Can you relieve me of this constant back pain?
Overview
Is lower back pain quite common?
According to experts, almost 80% of the population suffers from lower back pain at some time in their adult life. It is one of the most common reasons people visit doctor, and one of the most common causes for sick leave and disability. On a happier note, for 90% of patients, the low back pain is short-lived and goes away within a few days or couple of weeks. However, some cases may take a longer time to show improvement and in a few instances the persistent pain could require a thorough evaluation to identify the cause.
Overview
- Muscle ache
- Shooting or stabbing pain
- Limited flexibility and/or range of motion
- Inability to stand straight.
What is the back made up of?
Bones, muscles, and other tissues make up the structure that forms the back. The spinal column, in the middle, supports the weight of the upper body and also acts as a protective conduit for the spinal cord – the nervous system that controls the body’s movements and transmits sensations. The spinal column (or spine) comprises about 30 vertebrae, which are small bones arranged one on top of another, through which the spinal cord runs.
Sponge-like pads of cartilage between the vertebrae enable the back to be flexible and also cushion the stress on the bones when the body moves. The vertebrae are held in place by ligaments and tendons attach the muscles to the spinal column.
The spine comprises the following:
- 7 cervical or neck vertebrae
- 12 thoracic or upper back vertebrae
- 5 lumbar vertebrae, commonly known as the lower back
- Sacrum and coccyx, at the base of the spine, which are a group of bones fused together
What are the common causes for lower back pain?
Back pain, in an overwhelming number of cases, is a result of muscle strain due to lifting a heavy weight or twisting; sudden impact in an accident; a herniated disc brought about by stress on tissues and bones of the spine; or osteoarthritis, a degenerative disease of the joints. Lower back pain is commonly caused by:
- Mechanical or Functional Injury
- Inflammation
- Fracture
- Active Infection
- Cancer
- Referred Pain
When to visit a doctor?
Back pain is as common as the common cold and not everyone needs to visit a doctor. One may try home therapy before visiting a doctor. However, one should be aware that back pain should not be neglected under certain conditions such as:
- Back pain in children (<10 years) and the elderly (>70 yrs).
- Back pain in patients with risk of osteoporosis like those on cancer medications, on prolonged bed rest, with hypothyroidism or diabetics, on anti-epileptics etc.
- Back pain with neurological signs like radiating pain along the leg / weakness of foot / difficulty in urination (either straining at urination or urinary leakage) and /or loss of sensation in the perianal region.
- Back pain associated with features of infection like fever, loss of weight, loss of appetite.
Importance of accurate diagnosis
The doctor will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In some patients, imaging such as X-ray, MRI (magnetic resonance imaging), or CT (computerized tomography) scan may be advised to confirm diagnosis.
Mechanical lower back pain
Since mechanical lower back pain afflicts a great majority of the cases, it is worthwhile to take a closer look at it. To determine its cause, the doctor will consider the following factors:
- Muscle strain
- Spondylolisthesis (when one vertebral body slips onto the next)
- Herniated disc (when the cushions between the vertebrae swell up into the space containing the spinal cord or a nerve root, causing pain)
- Osteoarthritis (when the cartilage between joints breaks down, leading to formation of bony spurs that cause pain and swelling.)
- Spinal stenosis (when the bony canal narrows down, putting pressure on the spinal nerves or the spinal cord)
Treatment options for acute lower back pain
In most cases, the lower back pain is caused due to muscle strain and spasm and does not entail surgery.
To treat the pain, the following options may be adopted:
- Medications.
- Bed rest – although not recommended beyond 2 to 3 days. Patients should get back to active life as soon as possible.
- Exercise – effective in speeding up recovery and helping strengthen the muscles of the back and abdomen. It also helps reduce the risk of the back pain recurring.
- Lumbar corsets – helpful only in the work setting. Regular use could weaken spinal and abdominal muscles and delay recovery.
Surgery for lower back pain
Surgery is rarely indicated for isolated back pain. For back pain associated with any structural problem of the spine, surgery may prove beneficial. The type of surgery would depend on the cause for the back
