or kidney

infections.

Sleep disorders - individuals with sleep disorders are more likely to experience

back pain, compared to others.

Shingles - an infection that can affect the nerves.

Bad mattress - if a mattress does not support specific parts of the body and

keep the spine straight, there is a greater risk of developing back pain.

Everyday activities or poor posture

Back pain can also be the result of some everyday activity or poor posture.

Examples include:

Bending awkwardly

Pushing something

Pulling something

Carrying something

Lifting something

Standing for long periods

Bending down for long periods

Twisting

Coughing

Sneezing

Muscle tension

Over-stretching

Sitting in a hunched position for long periods (e.g. when driving)

Long driving sessions without a break (even when not hunched)

Diagnosing back pain

Most GPs (general practitioners, primary care physicians) will be able to

diagnose back pain after carrying out a physical examination, and interviewing

the patient. In the majority of cases imaging scans are not required.

If the doctor and/or patient suspect some injury to the back, tests may be

ordered. Also, if the doctor suspects the back pain might be due to an

underlying cause, or if the pain persists for too long, further tests may be

recommended.

Suspected disc, nerve, tendon, and other problems - X-rays or some other imaging

scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging)

scan may be used to get a better view of the state of the soft tissues in the

patient's back.

X-rays can show the alignment of the bones and whether the patient has arthritis

or broken bones. They are not ideal for detecting problems with muscles, the

spinal cord, nerves or disks.

MRI or CT scans - these are good for revealing herniated disks or problems with

tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.

Bone scan - a bone scan may be used for detecting bone tumors or compression

fractures caused by brittle bones (osteoporosis). The patient receives an

injection of a tracer (a radioactive substance) into a vein. The tracer collects

in the bones and helps the doctor detect bone problems with the aid of a special

camera.

Electromyography or EMG - the electrical impulses produced by nerves in response

to muscles is measured. This study can confirm nerve compression which may occur

with a herniated disk or spinal stenosis (narrowing of the spinal canal).

The doctor may also order a blood test if infection is suspected.

Chiropractic, Osteopathy and Physical Therapy (UK: Physiotherapy)

A chiropractor - the chiropractor will diagnose by touching (palpitation) and a

visual inspection. Chiropractic is known as a direct approach, with a strong

focus on the adjustments of the spinal joints. Most good chiropractors will also

want to see imaging scan results, as well as blood and urine tests.

An osteopath - the osteopathic approach also diagnoses by touching and a visual

inspection. Osteopathy involves slow and rhythmic stretching (mobilization),

pressure or indirect techniques and manipulations on joints and muscles.

A physical therapist (UK: physiotherapist) - a physical therapist's training

focuses on diagnosing problems in the joints and soft tissues of the body.

What are the treatment options for back pain?

In the vast majority of cases back pain resolves itself without medical help -

just with careful attention and home treatment. Pain can usually be addressed

with OTC (over-the-counter, no prescription required) painkillers. Resting is

helpful, but should not usually last more than a couple of days - too much rest

may actually be counterproductive.

Usually back pain is categorized into two types:

Acute - back comes on suddenly and persists for a maximum of three months.

Chronic - the pain gradually develops over a longer period, lasts for over three

months, and causes long-term problems.

A considerable percentage of patients with back pain experience both occasional

bouts of more intense pain as well as more-or-less continuous mild back pain,

making it harder for the doctor to determine whether they have acute or chronic

back pain.

If home treatments do not give the desired results, a doctor may recommend the

following:

Medication - back pain that does not respond well to OTC painkillers may require

a prescription NSAID (nonsteroidal anti-inflammatory drug). Codeine or

hydrocodone - narcotics - may also be prescribed for short periods; they require

close monitoring by the doctor.

Some tricyclic antidepressants, such as amitriptyline, have been shown to

alleviate the symptoms of back pain, regardless of whether or not the patient

has depression.

Physical Therapy (UK: physiotherapy) - the application of heat, ice, ultrasound

and electrical stimulation, as well as some muscle-release techniques to the

back muscles and soft tissues may help alleviate pain. As the pain subsides the

physical therapist may introduce some flexibility and strength exercises for the

back and abdominal muscles. Techniques on improving posture may also help. The

patient will be encouraged to practice the techniques regularly, even after the

pain has gone, to prevent back pain recurrence.

Cortisone injections - if the above-mentioned therapies are not effective

enough, or if the pain reaches down to the patient's legs, cortisone may be

injected into the epidural space (space around the spinal cord). Cortisone is an

anti-inflammatory drug; it helps reduce inflammation around the nerve roots.

According to The Mayo Clinic, USA, the pain-relief effect will wear off after

less than six weeks.

Injections may also be used to numb areas thought to be causing the pain. Botox

(botulism toxin), according to some early studies, are thought to reduce pain by

paralyzing sprained muscles in spasm. These injections are effective for about

three to four months.

Surgery - surgery for back pain is very rare. If a patient has a herniated disk

surgery may be an option, especially if there is persistent pain and nerve

compression which can lead to muscle weakness. Examples of surgical procedures

include:

Fusion - two vertebrae are joined together, with a gone graft inserted between

them. The vertebrae are splinted together with metal plates, screws or cages.

There is a significantly greater risk for arthritis to subsequently develop in

the adjoining vertebrae.

Artificial disk - an artificial disk is inserted; it replaces the cushion

between two vertebrae.

Discectomy (partially removing a disk) - a portion of a disk may be removed if

it is irritating or pressing against a nerve.

Partially removing a vertebra - a small section of a vertebra may be removed if

it is pinching the spinal cord or nerves.

CBT (Cognitive Behavioral Therapy) - according to some studies, CBT can help

patients manage chronic back pain. The therapy is based on the principle that

the way a person feels is, in part, dependent on the way they think about

things. People who can be taught to train themselves to react in a different way

to pain may experience less perceived pain. CBT may use relaxation techniques as

well as strategies to maintain a positive attitude. Studies have found that

patients with CBT tend to become more active and do exercise, resulting in a

lower risk of back pain recurrence.

Complementary therapies

A large number of patients opt for complementary therapies, as well as

conventional treatments; some opt just for complementary therapies.

According to the National Health Service (NHS), UK, chiropractic, osteopathy,

shiatsu and acupuncture may help relieve back pain, as well as encouraging the

patient to feel relaxed.

An osteopath specializes in treating the skeleton and muscles.

A chiropractor treats joint, muscle and bone problems - the main focus being the

spine.

Shiatsu, also known as finger pressure therapy, is a type of massage where

pressure is applied along energy lines in the body. The shiatsu therapist

applies pressure with his/her fingers, thumbs and elbows.

Acupuncture, which originates from China, consists of inserting fine needles and

specific points in the body. Acupuncture can help the body release its natural

painkillers - endorphins - as well as stimulating nerve and muscle tissue.

Studies on complementary therapies are have given mixed results. Some people

have experienced significant benefit, while others have not. It is important,

when considering alternative therapies, to use a well qualified and registered

therapist.

TENS (transcutaneous electrical nerve stimulation) - a popular therapy for

patients with chronic (long-term) back pain. The TENS machine delivers small

electric pulses into the body through electrodes that are place on the skin.

Experts believe TENS encourages the body to produce endorphins, and may possibly

block pain signals returning to the brain. Studies on TENS have provided mixed

results; some revealed no benefits, while others indicated that it could be

helpful for some patients.

A TENS machine should be used under the direction of a doctor or health care

professional.

Pregnant women, people with epilepsy, people with a pacemaker, and patients with

a history of heart disease should not use a TENS machine.

Prevention of back pain

Steps to lower the risk of developing back pain consist mainly of addressing

some of the risk factors.

Exercise - regular exercise helps build strength as well as keeping your body

weight down. Experts say that low-impact aerobic activities are best; activities

that do not strain or jerk the back. Before starting any exercise program, talk

to a health care professional.

Core-strengthening exercises; exercises that work the abdominal and back

muscles, help strengthen muscles which protect your back.

Flexibility - exercises aimed at improving flexibility in your hips and upper

legs may help too.

Smoking - a significantly higher percentage of smokers have back pain incidences

compared to non-smokers of the same age, height and weight.

Body weight - the fatter you are the greater your risk of developing back pain.

The difference in back pain risk between obese and normal-weight individuals is

considerable.

Posture when standing - make sure you have a neutral pelvic position. Stand

upright, head facing forward, back straight, and balance your weight evenly on

both feet - keep your legs straight.

Posture when sitting - a good seat should have good back support, arm rests and

a swivel base (for working). When sitting try to keep your knees and hips level

and keep your feet flat on the floor - if you can't, use a footstool. You should

ideally be able to sit upright with support in the small of your back. If you

are using a keyboard, make sure your elbows are at right-angles and that your

forearms are horizontal.

Lifting things - the secret for protecting your back when lifting things is to

think " legs not back " . In other words, use your legs to do the lifting, more

than your back. Keep your back as straight as you can, keep your feet apart with

one leg slightly forward so you can maintain balance, bend only at the knees,

hold the weight close to your body, and straighten the legs while changing the

position of your back as little as possible. Bending your back initially is

unavoidable, when you bend your back try not to stoop or squat, tighten your

stomach muscles so that your pelvis is pulled in. Most important, do not

straighten your legs before lifting; otherwise you will be using your back for

most of the work.

Do not lift and twist at the same time. If something is particularly heavy, see

if you can lift it with someone else. While you are lifting keep looking

straight ahead, not up nor down, so that the back of your neck is like a

continuous straight line from your spine.

Moving things - remember that it is better for your back to push things across

the floor, rather than pulling them.

Shoes - flat shoes place less of a strain on the back.

Driving - it is important to have proper support for your back. Make sure the

wing mirrors are properly positioned so you do not need to twist. The pedals

should be squarely in front of your feet. If you are on a long journey, have

plenty of breaks - get out of the car and walk around.

Your bed - you should have a mattress that keeps you spine straight, while at

the same time supporting the weight of your shoulders and buttocks. Use a

pillow, but not one that forces your neck into a steep angle.