Back pain is felt in the back. It is a very usual complaint. The kind of back pain may be acute, sub-acute, or chronic depending on the duration. The pain may be characterized as a dull ache, piercing or shooting pain, or a burning sensation. The pain may radiate into the hands and arms and legs or feet as well and may include weakness and numbness in the arms or legs. Even though the back pain may be painful and uncomfortable, it is not usually serious. It can affect people of any age, although it is mostly more common among adults aged between 35 and 55 years. According to the experts, it is associated with the way our bones, muscles and ligaments in our back work together. The pain may initiate from the bones, nerves, muscles, joints or other structures in the vertebral column (spine). Internal structures such as the pancreas and gallbladder may also cause it.
The anatomic classification back pain follows the segments of the spine:
- Neck pain (cervical)
- Middle back pain (thoracic)
- Lower back pain (lumbar)
Back pain is common with about 90% of adults experiencing it at some point in their life, and 50% of working adults having it every year. However, it is not possible for it to be permanently disabled, and in most cases of herniated disks and stenosis, rest, injections or surgery has similar general pain resolution outcomes on average after one year. Worldwide it is the single leading cause of disability.
Classification of Back pain
Back pain can be classified by various methods to aid its diagnosis management. The duration of the pain is divided into three categories, following the expected pattern of healing of connective tissue:
- Acute pain lasts up to 12 weeks
- Subacute pain refers to the second half of the acute period (6 to 12 weeks)
- Chronic pain is which persist beyond 12 weeks.
Nonspecific back pain is believed to result from soft tissues like muscles, ligaments and fascia. Radicular pain with or without spinal stenosis signifies involvement of nervous tissue. Secondary back pain outcomes from a known medical diagnosis such as infection or cancer. Back pain has different causes. Most of the back pain patient’s diagnosis of non-specific acute back pain in which no serious no serious underlying pathology is identified, but few are compromised by metastatic cancers.
Risk factors for back pain
The following factors are linked to a higher risk of getting low back pain:
- Age –older adults are more affected than young adults or children
- A mentally stressful job
- Pregnancy- pregnant women are much more likely to get back pain
- Gender- Back pain is more common among females than males
- Physical work
- Physical exercise (if not done properly)
Symptoms of back pain
The main symptoms of back pain are, as the name indicates, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs. In most events, signs and symptoms clear up on their own within a short period. It can be a serious medical issue, even though this not most frequently the underlying cause.
If any of the following symptoms accompany a back pain you should visit your doctor:
- Elevated body temperature (fever)
- Severe back pain– lying down or resting does not help
- Swelling in the back
- Pain down the legs
- The pain reaches below the knees
- A recent injury, blow or trauma or resting doesn’t help
- Difficulty urinating-passing urine is hard
- Urinary incontinence-you pee unintentionally (even small amounts)
- Faecal incontinence-you lose your bowel control
- Numbness around genitals
- Numbness around the anus
- Numbness in the buttocks.
The National Health Service (NHS), UK, mentions that the following groups of people should seek medical advice If they experience back pain:
- People aged less than 20 and more than 55 years
- Drug abusers
- Patients with cancer or who had cancer
- Patients with low immune system
- Patients who have been steroids for a few months.
Causes of back pain
The human back is made of a complex structure of muscles, ligaments, tendons, disks and bones. Problems with any of these components can cause back pain. Some cases of back pain it’s hard or even impossible to a found cause. There are several possible sources or causes of back pain. However, the diagnosis of specific tissues of the spines as the cause of pain recent problems.
Strain-the most common causes of back pain areas include:
- Strained muscles
- Lifting something improperly
- Strained ligaments
- Lifting something that is too heavy
- The results of an abrupt and awkward movement
- A muscle spasm
Back pain can also be the outcome of some everyday activities like include:
- Bending awkwardly
- Muscle tension
- Bending down for long periods
- Standing for long periods
- Sitting in a hunched position for long periods
- Long drives without a break
Structural problems- The following structural problem leads to back pain:
- Ruptured disks- Disks cushioned each vertebra in our spine. If the disk ruptures, there will more pressure on a nerve, which leads back pain.
- Bulging disks- Same as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Arthritis- patients with osteoarthritis have often experienced problems with the joints in the hips, lower back, knees and hands. In some cases, spinal stenosis can grow the space around the spinal chord narrow
- Osteoporosis- bones, including the vertebrae of the spines, become brittle and porous, making compression fractures more probable.
- Abnormal curvature of the spine- If the spine curves in not in the usual way the probability that patient experiencing back pain are high.
Some other causes of back pain:
- Cauda equina syndrome- The bundle of spinal nerve roots that arise from the lower end of the spinal cord is cauda equina. Patients with cauda equina syndrome feel a dull pain in the lower back and upper buttocks as well as lack of feeling in the buttocks, genitalia and thigh.
- Cancer of the spine- A tumour placed on the spine can press against a nerve, causing a back pain.
- Infection of the spine– If the patient has a fever as well tender, warm area on the back, it could be caused by an infection of the spine.
- Other infections- pelvic inflammatory disease (females), kidney or bladder infections.
- Sleep disorders- Person with sleep disorders are more affected by back pain, compared to others.
- Shingles- Nerves can be affected by an infection.
- Bad mattress- If a mattress does no support specific parts of the body and keep the spine straight, there is more risk of getting back pain.
Diagnosis of back pain
Most physicians will be able to diagnose back pain after some physical examination and questioning the patient. Usually, imaging scans are not required. If the doctor and/or patient suspect any injury to the back, the test may be suggested. If the doctor suspects the back pain might be due to an underlying cause or the pain remains for too long, further tests would be recommended.
Suspected disc, nerve, tendon and other problems- X-rays or some other imaging scan, like CT or MRI 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 broken bones.
- MRI or CT scans- they are usually done in revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
- Bone scan- It is done for detecting bone tumours or fractures.
- Electromyography or EMG- It measured the electrical impulses produce by nerves in response to muscles. The study can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.
Doctors may also suggest a blood test if an infection is suspected.
Prevention of back pain
To lower the risk of getting back pain consists mainly of addressing some of the risk factors.
Exercise- regular exercise help build strength as well as maintain your body weight. According to the experts, low-impact aerobic activities are best, activities that do not strain or jerk the back. Talk to a healthcare professional before starting any exercise.
Smoking- compared to the non-smokers of the same age, smokers have a higher percentage of having back pain.
Body weight- the fatter you are, you have a greater risk of getting back pain.
Posture when standing- always make sure you have a neutral pelvic position.
Treatments for back pain
Back ache usually resolves itself without medical help-just with careful attention and home treatment. Pain can usually be addressed with painkillers. Taking rest is helpful, but shouldn’t usually last more than a couple of days over rest may actually be counterproductive.
If home treatment does not give satisfaction or better result, a doctor may suggest the following:
Medication- Back pain that does not respond to the painkillers may require a prescription NSAID (non-steroidal anti-inflammatory drug). Codeine or hydrocodone-narcotics- may also be prescribed for short periods. Some tricyclic antidepressants have been shown to ease the symptoms of it, regardless whether or not the patient has depression.
Physical therapy- The application of heat, ice, ultrasound and electrical stimulation with some muscle release techniques to back muscles and soft tissues may help ease the pain. The therapist may introduce some flexibility and strength exercise for back and abdominal muscles.
Cortisone injection- If the above-mentioned therapies are not effective, or if the pain reaches down to the patient’s leg, cortisone may be injected. Back ache is an anti-inflammatory drug, it helps reduce inflammation around the nerve roots.
CBT (Cognitive Behavioral Therapy) – Studies show that CBT can help patients manage chronic back pain. The therapy is focused on the principle that the way person feel is, in part, dependent on the way they think about things. According to the study the patients with CBT tend to become more active and do exercise, resulting in a lower risk of it.
TENS (transcutaneous electrical nerve stimulation) – one of the popular therapy for patients with chronic (long-term) back pain. The TENS machine delivers electric little pulses into the body through electrodes that are placed on the skin. Experts believe TENS boost the body to produce endorphins, and may possibly block the pain signals returning to the brain.
- An osteopath specializes in treating the muscles and skeleton.
- Shiatsu is known as finger pressure therapy. The shiatsu therapist applies pressure with his fingers, thumbs and elbows.
- Acupuncture originates from China, consists of inserting fine needles and specific points in the body. Acupuncture helps the body to release its natural painkillers as well as stimulating nerve and muscle tissue.
- A chiropractor treats joints, muscles and bone problems.
Studies of complementary therapies have given mixed outcomes. Some people have experienced great benefit, while others have not. It is important when considering alternative therapies its best go to a well qualified registered therapist.