Back Pain

Musculoskeletal

Back pain is a musculoskeletal disorder caused by injury or stress to the spine and/or the joints, tendons, ligaments, and muscles that support the spinal cord. Pain type and severity can range from mild pain that is dull and throbbing to debilitating pain that is sharp and stabbing. It can affect the upper back and neck, middle back, and lower back, as well as the extremities – this happens when a nerve is pinched or compressed. The causes also vary greatly, from acute injury and age degeneration to inflammatory conditions like rheumatoid arthritis. Back pain is often temporary and can be relieved by over the counter (OTC) anti-inflammatories, pain relievers, and rest, but it can also be chronic (lasting over three months). While anyone can suffer back pain, it is more common in middle-aged to elderly adults. Back pain is the most common cause of disability and visits to the doctor for pain in the United States today.

If you are suffering back pain and it has been longer than a few days, consult your physician. A sudden injury to your back should always be evaluated by a doctor right away. Your doctor is the best resource for the diagnosis and treatment of back pain.

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Symptoms

Symptoms depend on the type of back pain you are experiencing:

Radicular back pain. Sciatic nerve pain and spinal stenosis cause radicular pain. It is described as a deep pain in the extremity closest to the area. You may also experience a pins and needles sensation, or numbness of extremities. This is a sign of spinal nerve compression, inflammation, or injury.

Axial back pain. Axial back pain is generally located in a specific region, but it can range in sensation from sharp pain to achy and dull. It is usually caused by an injury, problems with your back muscles, or a mechanical issue.

Referred back pain. Referred pain is any type of pain that is felt in one area but caused by something going on in another area.  This achy, dull pain tends to radiate to another area (e.g., buttock to thigh; lower back to pelvic area). Referred back pain is usually caused by a nerve injury in the lower back. Degenerative disc disease may cause back pain to show up in the thigh or hip area.

Risk Factors

  • Age
  • Lack of Exercise/Poor Muscle Strength
  • Obesity
  • Genetics
  • Arthritis
  • Cancer
  • Careers that involve physical labor
  • Smoking

Diagnosis

The doctor will take a full medical history and ask if you have had any recent injuries. You will need to tell the doctor about any medications that you are taking for pain or inflammation. Also, give your doctor a detailed list of medications and known allergies. Next, you will be given a physical exam. Your doctor will want to see how you move your legs, stand up, sit down, and walk. Tell your doctor what your pain level is on a scale of 1 to 10. Let your doctor know what your pain level is at rest and when you are moving around.Your doctor may send you for the following tests:

X-ray. An x-ray is an easy way to see minor injuries, arthritis, and crooked alignment of the back. X-rays are not very detailed however, so nerve issues, muscles, tendons, and ligaments need to be looked at with a CT or MRI scan.

CT and MRI scan. What an x-ray cannot pick up can be seen on either a CT or MRI scan. These will show deeper issues in the muscles, nerves, joints, and other soft tissues in the back.

Bone scan. If your doctor sees a fracture, you may need to have a bone scan to check for osteoporosis and tumors in the bones of the back.

Lab testing. To rule out infection or other internal issue, your doctor may do blood tests.

Nerve conduction studies. If the doctor thinks you may have compression of your spinal nerves, you may need to have nerve conduction tests to check how your muscles respond. For this test, you will be hooked up to electrodes to check the electrical impulses coming from the nerves and muscles. This is a painless and noninvasive exam.

Treatments

If the doctor does not find anything serious, you may be advised to rest and use OTC anti-inflammatories and pain relievers. You may also be advised to stay out of bed, contrary to what you might think. This is because long period of rest and not enough movement can also exacerbate back pain. Continuing normal activity as tolerated may help you recover faster.Be sure to get in touch with your doctor if the pain does not resolve after a few weeks. If you do have to go back to the doctor, they may recommend further treatment with:

  • Muscle relaxers
  • Narcotic pain relievers
  • Antidepressants
  • Cortisone injections
  • Topical pain medications

You may also be referred to a specialist for:

Physical therapy. A physical therapy (PT) program can help you learn better ways to protect your back and restore mobility. PT may involve massage, heat therapy, and ultrasound. They may also put you on machines to strengthen your core muscles and prevent further injury.

Surgical intervention. Surgery may be needed to repair damage to your back. This is common with disk rupture, nerve compression, and spinal stenosis. It is usually a last resort if other treatments have not worked for you.

Alternative Treatments and Home Remedies

If your doctor gives the okay, there are a few natural and alternative remedies that may help back pain:

Massage. Massage therapy can help with muscle strains and tension in your back and neck.

Chiropractic treatment. Chiropractors use spinal manipulation to put the spine back into place.

Yoga. There are gentle yoga techniques that can help you stretch your muscles and do deep breathing to help relieve back pain.

Acupuncture. Needles are placed at different locations in your skin to release energy flow and reduce back pain.

Glucosamine/chondroitin. Taking between 500 and 1,500mg daily may help to reduce joint pain. It should not be taken by people who are allergic to shellfish. Do not use if you are on blood thinners or suffer from asthma.

MSM. Taking 3,000mg of MSM two times a day may help protect you from degenerative joint and connective tissue disease. It may also help reduce joint pain.

Bromelain. This enzyme is a natural anti-inflammatory found in pineapples. Take 250mg twice daily but use caution if you are at risk for bleeding.

Turmeric. Herbalists recommend 300mg three times daily to help relieve inflammation and pain naturally. This can also be used in combination with bromelain to increase the effects. Use caution if you are at risk of bleeding.

Capsaicin. This natural pain reliever comes from chili peppers. It is used in a cream and applied topically to the skin but must be used consecutively over a number of days to feel the effects. Studies have shown that it really is effective.

Prevention

Strengthen core muscles. Make sure you do exercises that strengthen your core muscles. This helps to hold your back stable. You can ask your physical therapist for examples.

Keep your weight in a healthy range. If you are overweight, all the muscles and joints in your body experience extra stress. Losing just a few pounds helps to relieve stress and pressure.

Use proper posture. Using good body mechanics can relieve stress to your back. Here are a few tips:

  • Stand with one foot on a footstool and alternate feet. Keep your pelvis tucked in a neutral position when standing.
  • Use a chair with lower back support that swivels at the base. Make sure you keep your knees and hips in line and level. Get up and walk after sitting for two hours.
  • Lift with your knees and not your back. Always keep heavy objects close to your body and never twist while lifting.

References

Anaesth, Br. J. (2011, August 17). Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. British Journal of Anesthesia. (pp. 490-502). Retrieved from National Center for Biotechnology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169333/

Dahlhamer, J., Lucas, J., Zelaya, C., et al. (2018, September 14). Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. Morbidity and Mortality Weekly Report (MMWR), 67(38); 1001-1006. Retrieved from Centers for Disease Control: https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm#suggestedcitation

Dydyk, A. M., Das, J. M. (2020, October 24). Radicular back pain. Retrieved from National Center for Biotechnology: https://www.ncbi.nlm.nih.gov/books/NBK546593/

Hooten, M. W., Cohen, S. P. (2015). Symposium on pain medicine – Evaluation and treatment of low back pain: A clinically focused review for primary care specialists. Retrieved from Mayo Clinic Proceedings: https://www.mayoclinicproceedings.org/article/S0025-6196(15)00804-6/pdf

Mayo Clinic. (2020, August 21). Back pain – Symptoms and causes. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906

National Institute of Neurologic Disorders and Stroke. (2020, March). Low back pain fact sheet. National Institute of Health. Retrieved from National Institute of Neurologic Disorders and Stroke: https://www.ninds.nih.gov/sites/default/files/low_back_pain_20-ns-5161_march_2020_508c.pdf

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