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Back pain is a frequent complaint, often occurring due to the misuse or exhaustive use of the back muscles. It can range from a dull, mild ache to a chronic, severe, and disabling pain.
Regular back pain typically subsides within a couple of weeks on its own, but severe pain can impede your normal functioning, restrict your mobility, and therefore interfere with your daily activities.
How Common Is Back Pain?
The overwhelming incidence of back pain all over the world can be estimated from the following statistics:
- In America, back pain is the second leading reason for disability. It is generally treated with interventional pain procedures or conservative therapy. (1)
- Approximately 23% of the world’s adult population has chronic lower back pain. Moreover, these individuals experience a one-year recurrence rate of 24%–80%. (2)(3)
Types of Back Pain
Back pain can be categorized into two different types:
Most cases of back pain last for a few days to a few weeks and are therefore classified as short term or acute.
This kind of pain rarely results in any loss of function and usually subsides within a few days through self-care measures, but it can sometimes persist for months before resolving completely.
Pain in the back lasting for 3 months or more is considered to be chronic. It may result from structural disease, injury, or excessive physical stress on specific parts of the body.
Causes of Back Pain
There can be several reasons for back pain.
The most frequent causes of back pain include:
- Muscle spasms
- Fracture, especially in the spine
- Pinched nerve
- Sedentary lifestyle
- Autoimmune conditions (such as ankylosing spondylitis)
- Poor posture
- Health disorders
Postural habits that cause back pain include:
- Tipping forward of the head while looking down at your phone, screen, or desk
- Sitting with the shoulders rolled forward
- Leaning forward from your lower back, therefore putting excess pressure on the lower vertebrae of your spine
- Overuse of muscles from repetitive movements or sports
- Driving with a hunched back
- Driving for a long duration
- Sitting down for long after experiencing pain
- Using your back muscles instead of the leg muscles for lifting heavy weights
Health disorders that cause back pain include:
- Muscle injuries: A strain, sprain, or injury to the ligaments, discs, and muscles around your spine can lead to back pain.
- Ruptured or bulging disc: This is caused by wear and tear of the spine in old age.
- Sciatica: This condition is a result of an irritation in the sciatic nerve at the nerve roots joining outside the spine.
- Spine osteoarthritis (aka degenerative disc disease): This causes increased pressure on the adjacent vertebrae, resulting in the growth of spinal joint spurs, which, when associated with a pinched nerve, can cause localized pain.
- Osteoporosis: This refers to the weakening of the bones, increasing fracture risk.
- Spondylolysis: This is caused by weakness in the bony bridges between the vertebrae, especially in the lower spine, which induces back pain that is aggravated by activity.
- Spinal stenosis: This occurs as a result of the narrowing of the open spaces in the lower spine, which causes pressure on the nerves and back pain that radiates down the legs.
- Scoliosis: Curving of the spine to a side is known as scoliosis. The condition may start to appear physically in childhood, but it may also produce symptoms such as pain only around middle age.
- Referred pain: Disorders of the heart (aortic dissection), pancreas (pancreatitis), gallbladder (gallstones), or kidney (stones) can also cause symptoms of back pain.
Symptoms of Back Pain
Back pain is usually experienced as a sharp, burning, or dull ache confined to a single spot or covering a large area of your back.
Mild back pain typically does not have any other signs, but chronic back pain arising from a severe condition that impinges on the nerves may be accompanied by:
- Shooting pain that radiates to the bottom of one or both legs
- Incontinence, which indicates nerve compression or spine infection such as meningitis or discitis
- Numbness or tingling in the leg, which indicates cauda equina syndrome caused by squeezing of the nerve endings of the spinal cord
- Stiffness in the areas surrounding your spine
Medical Treatment for Back Pain
Multiple treatment modalities may be used to treat back pain depending upon the cause.
The following medicines may be prescribed:
a. Oral drugs
These typically include pain relievers, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, and ibuprofen, may be used to help relieve musculoskeletal pain.
- OTC analgesics, such as acetaminophen (Tylenol).
- Opioids, such as oxycodone, and hydrocodone (Vicodin), act on the nerve cell receptors in the brain and body to help reduce acute pain. However, opioids pose a risk of addiction and should be used with caution, especially in chronic pain situations.
- Gabapentin or pregabalin may be considered depending on the cause.
- Muscle relaxants, such as baclofen, cyclobenzaprine, and carisoprodol, can help relieve the muscle tension and associated pain.
Note: It is essential to take these medicines only upon your doctor’s recommendation and follow the given dosage to avoid any side effects. Please consult your physician before using any medications.
b. Topical ointments
Topical formulations of ketoprofen and diclofenac are found to be effective in treating acute pain caused by sprains and strains. (4)
c. Steroid injections
Severe back pain may require cortisone injections. These injections are generally effective for approximately 3 months.
Surgery is considered the last resort of treatment if no other measures help relieve your pain. You may consult a pain management specialist to determine if you need surgery.
Typically, surgeries are required to treat spinal stenosis, vertebral fractures, ruptured discs, and spondylolisthesis.
Common surgical procedures used to resolve lower back pain are:
- Spinal decompression or laminectomy
- Artificial disc replacement
Diagnosing Back Pain
The following procedures and tests will be performed to diagnose back pain:
1. Medical history
The doctor will review your medical history and symptoms to shortlist potential causes and understand the full extent of your problem.
The doctor will ask the duration and location of the pain, along with any factors that seem to subside or alleviate the pain.
2. Physical exam
The doctor will inspect your spine and related areas, looking for signs such as:
- Spinal curve
- Walking ability
- Skin changes
Additionally, the doctor will feel each backbone and surrounding tissue to identify the origin of the pain.
You may be asked to bend or move your legs to check if there is any pressure on the spine that is impeding your lower body movement.
3. Imaging tests
The doctor may order the following imaging tests to analyze the bones and muscles in and around your spine:
- MRI or CT scan
- Bone scan
4. Lab tests
Lab tests are not commonly used in the diagnosis of acute back pain.
However, if the doctor suspects an infection, tumor, or another organ as the cause, a blood cell count, blood chemistries, urinalysis, organ-specific enzyme tests, and inflammation marker tests may be done.
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Risk Factors Associated With Back Pain
Back pain is observed in both genders and individuals of all ages. However, certain factors can increase the likelihood of developing back pain:
- People generally experience back pain between the ages of 30 and 50 for the first time, but it usually becomes more frequent or severe as age increases, especially if age-related osteoporosis develops.
- Obesity, overweight, or sudden weight gain can put excessive pressure on your back.
- Lack of exercise can waste away or stiffen your back muscles.
- Smoking can wear down your spinal discs and impede body healing.
- Negative mood, anxiety, and stress can aggravate your back pain.
When to See a Doctor
It is advised to consult a doctor at the earliest if you have:
- Back pain after a severe fall
- Incontinence (loss of control over urination or bowel movements)
- Pain radiating to the legs
- Pain that aggravates upon lying down
- Fever accompanied by back pain
- Swelling or redness around the spine
- Numbness or weakness in the leg, thigh, buttocks, or pelvis
- Unexplained weight loss
- Persistent back pain (more than 4 weeks)
- Significant nighttime symptoms
It is vital to treat back pain early to prevent it from becoming a chronic problem. As multiple treatments for back pain are available, no single method can be considered the best.
The treatment methods need to be selected according to the cause of the back pain, generally starting with home care with doctor-approved analgesics and progressing to more complex treatments if no response is seen.