Back pain
This can be caused by a various problems with any parts of the, interconnected network of spinal muscles, complex nerves, bones, tendons or discs in the lumbar spine. This typical sources of back pain include:
· An inter-vertebral disc may be degenerating
· The smaller nerves that supply the low back may be irritated
· The large nerve roots in the low back that go to the legs may be irritated
· The large paired lower back muscles (erector spinae) may be strained
· The ligaments or joints, bones, may be damaged
Types of back pain:
Causes of back pain:
- Strained muscles and ligaments
- Lifting too heavy or something improperly
- A muscle spasm.
- Pushing or Pulling something
· Sitting in a hunched position for long periods (e.g. when driving)
Signs and symptoms of back pain:
- Fever
- Weight loss
- Pain down the legs
- Inflammation (swelling) on the back
- Difficulty urinating
- Fecal incontinence
- Numbness around the buttocks, genitals, anus
Complications:
Structural problems - the following structural problems may also result in back pain:
§ Arthritis: Patients with osteoarthritis commonly experience problems with the joints in the hands, knees, lower back, and hips. In some cases spinal stenosis can develop - the space around the spinal cord narrows.
§ Bulging disks: In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
§ Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, which results in back pain.
§ Sciatica: A sharp and shooting pain that travels through the buttock and down back of the leg, caused by a herniated or bulging disk pressing on a nerve.
§ Osteoporosis: bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
§ Abnormal curvature of the spine: If the spine curves in an unusual way the patient is more likely to experience back pain. For example in scoliosis, when the spine curves to the side.
Diagnosis:
- imaging scans or X-rays
- Computerized tomography
- Magnetic resonance imaging
- Bone scan: Used for detecting bone tumors or compression fractures caused by brittle bones
- Electromyography or EMG
Treatments for back pain:
- NSAID (non-steroidal anti-inflammatory drug): Codeine or hydrocodone - narcotics - may also be prescribed for short periods; close monitoring is required.
- Tricyclic antidepressants: They have been shown to alleviate the symptoms of back pain, regardless of whether or not the patient has depression. Amitriptyline, is used to treat backpain.
- Physical Therapy: Application of heat, ice, ultrasound and electrical stimulation, as well as some muscle-release techniques to soft tissues and the back muscles may help alleviate pain. As the pain subsides the physical therapist may introduce some strength exercises and flexibility for the back and abdominal muscles.
- Cortisone injections: If the above therapies are not effective or enough, if the pain reaches down to the patient's legs, cortisone may be injected into the epidural space (space around the spinal cord). Cortisone is an anti-inflammatory drug; it helps reduce inflammation around the nerve roots.
- Botox (botulism toxin): according to some early studies, botax reduces the pain by paralyzing the sprained muscles in spasm. These injections are effective for about 3-4 months.
- Surgery: It is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness. Examples of surgical procedures include:
- Artificial disk - an artificial disk is inserted; it replaces the cushion between two vertebrae.
- Fusion - two vertebrae are joined together, with a gone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.
- Discectomy (partially removing a disk) - a portion of a disk may be removed if it is irritating or pressing against a nerve.
- Partially removing a vertebra - a small section of a vertebra may be removed if it is pinching the spinal cord or nerves.
- CBT (Cognitive Behavioral Therapy): According to some studies, CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things. People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.
Complementary therapies:
- An osteopath specializes in treating the skeleton and muscles.
- A chiropractor treats joint, muscle and bone problems - the main focus being the spine.
- Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with his/her fingers, thumbs and elbows.
- Acupuncture, which originates from China, consists of inserting fine needles and specific points in the body. Acupuncture can help the body release its natural painkillers - endorphins - as well as stimulating nerve and muscle tissue.
Prevention:
- Exercise: Regular exercise helps build strength as well as keeping body weight down. Core-strengthening exercises; exercises that work the abdominal and back muscles, help strengthen muscles which protect your back.
- Flexibility - exercises aimed at improving flexibility in your hips and upper legs may help too.
- Body weight - the fatter you are the greater your risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable.
- Posture when standing - make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet - keep your legs straight.
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