What is Back Pain?

If you’ve ever groaned, “Oh, my aching back!”, you are not alone. According to MedlinePlus, Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take awhile. Taking over-the-counter pain relievers and resting can help. However, staying in bed for more than 1 or 2 days can make it worse.

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms of back pain may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Is there any treatment for Back Pain?

According to National Institute of Neurological Disorders and Stroke (NINDS), “most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation.  The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury.  Back Pain medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies.  Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.  Bed rest is recommended for only 1–2 days at most.  Individuals should resume activities as soon as possible.  Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.   In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.”

What is the prognosis for Back Pain?

NINDS researchers observed that most back Pain  patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.  Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

What research is being done of Back Pain?

The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct pain research in laboratories at the NIH and also support pain research through grants to major medical institutions.  Currently, researchers are examining the use of different drugs to effectively treat back pain, in particular, chronic pain that has lasted at least 6 months. Other studies are comparing different health care approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or massage therapy). These studies are measuring symptom relief, restoration of function, and patient satisfaction. Other research is comparing standard surgical treatments to the most commonly used standard nonsurgical treatments to measure changes in health-related quality of life among patients suffering from spinal stenosis.

What Are the Causes of Back Pain?

There are many causes of back pain. Mechanical problems with the back itself can cause pain. Examples are:

• Disc breakdown
• Spasms
• Tense muscles
• Ruptured discs

Injuries from sprains, fractures, accidents, and falls can result in back pain.

Back pain can also occur with some conditions and diseases, such as:

• Scoliosis
• Spondylolisthesis
• Arthritis
• Spinal stenosis
• Pregnancy
• Kidney stones
• Infections
• Endometriosis
• Fibromyalgia

Other possible causes of back pain are infections, tumors, or stress.

Can Back Pain Be Prevented?

The best things you can do to prevent back pain are:

• Exercise often and keep your back muscles strong.
• Maintain a healthy weight or lose weight if you weigh too much. To have strong bones, you need to get enough calcium and vitamin D every day.
• Try to stand up straight and avoid heavy lifting when you can. If you do lift something heavy, bend your legs and keep your back straight.

When Should I See a Doctor for Back Pain?

You should see a doctor if you have:

• Numbness or tingling
• Severe pain that does not improve with rest
• Pain after a fall or an injury

• Pain plus any of these problems:

  • Trouble urinating
  • Weakness
  • Numbness in your legs
  • Fever
  • Weight loss when not on a diet.

How Is Back Pain Diagnosed?

To diagnose back pain, your doctor will take your medical history and do a physical exam. Your doctor may order other tests, such as:

• X rays
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Blood tests.

Medical tests may not show the cause of your back pain. Many times, the cause of back pain is never known. Back pain can get better even if you do not know the cause.

What Is the Difference Between Acute and Chronic Pain?

Acute pain starts quickly and lasts less than 6 weeks. It is the most common type of back pain. Acute pain may be caused by things like falling, being tackled in football, or lifting something heavy. Chronic pain lasts for more than 3 months and is much less common than acute pain.

How Is Back Pain Treated?

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take acetaminophen, aspirin, or ibuprofen to help ease the pain. Exercise and surgery are not usually used to treat acute back pain.

Following are some types of treatments for chronic back pain.

Hot or Cold Packs (or Both)

Hot or cold packs can soothe sore, stiff backs. Heat reduces muscle spasms and pain. Cold helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this treatment does not fix the cause of chronic back pain.

Exercise

Proper exercise can help ease chronic pain but should not be used for acute back pain. Your doctor or physical therapist can tell you the best types of exercise to do.

Medications

The following are the main types of medications used for back pain:

• Analgesic medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications.
• Topical analgesics are creams, ointments, and salves rubbed onto the skin over the site of pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that reduce both pain and swelling. NSAIDs include over-the-counter drugs such as ibuprofen, ketoprofen, and naproxen sodium. Your doctor may prescribe stronger NSAIDs.
• Muscle relaxants and some antidepressants have also been prescribed for chronic back pain, but it is not yet known if they work for back pain.

Behavior Changes

You can learn to lift, push, and pull with less stress on your back. Changing how you exercise, relax, and sleep can help lessen back pain. Eating a healthy diet and not smoking also help.

Injections

Your doctor may suggest steroid or numbing shots to lessen your pain.

Complementary and Alternative Medical Treatments

When back pain becomes chronic or when other treatments do not relieve it, some people try complementary and alternative treatments. The most common of these treatments are:

• Manipulation. Professionals use their hands to adjust or massage the spine or nearby tissues.
• Transcutaneous electrical nerve stimulation (TENS). A small box over the painful area sends mild electrical pulses to nerves. Studies have shown that TENS treatments are not always effective for reducing pain.
• Acupuncture. This Chinese practice uses thin needles to relieve pain and restore health. Acupunture may be effective when used as a part of a comprehensive treatment plan for low back pain.
• Acupressure. A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for back pain.

Surgery

Most people with chronic back pain do not need surgery. It is usually used for chronic back pain if other treatments do not work. You may need surgery if you have:

• Herniated disc. When one or more of the discs that cushion the bones of the spine are damaged, the jelly-like center of the disc leaks, causing pain.
• Spinal stenosis. This condition causes the spinal canal to become narrow.
• Spondylolisthesis. This occurs when one or more bones of the spine slip out of place.
• Vertebral fractures. A fracture can be caused by a blow to the spine or by crumbling of the bone due to osteoporosis.
• Degenerative disc disease. As people age, some have discs that break down and cause severe pain.

Rarely, when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, surgery is needed right away to ease the pain and prevent more problems.

What Kind of Research Is Being Done?

Back pain researchers are studying:

• Surgical versus nonsurgical treatment for back pain
• The best treatments for low back pain
• How well lumbar fusion surgery works for disc pain
• How often there are problems after lumbar fusion surgery
• Loss of movement and low back pain
• Ways for people with acute low back pain to feel better
• The role of nerves in low back pain
• Ways to use the Internet to teach people about back pain.

Good News for people with chronic low Back Pain

WEDNESDAY, Oct. 7 (HealthDay News) — Good news for people with chronic low back pain: About four in 10 will recover within a year, according to a study that challenges the common belief that recovery from this type of pain is unlikely.

The Australian study included about 400 patients who sought treatment for acute low back pain at primary care clinics and had not recovered after 90 days. Acute low back pain was defined as pain that had lasted more than 24 hours but less than two weeks.

During telephone surveys nine and 12 months later, the patients were asked about their pain and disability levels and work status. Complete recovery was reported by 35 percent of patients within nine months and by 41 percent within a year, the researchers noted.

The findings show that the rate of recovery from chronic low back pain is higher than previously reported and that the prognosis for these patients isn’t uniformly poor, said lead study author Dr. Luciola Menezes Costa of the University of Sydney. These findings should prove reassuring for patients because it shows that it’s possible to recover from a new episode of low chronic back pain, the researchers added.

The study appears in the Oct. 7 online edition of the BMJ.

While these findings seem encouraging, much longer follow-up of patients with chronic low back pain is needed in order to learn more about how different patterns emerge and in what order, and why some people recover while others have episodic pain for years or long-term constant pain, two researchers from Keele University in the U.K. wrote in an accompanying editorial.

SOURCE: BMJ, news release, Oct. 7, 2009

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