Back pain affects 15-20% of Americans (Jones et al, 2010). It can begin at any age and targets men and women equally, but generally onsets between ages 20 and 40 years old. It is the leading cause of missed workdays and job related disability, and second only to headaches as the leading neurological ailment in the U.S. (National Institutes of Health, 2011). Americans spend $50 billion dollars a year on treating back pain (National Institutes of Health, 2011).
Most back pain is due to benign mechanical issues, such as disc degeneration, muscle strain, spinal stress, weight gain or bulging discs. Often any one of these problems can cause irritation to the joints or discs resulting in severe pain from these simple mechanical issues. Other times complications result from other disorders and lead to chronic back pain. This can include degenerative disc disorder, sciatica, vertebral fractures, osteoporosis complications, congenital abnormalities of the spine and scar tissue build up. Any of these problems can result in chronic pain that can greatly affect daily functioning and quality of life.
Occasionally, chronic back pain signifies a serious disorder that requires a specialist to intervene before permanent damage occurs. These issues may include malignancy, infection, vascular dysfunction, nerve tissue damage, neuropathy, Fibromyalgia, Spondylitis and Cauda Equina Syndrome. Any of these complications require medical treatment from a specialist before back pain treatments can begin.
Though lower back pain is the most frequent complaint, back pain patients may report mild symptoms such as pain in the lower, mid or upper back, pain that radiates into the lower or upper extremities, and pain that worsens with specific movements, physical activities or strenuous exertion.
Occasionally, patients may report extreme symptoms that require immediate medical attention. These symptoms can include weakness, numbness, tingling, fever, weight loss, bowel control issues, bladder dysfunction and pain when coughing.
When a patient is first seen for back pain treatment they need to receive a thorough initial examination from a qualified professional. Initial examinations for chronic back pain may include comprehensive patient history, a complete physical examination and a full neurological workup to identify compressed nerves versus herniated discs. Imaging/scans may be ordered if long-term pain or serious disease is present, and X-rays may be performed if a bone infection or tumor is suspected. If it appears disc herniation is possible, the physician may order an MRI (Magnetic Resonance Imaging). In cases where a spinal disc is suspected of causing pain, that disc is injected with special contrast dye during a discography procedure to determine cause and location of pain. Finally, Computerized Tomography (CT) may be recommended if disc rupture, spinal stenosis or damage to vertebrae may be possible.
Once a thorough exam has been completed, back pain treatment can occur. Conservative back pain treatments can relieve pain in a few weeks. These treatments can include spinal manipulation by a licensed Chiropractor, physical therapy or exercise such as strength training to strengthen back muscles and speed up the recovery process, yoga to relax, strengthen, and stretch muscles, or stretching exercises to alleviate stiffness and tightness. Lifestyle adjustments are usually recommended as well such as proper diet and nutrition to strengthen bones, reduction of alcohol intake, cessation of tobacco use, weight loss to reduce strain, elimination of drug use, abstinence from strenuous activities, avoid aggravating movements, or bed rest. Many times, alternative therapies are also recommended for acute back pain relief such as acupuncture, massage and biofeedback. The most common form of conservative back pain treatment is the use of pain medications such as over-the-counter pain medications such as acetaminophen, ibuprofen and naproxen, or prescription opioids such as Codeine, Oxycodone, Hydrocodone or Morphine. Further back pain medications include prescription muscle relaxants, anticonvulsants, or antidepressants such as Amitriptyline or Desipramine, which have all been found to be effective for back pain treatment.
If chronic back pain is not eliminated by conservation measures, a physician may suggest more progressive measures. Aggressive pain management treatments may include catheterization to administer drugs directly into the spinal cord, spinal cord stimulation, or interventional therapy, which involves injecting local anesthetics, steroids or opiates at the pain site to reduce pain symptoms. A physician can also choose to perform nerve blocks in order to block the nerves that are transmitting pain signals to the brain. In some cases surgical intervention may be necessary in order to relive pain such as Spinal fusion, Discectomy, Foraminotomy, Spinal laminectomy, Rhizotomy or Cordotomy.
- Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/pdxmd/body/268245516-3/0?type=med&eid=9-u1.0-_1_mt_1014913.
- Lin, M. (2009). UpperBackPain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy1.library.arizona.edu/books/page.do?eid=4-u1.0-B978-0-323-05472-0..00051-7–s0220&isbn=978-0-323-05472-0&sid=1175026577&uniqId=262415626-3#4-u1.0-B978-0-323-05472-0..00051-7–s0220.
- National Institutes of Health 2011. LowBackPain Fact Sheet. NINDS. Available at http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#167453102. NIH Publication No. 03-5161
- Nidus Information Services 2010: LowBackPain – Chronic. Patient Handouts page. MD Consult Web site, Core Collection. Available at http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/patient/body/231440260-4/1104412125/10041/37946.html. Accessed January 14, 2011