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What is it?
Back pain or specifically lower back pain, lumbago, in of itself, is not a disease or disorder but is rather a symptom of a vast majority of disorders and other medical conditions. Acute backaches, those that are caused by falls or heavy lifting, have a sudden onset and can resolve themselves within a few weeks. Chronic backaches, on the other hand, have a gradual onset and can last for three months or longer, sometimes for life even after the causes have been treated. Chronic back pains are less common than acute back pains.
Back pain can range from constant and dull to sudden and sharp. Many times, back pain often develops without an obvious cause that the doctor must then test to determine. Causes for back pains are numerous, some of which have been listed below.
How common is it and who is at risk?
Lower back pain is the most common job-related condition with nearly 80 percent of adults reporting to have experienced it at some point in their lives. It serves as one of the leading causes of health-related work absences.
Biological sex is not a risk factor as men and women are equally affected by lower back pain. Children and teens can also be affected, however, risks of developing back pain tend to increases with age. A lack of exercise can increase chances of back pains as well, due to the muscles stiffening in place caused by a lack of regular movement. Those suffering from obesity are at risk, too. Acute back pains can arise from the improper lifting of heavy items. Moreover, people with psychological conditions like depression or anxiety and those who smoke at also at a greater risk of developing back pains than others.
Furthermore, pregnant women frequently complain of back pain due to the shifting of their center of gravity and other alterations that occur in their body. These pains usually resolve themselves postpartum.
What are the symptoms?
Symptoms of back pain can vary in severity depending on the associated problem causing it. Common symptoms can include aching muscles, stabbing and shooting sensations of pain, pain that increases in intensity when one stands, walks, bends or lifts heavy objects or pain that extends down to the legs. Another symptom can be that this pain reduces when one reclines.
Usually, the pain can subside by adequate self-care and rest at home. It may take a few weeks to resolve in its entirety. If the condition persists, a doctor’s appointment would be required. If certain other symptoms coincide with back pain, a serious medical condition may exist. Some alarming signals would be if the back pain is accompanied by abnormal bladder or bowel reactions, a fever or inexplicable and sudden weight loss.
If the pain spreads to both legs, causes numbness in the legs or is just severe and unrelenting regardless of rest, a doctor should be contacted. If the back pain begins for the first time after the age of 50, or if there is a history of osteoporosis, cancer or steroid use, then too, one should contact their doctor.
How is it diagnosed?
A full medical history of the patient and their family is an effective starting point for a diagnosis. Knowledge of drug and alcohol addictions, cancers, steroid use, and other medical conditions can help the doctor root out the cause or causes of the pain. The doctor will also perform a physical exam wherein the doctor will assess the patient’s ability to sit up, stand, walk or bend over and ask them the extremity of pain felt in each task. Through this examination, the doctor can assess the patient’s ease of movement and determine whether they have muscle spasms. Neurological tests can also provide help in deciphering the cause of the pain.
In most cases of back pain, imaging tests are not required in making a diagnosis, however, they can help in ruling out some specific conditions of which back pain is a symptom like spinal stenosis or arthritis. X-rays can be used to see if there are any fractures in the spine, broken bones, bone spurs or any vertebral misalignment. Computerized tomography, a CT scan, is done to visualize spinal structures not visible through X-rays for example tumors or disc ruptures. Myelograms can also be recommended for even clearer results from CT scans and X-rays. They can allow the doctor to see nerve compressions caused by fractures or herniated discs.
Magnetic resonance imaging or MRI is another imaging test that uses magnetic fields to generate an image of the body’s muscles, tendons, blood vessels, and ligaments. The MRI can help the doctor diagnose or rule out conditions like cancers or arthritis. The MRI can also disclose whether any disc herniation, rupture or inflammation in the spine exists or if there is pressure on any nerve.
Further ahead in the diagnosis, electro-diagnostic procedures may be conducted to check whether the pain is a case of lumbar radiculopathy. These are detailed procedures and include electromyography or EMG, nerve condition studies and evoked potential studies. Bone scans can also help to diagnose back pain causes by detecting disorders or infections in the bone. The resulting images can identify instances of abnormal blood flow or irregular bone metabolism around the pain affected areas.
Although not regularly required, blood tests may be conducted to rule out certain conditions that also cause back pain like ankylosing spondylitis or reactive arthritis. These tests include complete blood count, C – reactive protein and erythrocyte sedimentation rate. Blood tests can also be used to check for genetic markers of different diseases.
What are the treatment options available?
In most cases, back pain can get resolved within a few weeks with rest. However, if the pain persists and affects the quality of life, steps should be taken to get it treated. In the case of acute back pain, a course of pain relief drugs, muscle relaxants, salves, and ointments, or heat application can be enough to treat the pain. Light activity like short walks can improve the condition. However, activities should be ceased when the pain hits or is intolerable.
For more serious conditions, the doctor may prescribe the use of narcotics or opioids for a short course of time under supervision. However, opioids are not effective in the treatment of chronic pain, in case of which antidepressants, such as amitriptyline, in small doses may prove to be beneficial. If these measures are ineffectual as well, injections with medication like cortisone may be directly administered into epidural space. Cortisone can reduce inflammation that may numb the pain.
Physical therapy is an effective treatment for many with chronic back pain. Physical therapy can include applying heat, electrical stimulation to the body and muscles that can subside inflammation and relieve the stiffness in the tissues, nerves, and muscles. Additionally, the physical therapist can teach the patient exercises to enhance flexibility, strengthen the back muscles and improve posture. Regular exercise can keep the body from wearing out and can help the chronic pain stay within control.
As a last resort for cases where the severity of the pain is unbearable and continuous, doctors may recommend surgery to resolve structural problems within the spine. Conditions like spinal stenosis may benefit from surgical procedures targeted at improving nerve compression or widening the spine.