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Aug 01, 2006

Back pain: Causes, Treatment & Risks

by SirGan/General

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Almost everyone has experienced, at least once in a lifetime, some kind of back pain. This pain could be acute or short-term which means that it generally lasts from a few days to a few weeks, and it can be chronic- which represent a pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis.

Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.

People injure their backs in all kinds of ways, and often the pain is a result of a strain rather than a dramatic accident. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or in some accidents such as car accident or other stress on spinal bones and tissues.

Normal anatomy of the back

It is known that the back is a well-designed structure made up of bone, muscles, nerves and other soft tissues. Starting at the top, the spine has four regions:

the seven cervical or neck vertebrae (labeled C1–C7),
the 12 thoracic or upper back vertebrae (labeled T1–T12),
the five lumbar vertebrae (labeled L1–L5), which we know as the lower back, and
the sacrum and coccyx, a group of bones fused together at the base of the spine

Small nerves enter and emerge from the spinal cord through spaces between the vertebrae. Because every person relies on back to be the workhorse of the body- its function is essential for nearly every move that person make. Several researches done in the past have came to the conclusion that 4 out of 5 adults have at least one bout of back pain sometime during life. When someone experience pain in these structures, it could be originating from your spine, but also from surrounding muscles and nerves. Damages of some organs in abdomen, such are kidneys, could also produce pain in back region.

In most cases- some simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul.

Possible causes of back pain

Everyone is familiar with the fact that lower back bears most of the weight and stress of body. Therefore, it is proven that back pain most often occurs from strained back muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Experts are saying that there are several specific conditions which can also cause back pain. Some of those are:

Herniated disk

Almost everyone has heard about disc herniation. This occurs when disk material presses on a nerve and it is accompanied with very strong pain because some nerve structures are also involved!

Sciatica

Patient should know that this condition often occurs when a herniated disk impinges on the sciatic nerve causing sharp, shooting pain through the buttocks and back of the leg.

Spinal stenosis

It is proven that this condition occurs when the space around the spinal cord and nerve roots narrows. It can happen due to arthritis and bone overgrowth. This can press or pinch a nerve and also cause very strong pains!

Spondylosis

It is known that spondylosis is a type of arthritis affecting the spine. It is due to the degenerative changes in the spine that often come with aging.

Spondylolisthesis

Although this isn't some common condition- it is still important to know that this condition occurs when one vertebra in the spinal column slips forward over another.

Cauda equina syndrome

Not too many people have heard about this syndrome. It is important to know that this represents a serious neurological problem causing weakness in the legs, numbness in the groin area, and sometimes- even loss of bowel or bladder control.

Cancer in the spine

It is a fact that any tumor located on the spine can press on a nerve causing back pain. Removing of the tumor will resolve all the symptoms.

Infection of the spine

If the back pain is accompanied with a fever and a tender, warm area – experts are saying that the cause could be an infection.

Injury

Reasonably- every damage to the bones, ligaments, or muscles of the back can cause severe pain.

Osteoporosis

Small fractures to the spine from osteoporosis

Poor alignment of the vertebrae
Other medical conditions like fibromyalgia

Back pain from organs in the pelvis or elsewhere include:

Bladder infection
Kidney stone
Endometriosis
Ovarian cancer
Ovarian cysts
Testicular torsion

Risks for developing back pain

Several researches done in the past have came to the data that a person is at particular risk for low back pain if that person:

Work in construction or another job requiring heavy lifting or whole body vibration
Have bad posture
Are pregnant
Are over age 30
Smoke, don't exercise, or are overweight
Have arthritis or osteoporosis
Have a low pain threshold
Feel stressed or depressed

Experts are suggesting that for avoiding back strain, children that carry backpacks should bend both knees when lifting heavy packs, visit their locker or desk between classes to lighten loads or replace books.

Diagnosis of back pain

It is logical that in fact diagnostic tests aren't usually necessary to confirm the cause of back pain because the patients are the key of diagnosis. However, it could be very helpful for determination of the right cause of that pain. Several diagnostic tools help determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms. They will also help rule out more serious causes of back pain.

There are several tests which are being used:

X-ray

X-ray images could be extremely helpful because they show the alignment of bones and whether you have degenerative joint disease or broken bones. There is a big problem with X-ray images because they won't directly show problems with spinal cord, muscles and fibrous tissues.

Magnetic resonance imaging (MRI) or computerized tomography (CT) scans

These are probably the best diagnostic tools because these scans can literally generate 3D images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

Bone scan

This is rather complicate procedure which is used only in rare cases when doctor wants to use bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, patient will receive an injection of a small amount of a radioactive substance into one of your. The substance collects in bones and allows doctor to detect bone problems using a special camera.

Nerve studies (electromyography, or EMG)

This test measures the electrical impulses produced by the nerves and the responses of patient’s muscles.

Treatment of back pain

Medications and therapies

Physical therapy and exercise

There are several types of physical therapy such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques. Of course, when pain improves, the therapist can teach patient specific exercises to increase flexibility and strengthen back muscles.

Medications

Sometimes nonsteroidal anti-inflammatory drugs are being prescribed or even some muscle relaxants, to relieve mild to moderate back pain.

Cortisone injections

Sometimes doctors may prescribe cortisone injections — an anti-inflammatory medication — into the space around your spinal cord.

Transcutaneous electrical nerve stimulation (TENS)

A procedure called transcutaneous electrical nerve stimulation (TENS) uses a specific device which sends a weak electrical current through specific points on the skin to nerve pathways

Acupuncture

Acupuncture involves the insertion of needles the width of a human hair along precise points throughout the body

Treatment for chronic back pain may also include using:

Antidepressant medications
Narcotics (opioids)

Surgical and other procedures

Good thing is that back surgery is rarely indicated. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Types of back surgery include:

Laminectomy and laminotomy

Every patient should know that these procedures involve removing part of vertebra in order to relieve pain! This procedure may relieve leg pain caused by bone spurs or disk fragments that protrude into spinal canal.

Fusion

This surgery involves joining two vertebrae to eliminate painful movement and further vertebrae damage!

Intradiscal electro-thermal therapy (IDET)

In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. It showed to be highly beneficial!

Prevention of back pain

It is proven that regular low-impact aerobic exercises can increase strength and endurance in back and allow muscles to function better. Beside exercises- walking and swimming are good choices
Every patient should build muscle strength and flexibility. Abdominal and back muscle exercises help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
It is proven that smokers have diminished oxygen levels in their spinal tissues
Maintain a healthy weight

Important notification about information and brand names used in this article!

Author's biography

SirGan is doing his specialization in neurosurgery at Portugal. He is interested in expertise for radiosurgery, as well as treatment of brain tumors, and currently he is studying interventional radiology. He gained significant operative experience that is done under the supervision and guidance of senior residents.

Article sources

http://en.wikipedia.org/wiki/Back_pain
http://www.mayoclinic.com/health/back-pain/DS00171
image: http://quicklookonline.com

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