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Back Pain

Back pain is the most common reason for limitation of physical activity in working-age adults between the ages of 20 and 64.

Back pain can range from being annoying to debilitating. [©Shutterstock, 2010]
©Shutterstock, 2010
Back pain can range from being annoying to debilitating.

Back Pain

Back pain is the most common reason for limitation of physical activity in working-age adults between the ages of 20 and 64. According to the Mayo Clinic, 80 percent of all Americans will suffer from lower back pain at least once. Back strain, injury and certain medical conditions can cause skeletal, muscular or nerve problems that result in a range of sensations from sharp and sudden pains to dull, persistent aching. Acute back pain comes on suddenly and can last from a few days to weeks. Pain that lasts longer than three months is categorized as chronic.

Fortunately, most back pain is preventable and will usually disappear without treatment. A health care professional should be contacted in the case of severe back pain, pain that does not go away after three days or pain that arises as the result of an injury. There are a number of medications and injections available to help relieve persistent back pain, as well as surgical options.

Causes of Back Pain

The most common causes of back pain are strained muscles or sprained ligaments in the back. Sprains and strains are caused by lifting heavy objects, improper lifting, sudden and awkward motions or repeated minor injuries. Sprains and strains are usually not serious. Over 90 percent of people suffering from lower back pain caused by a sprain or strain fully recover in less than a month, according to the National Pain Foundation.

Structural problems may also cause back pain. Disks that separate and cushion vertebrae in the spine may rupture or bulge and pinch nerves, causing pain. If a disk pinches the sciatic nerve that extends from the lower back down each leg, patients may suffer from sciatica. Sciatica can cause pain in the lower back as well as in legs and feet.

Skeletal problems like spinal stenosis, scoliosis and osteoporosis can also lead to back pain. Spinal stenosis is caused by arthritis narrowing the spinal canal surrounding the spinal cord. This usually occurs in older patients, although in rare instances babies may be born with congenital spinal stenosis. Scoliosis (a sideways curving of the spine) and other abnormal spinal curvatures may cause back pain. Osteoporosis weakens bones and can lead to compression fractures in spinal vertebrae.

A number of uncommon but dangerous conditions may also be the cause of back pain. A tumor on the spine caused by spinal cancer can pinch a nerve. A spinal infection, accompanied by a fever and warm area in the back, may also cause back pain. Cauda equina syndrome is a neurological ailment that afflicts nerve roots in the lower back and legs. This condition is quite serious and can cause groin numbness, loss of control over bowel and bladder functions, and leg weakness. Kidney problems and some vascular maladies can cause back pain.

Diagnosing Back Pain

Most back pain will improve without professional care, but there are a number of warning signs that indicate the need to consult a health care provider. According to the North American Spine Society, a specialist should be contacted in any of the following cases:

  • Acute back pain does not abate after three weeks
  • Severe back pain arises after a physical injury like a fall
  • Back pain increases during or disrupts sleep
  • Legs become weak or numb while walking
  • Low back pain continues down into the legs
  • Bending or lifting knees to the chest enhances leg pain
  • Frequent bowel or bladder problems

Diagnostic tests are generally unnecessary to determine the cause of back pain, although doctors may have patients undergo a series of simple physical tests first to assess reflexes and their ability to sit, stand, walk and lift the legs. If a serious issue like a fracture, tumor or infection is believed to be the cause of back pain, diagnostic tests may be ordered.

Bone health may be checked with either an x-ray that shows evidence of broken bones or arthritis, or with a bone scan that shows bone tumors or fractures caused by osteoporosis. In a bone scan, a radioactive substance called a tracer is injected into a vein so it collects in the bones. Doctors then use a special camera to identify any problems.

Magnetic resonance imaging (MRI) or computerized tomography (CT) scans can help identify problems in bones, blood vessels and a variety of body tissues, including muscles, tendons, ligaments and nerves. Nerve damage caused by herniated disks or spinal stenosis can also be diagnosed with the help of electromyography (ERG).

Back Pain Treatment

Back pain usually gets better in a few weeks with careful attention and home treatment. Over-the-counter pain relievers can lessen pain, and bed rest for a short period of time may be beneficial. If pain persists, a doctor may prescribe more powerful medications, physical therapy or even surgery.

Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to treat muscle and bone pain. When taken for an extended period of time, however, they may cause side effects like gastrointestinal bleeding, bleeding disorder, hypertension and fluid retention. Narcotics are another alternative that change the way the brain normally processes pain. Muscle relaxants may also be prescribed for short periods of time. Back pain caused by nerve problems may be successfully treated with nerve-blocking medications. Steroid medications are also effective in eliminating acute inflammation, but should only be used for limited periods of time due to a variety of serious side effects.

Physical therapists can help reduce back pain and prevent its recurrence with exercises that strengthen the back and abdominal muscles and improve physical conditioning, posture and flexibility.

If other therapies dont relieve back pain or the pain extends into the legs, injections of cortisone or numbing medications may be used. Cortisone decreases inflammation around nerve roots in the epidural space around the spinal cord, but is usually effective for less than six weeks. Some studies show that botulism toxin (Botox) can relieve back pain, but an injection is only effective for three to four months.

Surgery cannot improve muscle tissue or soft tissue problems, but it can correct a herniated disk or problems caused by nerve compression. Fusion surgery joins two vertebrae and stops painful movement, but puts the patient at risk for developing arthritis in adjacent vertebrae. Disks that are causing problems may be partially removed or fully replaced with artificial disks. If the spine develops bony growths that pinch nerves or the spinal cord, surgery may be used to partially remove a vertebra.

Prevention of Back Pain

Maintaining a healthy back is the best way to prevent back pain. Strong back muscles and bones can avert muscular or skeletal causes of back pain. Losing weight can reduce the strain on back muscles, and quitting smoking increases blood flow to disks in the spine. Lifting and carrying heavy objects or stretching to reach objects can stress back muscles and cause back pain. Pushing objects rather than pulling puts less strain on the back, as does carrying multiple smaller objects rather than a single large one. Sleeping on the back puts a large amount of pressure on it; however, placing pillows under the knees during sleep decreases the pressure by half. Sleeping on a side with a pillow between the knees decreases pressure on the back as well.

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