Back pain can be chronic or acute, consist of a persistent dull ache or sharp pain on movement, and may be attributable to a clear cause, such as acute spinal trauma, or remain unclassified and unaddressed for many years. Dorsalgia, the clinical term for back pain may originate from the spinal muscles, nerves, spinal cord, spinal joints including the facet joints, intervertebral disc degeneration, and bones of the spinal column. Classification of pain usually involves a recognition of its location, such as cervical spinal pain, thoracic spinal pain, or lumbar pain. More commonly these simply become neck pain, upper or mid-back pain, and lower back pain or tailbone pain. Lumbar pain is also often referred to as lumbago and nearly everyone is thought to experience some degree of back pain at some time during their lives, making it one of the most common reasons for visits to the doctor.
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Where back pain goes untreated or where treatment is not successful the pain can spread to other areas depending on the cause of the condition. Nerve compression through spinal stenosis is a major cause of chronic back pain and conditions such as sciatica. The nerves of the spine are responsible for innervating areas far away from the spine itself and any inflammation, irritation, or compression of the nerves as they exit the spine may result in either acute or permanent radiculopathy. In some cases the onset of back pain may be followed by problems with bladder or bowel control, weakness and numbness in the limbs, or extreme pain that does not respond to analgesic medications. In such cases back surgery may be an immediate necessity in order to prevent permanent nerve damage occurring and to relieve possible pressure on the spinal cord causing the symptoms of myelopathy or cauda equine syndrome.
Acute Back Pain
Acute back pain is classed as pain that lasts less than four weeks, subacute pain lasts four to twelve weeks, and chronic pain is the term used to refer to pain lasting over twelve weeks.
Almost all patients suffering from back pain are diagnosed with nonspecific acute back pain which has no serious underlying pathology. Those remaining patients with chronic back pain may be suffering due to an underlying condition such as metastatic cancer, a spinal abscess, or osteomyelitis. Such cases are extremely rare however, and for a large number of patients with back pain the cause is a herniated disc which is causing compression of the spinal nerves as they exit the spine. Most intervertebral disc herniations occur at L4/5 and some disc herniations are addressed through back surgery such as a discectomy, foraminotomy with discectomy, or discectomy with spinal fusion. For many patients, rest, simple prescribed exercises for disc herniation, and analgesic and anti-inflammatory medications suffice to allow the disc to heal and pressure to be taken off the irritated nerve.
Where back pain occurs in conjunction with a fever, loss of appetite, or unexplained weight loss it is important to consider an alternative underlying pathology rather than assume that back pain is due to disc herniation, commonly referred to as a ‘slipped’ disc. In cases where acute trauma has recently occurred, such as whiplash, or blunt force trauma during physical activity such as football, it is important to consider that a fractured bone or damaged cartilage may be the cause of back pain. Applying heat to a swollen and painful area would be contraindicated and ice would be more appropriate whilst waiting for further treatment. Knowing the cause of back pain can reduce the risks of exacerbating the condition through incorrect treatment; a prompt diagnosis is invaluable but, unfortunately, not always available.
Where back pain occurs only on specific movements, such as forward bending of the neck, or backwards bending of the lower back, it is possible that spinal stenosis is present and that the motion of the spine is causing extra compression of spinal nerves. Diagnostic imaging techniques such as X-Ray, MRI, and CT scans can help identify such narrowing of the spinal canal and selective nerve root blocks may help isolate the origin of the pain. back surgery such as the X-Stop procedure may be appropriate to relieve pain from lumbar spinal stenosis, or a discectomy, facetectomy, anterior cervical discectomy with fusion, or other back surgery procedure may be warranted if pain continues for six months or more and is severe.
Back Pain Treatment
In many cases pain is manageable using conservative treatments including analgesic medications, whether pharmaceutical or natural remedies for back pain relief, along with physical therapy and activities such as acupuncture and acupressure for back pain. Non-surgical traction for spinal stenosis may not be beneficial for many patients, and facet thermal ablation is also largely unsupported by evidence for most cases of back pain, even where facet joint arthritis is evident. Yoga appears to be helpful in reducing the incidence of back pain, and the severity of the condition should it occur, with Iyengar yoga most supported by evidence. Patients may also find that the Alexander Technique can help if back pain is caused, or exacerbated by postural problems. A workplace ergonomic assessment may also reveal poor postural practices that could be helped with simple changes to the work set-up. In a number of cases back pain, particularly chronic back pain, has been found to be associated with stress, both at work and in home life. Reducing stress may, therefore, be helpful in reducing back pain, although, as back pain itself can be stressful, the circle is rather a vicious one.
Other conditions, such as fibromyalgia, multiple sclerosis, lupus, rheumatoid arthritis and other autoimmune diseases and syndromes, along with those not of an autoimmune origin, may contribute to and be made worse by back pain. Where a number of co-morbidities exist the diagnosis of back pain and the attribution of symptoms to a particular disease or condition can become extremely difficult. In many cases a patient with one condition that could cause back pain may simply have their pain dismissed as part of that condition without due consideration of other pathology. Recognition is growing, albeit slowly, that chronic pain underlies a number of stress-related conditions such as fibromyalgia and that addressing the cause of the pain itself may help relieve the condition originally diagnosed. Improving diagnostic procedures and making better treatment options available will not make chronic back pain a thing of the past, but do provide some hope for those suffering with this, often life-changing condition.