Back Pain

Any pain that occurs in the low back, middle back or upper back is classified as back pain. Back pain is one of the most common problems afflicting a majority of adults. Research shows that it is one of the leading causes of lost job time and a leading expense indulged in, by people seeking pain relief. There are many conditions that cause back pain and most symptoms are relieved by pain medication.

Anatomy of the Back

The spine, which is also called the back bone, is made up of a column that consists of 33 bones (vertebrae) and tissue. This column runs down from the skull to as low as the pelvis, protecting the spinal cord. An intervertebral disc or a cartilage band is present between each vertebra, which serves as a shock absorber.

The vertebrae are divided into cervical vertebrae, thoracic vertebrae and lumbar vertebrae, and the last two bones at the bottom of the spine are the sacrum and coccyx (tailbone). The sacrum has five joined vertebrae and the tailbone is formed from four vertebrae.

A problem anywhere along the backbone, with any vertebrae, sacrum, coccyx, vertebral discs, tissues or any other part related to the backbone is considered back pain.

Causes of Back Pain

Back pain may be caused due to degeneration, trauma or a disease condition. Most causes are mechanical and only a small percentage is related to a more serious illness.

  • Muscle strain
  • Degenerative disc disease
  • Herniated disc
  • Vertebral fractures associated with osteoporosis
  • Arthritis
  • Spondylolisthesis – the vertebra slips due to a vertebral fracture or defect
  • Cervical radiculopathy – compression of one or more nerve roots near the cervical vertebrae. It causes pain, weakness, and loss of sensation in the neck, arms or shoulders.

Rare and serious causes:

  • Cancer
  • Nervous tissue damage
  • Vascular problems
  • Infection

Symptoms of Back Pain

While the severity of the back pain is nothing to be concerned about, there are certain symptoms that raise red flags indicating the possibility of a more serious condition. They may need an emergency consultation with the doctor and perhaps surgery.

General Symptoms:

  • Movement aggravates the pain
  • Limited range of motion
  • Tenderness upon touch

More Serious Symptoms:

  • Back pain with weakness in the back or extremities
  • Numbness or tingling
  • Fever
  • Weight loss
  • Bowel or bladder control problems

Diagnosis

The first thing a physician does is perform a complete history and physical exam for the back pain. If the pain is severe, the doctor may suggest a few diagnostic studies.

  • Neurological workup: A full neurological workup may be done to identify any compressed nerves due to a herniated disk.
  • X-rays: X-rays are ordered if the doctor suspects a bone infection or tumor. An x-ray of the back bone reveals a lot about the bone structures. It also helps find any problems such as instability in conditions like spondylolisthesis, fractures in any bones and tumors.
  • CT Scans: A CT scan helps find herniated discs or spinal stenosis.
  • MRI Scan: An MRI provides an image of the discs and nerve roots in the back. They are usually done prior to a surgery.

There are other imaging and electrical studies that may be ordered to identify back problems, based on the preliminary comprehensive examination. There are some injections used for diagnostic purposes as well as for pain relief.

Treatment

The main goal of treatments for back pain is to ensure the patient experiences pain relief and better range of motion and functioning. There are a variety of treatment modalities based on the diagnosis. For back pain that is not of serious nature, conservative methods are adopted.

Conservative Treatments

  • Pain relieving medications: Over-the-counter pain medicines such as ibuprofen (Advil), acetaminophen (Tylenol), prescription opioids and muscle relaxants are administered.
  • Physical therapy:  The patient may be referred to a physical therapist to learn back stretching and strengthening exercises. By performing appropriate exercises, it is possible to strengthen the back to avoid other flairs or reduce the strain on degenerative spine disease. Sometimes a TENS unit or traction are also used during physical therapy.
  • Weight management: People who are overweight generally suffer from back pain as the stress of the entire body weight falls on the spine. Reducing weight through a combination of nutritious diet and exercise can bring about significant relief.
  • Stress management:  Everything in our body is linked to our state of mind. It has been seen that reducing emotional stress often leads to reduced pain levels. The level of pain is higher when the patient is under stress. Yoga, meditation and breathing techniques help relieve stress.
  • Heat/ice packs:  Heat or ice applied at regular intervals is beneficial for some patients.
  • Complementary medicine: Alternative therapies such as Yoga, massage, acupuncture may also be recommended.
  • Physiatry: A majority of people use their bodies in the wrong way. This therapy involves an in-depth examination of how your body is being used. It is all about making the necessary changes to reduce the symptoms and improve the overall functioning.
  • Biofeedback:  This is a technique that controls the body’s responses and helps create better awareness of the physiologic functions.  It helps patients with back pain and pain in other areas of the body.

Non-Conservative Treatments

  • TENS therapy: This is a pain management treatment, where low-voltage electric current is used to stimulate the nerves in the area of pain, which blocks the pain signals sent to the brain. This is effective for diabetic neuropathy but not recommended for chronic low back pain.
  • IDET therapy: Intradiscal Electrothermal Therapy is administered when intervertebral discs that cushion the vertebrae are damaged and cause pain. Heat from electric current is used on the nerve fibers, to destroy pain receptors in the targeted area. Some patients experience long-term pain relief for 6 months or more.
  • Radiofrequency Discal Nucleoplasty: This is a relatively new procedure performed for patients with disc compression/bulging discs. Radio frequency is used to destroy a portion of the disc material, decompressing the disc partially, leading to reduced pain.
  • Bioelectric therapy: This simple procedure offers temporary pain relief from acute and chronic back pain.  It relieves pain by stopping pain signals to the brain and is usually administered with other medication for long-term effects.
  • Nerve blocks: These are nerve-numbing injections of medication in the area of pain to block the pain. They are used both for diagnosis and treatment of pain.
  • Spinal stimulation: Doctors usually resort to spinal stimulation when other methods including surgery have failed or in patients where surgery is not likely to help. It involves delivering low-level electric signals to the spinal cord or to specific nerves to block pain signals.
  • Surgery is one of the last options and includes…

o    Laminectomy – A part of the spinal bone/s is removed. Bone spurs and ligaments pressing on nerves are also removed.

o    Spinal fusion – A common treatment for back pain. It involves joining the spinal bones together, restricting their movement and restricting nerve stretching, which offers pain relief.

o    Discectomy – This involves removal of herniated disc.

Precautions for Back Pain

It is important to strengthen the back bone and this can be done through proper diet and regular exercise. Avoiding alcohol, tobacco and drugs helps. Patients are advised to maintain a proper posture and restrict any repetitive movements they are used to. Avoid heavy lifting and stretching too far in any direction. Treating depression and obesity can also lead to significant pain relief.