Back pain affects many people in different age groups and for different reasons. This condition can be very problematic as it impacts everyday activities and may lead to discomfort in simple activities like work, exercise, driving and even buying groceries. Back pain can be either acute (sudden), or chronic (over a long period of time). The pain felt by the patient can take two different forms. It is either a sharp needle pain, or a dull aching pain. The pain is either localized in one spot, or radiating to other parts of the body.
Back pain arises from muscles, nerves, tendons, ligaments, bones, joints and discs located at the back. The spine consists of 33 vertebras. They are divided into 4 groups: 7 cervical vertebras, 12 thoracic vertebras, 5 lumbar vertebras and the sacrum and coccyx vertebras.
- Muscles and Ligaments
Back pain caused by strained muscles and ligaments can be easily avoided as it result from heavy lifting or sudden wrong movements. This kind of back pain is usually localized and does not radiate to other parts of the body. In some cases, the strain leading to back pain can be the result of a trauma or an accident.
Abnormalities in spine bones can cause back pain if the spine curve has an irregular form. Beside the suffered pain, the back looks noticeably irregular. Bone irregularities that cause back pain happen for more than one reason.
- Scoliosis: a disease causing the spine to be shifted towards one side of the back.
- Osteoporosis: a decreased amount of calcium leading to fragile bones. This disease can lead to back pain through compression fractures.
- Cancer: metastatic cancer in the bone cause bone fragility leading to fractures.
- Posture: Sitting in the wrong position can impact the spine on the long run creating bone irregularities in the spine and causing pain.
- Obesity: The extra weight in obese patients poses an increased burden on the spine and back muscles. This causes back pain caused by either back deformities or muscle strains, or both.
The lower back with its spine joint is the common site for osteoarthritis: a type of arthritis that causes cartilage destruction. Everyday activities result in friction between bones after cartilage wears out creating back pain attacks.
- Nerves and discs
The disc is a cartilage located between the spine vertebras acting as a cushion. Trauma and heavy lifting allow the disc to bulge out. Out of place, the disc pressures the spinal cord nerves causing severe pain. This type of pain is radiating and can affect any part of the body beside the back depending on which nerves are affected. One of the most common disc herniations is ‘Sciatica’ which affects the nerves of the lower part of the body.
Back pain can affect people from any age group, sex and race. 90% of adults reportedly experience back pains at one point of their life, and 50% of working adults suffer from back pain every year. Back pain is more common in pregnant women. 50% of pregnant women experience back pains. This is because of the added weight posing an extra load on the back. Acute lower back pain is very common, counting as the fifth most common reason for doctor visits in the United States.
- Muscle pain in the back
- Stabbing pain in the back
- Radiating pain in any part of the body
- Decreased flexibility and range of motion
- Back pain may be accompanied by bowel or bladder incontinence or progressive weakening in legs, if the spinal cord is affected
Treatment may vary from bed rest to heavy narcotic medications, and at times, surgery. Most back pains are treated using at home treatments like rest and over the counter pain killers. If bed rest and pain killers are not effective, physical therapy and exercise are used to relief the pain, especially in back pains resulting from muscle, joint and bone problems. Physical therapy and exercise improve flexibility, strength and posture, which in turn enable the back to bear weight and heavy lifting; allows a wide range of motion; and correct any bone deformity.
Pain killers are used for initial management of back pain as they relief pain and decrease inflammation at the same time. These pain killers include NSAIDs and acetaminophen. In cases suffering from severe pain, low doses of narcotics like codeine are used. Another group of drugs used is muscle relaxants as they relief muscle strains leading to back pain.
In some cases, back surgery may be necessary. Indications for back surgery are:
- Lumber disc herniation
- Lumber spinal stenosis
- Compression fractures
Back surgeries are fusion surgery, partial removal of a disc or a partial removal of a vertebra. Fusion surgeries join two vertebras together to eliminate painful movement. Partial removal surgeries are used to remove either a disc or a vertebra depending on stenosis or pressure on the spinal cord nerves.