Back Pain

Up to 80 percent of the population will suffer from back pain at some period in their life. Felt in the back, the pain is divided according to the three divisions of the vertebral column. The cervical or neck vertebrae consists of seven vertebrae, the thoracic or middle back vertebrae are twelve in number, and there are five lumbar or lower back vertebrae. Lumber or sacral occurs in the lower back and is the most common type of back pain. 

Back pain may be a dull ache or felt as shooting pains; it may also be perceived as a piercing or burning sensation in the back. Back pain may radiate into arms and legs as and may result in numbness or weakness in the arms and legs. 

Back pain is classified into three kinds of pain, depending on the timeframe of symptoms. Acute pain lasts less than six weeks; sub-acute pain can last from six to twelve weeks, while chronic pain is a debilitating condition that can affect the quality of life for any time over six weeks.

How is back pain diagnosed?

Initial assessments will involve a medical history and a physical exam. Location, duration, and severity of pain, history, and cause such as possible traumas will be investigated. Other essential factors that the doctor will take into account will weight loss, fever, urinary incontinence, weakness, or sensory changes. The straight leg maneuver is performed to find any signs of lumbosacral radiculopathy, which indicates underlying nerve root causes. Non-radiculopathy pain usually has trauma-related origins or occurs due to a herniated disk or degenerative spinal disease. Imaging of the spine is with magnetic resonance imaging is not performed or recommended during an initial assessment. Up to 10 percent of the people suffering from back pain may be diagnosed through imaging.

Why does back pain occur? 

Up to 90 percent of cases of back pain go undiagnosed and are listed as nonspecific cases of back pain. No diagnostic anomalies or physiological causes are ever found apart from the sometimes-debilitating pain that the patient has to suffer through. 

Nonspecific pain may be due to strains and sprains, as well as due to muscle or ligament injury. The patient may never be able to recall the cause, but back pain is sometimes associated with chugging heavy weights or quick, sharp movements.

Chronic pain may also result from central sensitization where an initial injury results in heightened feeling or sensitivity to pain in the region that persists even though the damage is resolved. 

Specific Causes of Back Pain

Four percent of people will present with a vertebral compression fracture. Metastatic cancer accounts for 0.7 percent of the cases of back pain, while infection accounts for 0.01 percent of cases. Cauda equina accounts for 0.04 percent of back pain patients only. 

Spinal disc disease causes chronic and sometimes debilitating pain. This occurs when the nucleus pulposus, which is a gel-like material at the core of the vertebrae, ruptures. The rupture results in the nerve roots being compressed and these nerves cause pain that may be localized or spreads into other parts of the body, such as the legs. Cauda equina is a syndrome that occurs when the cauda equina nerve is compressed and results in lower back pain. The pain also involves one or both legs and may cause numbness of the groin. Cauda equina caused by disk herniation occurs mostly in males in their 30s and 40s. 

Infections such as osteomyelitis, which is a bacterial infection that affects the bones, will cause back pain. Staphylococcus bacteria most often cause osteomyelitis in the vertebrae. Risks factors that may lead to osteomyelitis include skin or urinary tract infections, endocarditis, lung disease, or the use of IV drugs or caterers. Septic diskitis and epidural abscess, which is caused by severe bacteremia, will also cause back pain.

How to Avoid Back Pain

  • Avoid heavy lifting. Heavy lifting in an incorrect position can lead to compressed nerves, herniated, or slipped disks. The correct position to life something heavy is to bend your knees and keep your back straight to keep the weight of your back. 
  • Maintain a healthy weight as your back has to carry any excess weight you put on. 
  • Do back strengthening exercises to strengthen muscles ligaments and bones. 
  • Maintain the correct posture by keeping your back and neck straight at all times; incorrect posture can over long periods result in chronic back pain. 
  • The back school involves education and physical exercises that may prevent back or alleviate back pain. 

How to manage back pain in non-pharmacological ways

The first line of defense in back pain is usually non-pharmacological. It will involve heat therapy, which has been showed to reduce lower back pain. Gentle strengthen exercise and physiotherapy may be encouraged in uncomplicated cases. Massage therapy reduces pain and swelling and is sometimes used instead of or alongside conventional pain killers as pain management. Acupuncture offers relief to some patients, while spinal manipulation may be recommended for others. Insoles in shoes or traction for back pain are not valid as pain management.

Managing back pain with medications 

NSAIDs or non-steroidal anti-inflammatory drugs are first prescribed to control the pain. They are typically more effective than paracetamol for alleviating symptoms. Opioids or anti-depressants are no better than NSAIDs for back pain relief. Skeletal muscle relaxers may offer some relief and are used for short term pain alleviation. Epidural Corticosteroid injections involve the injection of steroids into an epidural space to reduce inflammation, alleviate pain, and improve function.

Surgery as a last resort in back pain management

When serious neurological problems are visible, surgery may be chosen. Surgery may be an option of people suffering from severe back pain due to myelopathy or cauda equina syndrome. The benefits of surgery are, however, often only a short-term solution.

A surgical procedure that is performed to alleviate back pain includes a multi-level laminectomy which widens the spinal canal or a foraminotomy to relieve nerve root compression. A discectomy is shown to improve symptoms caused by a torn intervertebral disc. Total disc replacement or spinal fusion are also surgical procedures that are performed concerning back pain. 

Back pain during pregnancy

Significant pain is experienced by up to a third of pregnant women. All the extra weight during pregnancy results in curvature of the back, which increases the risk of back pain, especially for the women who suffered from back pain before they got pregnant. The softening of structural tissues to prepare for labor and delivery also causes back pain, as does the pressing down of the fetus on the sacral plexus and lumbar plexus.