Back Pain

Back pain: Causes, symptoms, and treatments

Back pain is a very common complaint. According to the Mayo Clinic, 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 and doctor visits. 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 and connect 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.

 

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 called disks. 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
  • A muscle spasm

Things that can lead to strains or spasms include:

  • Lifting something improperly
  • Lifting something that is too heavy
  • The result of an abrupt and awkward movement

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, which is the term used to describe when 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, a condition in which 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 may also lead to back pain.
  • Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
  • Shingles – an infection that can affect the nerves may lead to back pain, depending on the nerves affected.
  • 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.

Signs and symptoms

A symptom is something that 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. Some back issues can cause pain in other parts of the body, depending on the nerves affected.

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, people should see their 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 British National Health Service (NHS), 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 depressed immune systems

Treatments

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 over-the-counter (OTC) painkillers. Applying a hot compress or an ice pack to the painful area may also relieve pain.

Resting is helpful, but should not usually last more than a couple of days. Too much rest may actually be counterproductive by allowing muscles to weaken, which can lead to further episodes of back pain in the future.

Usually back pain is categorized into two types:

  • Acute – back pain 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 – 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, 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 3 to 4 months.

CBT (cognitive behavioral therapy) – 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.

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