HealthyCanada.com

Overview

Back pain is an all-too-familiar problem that affects an estimated 8 out of 10 people at some time in their life. It can come on suddenly - from an accident a fall or lifting something too heavy - or it can develop slowly perhaps as the result of age-related changes to the spine. Regardless of how it happens you'll know when you have it. You may experience a dull constant ache or a sudden sharp pain that leaves you incapacitated.

Symptoms

Acute pain is pain that hits you suddenly perhaps after falling from a ladder being tackled on the football field or lifting a load that is just too heavy. Acute pain comes on quickly and often leaves just as quickly. You'll feel a dull ache or sharp pain in the back that seems to come and go with varying degrees of intensity. To be classified as acute pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.

Chronic pain on the other hand may come on either quickly or slowly and it lingers a long time. In general pain that lasts more than 3 months is considered chronic. Chronic pain is characterized by deep dull or burning pain in the back or numbness tingling and a pins and needles feeling down the legs.

Causes

Back pain is a symptom of a medical condition not a diagnosis itself. Medical problems that can cause back pain include the following:

Mechanical problems: A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms muscle tension and ruptured discs which are also called herniated discs.

Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis a condition that causes weak porous bones. Less commonly back pain may be caused by more severe injuries that result from accidents and falls.

Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis including osteoarthritis rheumatoid arthritis and ankylosing spondylitis; and spinal stenosis a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia which causes fatigue and widespread muscle pain.

Infections and tumors: Although they are not common causes of back pain infections can cause pain when they involve the vertebrae a condition called osteomyelitis or when they involve the discs that cushion the vertebrae which is called discitis. Tumors too are relatively rare causes of back pain. Occasionally tumors begin in the back but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.

Although the causes of back pain are usually physical it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways including causing back muscles to become tense and painful.

Although anyone can have back pain a number of factors increase your risk. They include:

Age: The first attack of low back pain typically occurs between the ages of 30 and 40. Back pain becomes more common with age.

Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. "Weekend warriors" - people who go out and exercise a lot after being inactive all week - are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise is good for the discs that cushion the vertebrae the individual bones that make up the spine.

Diet: A diet high in calories and fat combined with an inactive lifestyle can lead to obesity which can put stress on the back.

Heredity: Some causes of back pain including disc disease may have a genetic component.

Race: Race can be a factor in some back problems including spondylolisthesis a condition in which a vertebra of the lower spine - also called the lumbar spine - slips out of place.

The presence of other diseases: Many diseases can cause or contribute to back pain. These include various forms of arthritis such as osteoarthritis rheumatoid arthritis and ankylosing spondylitis and cancers elsewhere in the body that may spread to the spine.

Occupational risk factors: Having a job that requires heavy lifting pushing or pulling particularly when this involves twisting or vibrating the spine can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain especially if you have poor posture or sit all day in an uncomfortable chair.

Cigarette smoking: Although smoking may not directly cause back pain it increases your risk of developing low back pain and low back pain with sciatica. (Sciatica is back pain that radiates to the hip and/or leg due to pressure on a nerve.) For example smoking may lead to pain by blocking your body's ability to deliver nutrients to the discs of the lower back. Or repeated coughing due to heavy smoking may cause back pain. It is also possible that smokers are just less physically fit or less healthy than nonsmokers which increases the likelihood that they will develop back pain. Furthermore smoking can slow healing prolonging pain for people who have had back injuries back surgery or broken bones.

Diagnosis

Knowing that you have a pain in your back is one thing but your doctor will need to know specifically what might be causing it before he or she begins treatment. First he will ask about your medical history such as:

• Have you fallen or injured your back recently?
• Does your back feel better - or hurt worse - when you lie down?
• Are there any activities or positions that ease or aggravate pain?
• Is your pain worse or better at a certain time of day?
• Do you or any family members have arthritis or other diseases that might affect the spine?
• Have you had back surgery or back pain before?
• Do you have pain numbness and/or tingling down one or both legs?

During the physical exam your doctor may:

• watch you stand and walk
• check your reflexes to look for slowed or heightened reflexes either of which might suggest nerve problems
• check for fibromyalgia by examining your back for tender points which are points on the body that are painful when pressure is applied to them
• check for muscle strength and sensation
• check for signs of nerve root irritation.

Often a doctor can find the cause of your pain with a physical and medical history alone. However depending on what the history and exam show your doctor may order any of the following medical tests to help find the cause:

X rays: Traditional x-rays use low levels of radiation to project a picture onto a piece of film (some newer x-rays use electronic imaging techniques). They are often used to view the bones and bony structures in the body. Your doctor may order an x-ray if he or she suspects that you have a fracture or osteoarthritis or that your spine is not aligned properly. Although many back pain sufferers "feel the pain in their spine" the vast majority of x-rays for back pain do not change treatment. Most of the time the pain is because of spasm in the soft tissues and muscles of your back. If you are older and have osteoporosis (weak bones) the x-ray may be helpful to show a fracture in your spine.

Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic force instead of radiation to create an image. Unlike an x ray which shows only bony structures an MRI scan produces clear pictures of soft tissues too such as ligaments tendons and blood vessels. Your doctor may order an MRI scan if he or she suspects a problem such as an infection tumor inflammation or pressure on a nerve. An MRI scan in most instances is not necessary during the early phases of low back pain unless your doctor identifies certain "red flags" in your history and physical exam. An MRI scan is needed if the pain persists more than 3-6 weeks or if your doctor feels there may be a need for surgical consultation. Because most low back pain goes away on its own getting an MRI scan too early may sometimes create confusion for the patient and the doctor.

Computed Tomography (CT) scan: A CT scan allows your doctor to see spinal structures that cannot be seen on traditional x-rays. It is a three-dimensional image that a computer creates from a series of two-dimensional pictures that it takes of your back. Your doctor may order a CT scan to look for problems including herniated discs tumors or spinal stenosis.

Medical tests alone often do not diagnose the cause of back pain. In fact experts say that up to 90 percent of all MRI scans of the spine show some type of abnormality in people without symptoms and sometimes the x-rays and CT scans of people without pain also show problems. Only with a medical history and exam - and sometimes medical tests - can a doctor diagnose the cause of back pain. Many times the precise cause of back pain is never known. In these cases it may be comforting to know that most back pain gets better whether or not you find out what is causing it.

Treatment

Treatment for back pain generally depends on what kind of pain you experience: acute or chronic.

Acute Back Pain

Acute back pain usually gets better on its own and without treatment although your doctor may suggest taking acetaminophen aspirin or ibuprofen to help ease the pain. Often it is best to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness relieve pain and have you back doing your regular activities sooner. However exercises are not usually recommended for acute back pain nor is surgery.

Chronic Back Pain

Treatment for chronic back pain falls into two basic categories: the kind that requires an operation and the kind that does not. In the vast majority of cases back pain does not require surgery. Doctors will almost always try non-surgical treatments first. In a very small percentage of cases - when back pain is caused by a tumor an infection or a nerve root problem for example - prompt surgery is necessary to ease the pain and prevent further problems. Typically it has been shown that surgery can be helpful for nerve pain that goes down the leg but not usually helpful for pain that is relegated to the back.

Following are some of the more commonly used treatments for chronic back pain.

Nonoperative treatments

Motion is lotion: We used to treat back pain by having the person lie down for days on end but now the research is telling us the exact opposite. Sometimes this can be very difficult but the evidence overwhelmingly shows that people who keep moving even if they have to take some of the medications discussed below have the best outcomes. Some pain is not harmful.

Hot or cold: Hot or cold packs - or sometimes a combination of the two - can be soothing to chronically sore stiff backs. Heat dilates the blood vessels improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin it numbs deep pain. Applying heat or cold may relieve pain but it does not cure the cause of chronic back pain.

Exercise: Although exercise is usually not advisable for acute back pain proper stretching exercises and others can help ease chronic pain and perhaps reduce its risk of returning. Your doctor can recommend certain exercises or refer you to a physiotherapist. Recently both "Pilates" (where you strengthen your core muscles) and yoga have proven some benefit- but only if done properly.

Medications: A wide range of medications are used to treat chronic back pain including analgesics such as acetaminophen and aspirin. People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful. These creams ointments and salves are rubbed directly onto the skin over the site of pain. Your doctor may prescribe Nonsteroidal anti-inflammatory drugs to relieve both pain and inflammation which may also play a role in some cases of back pain.

Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities - particularly those involving heavy lifting pushing or pulling - are sometimes part of the treatment plan for people with back pain. Other behavior changes that might help pain include adopting healthy habits such as exercise relaxation and regular sleep and dropping bad habits such as smoking and eating poorly.

Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain doctors may recommend injections for pain relief.

Prevention

Recent studies indicate that the most important factor in avoiding back injury may be your general physical conditioning. This suggests that regular aerobic exercise such as walking or swimming may provide the conditioning a back needs to stay healthy. However a specific exercise program to mobilize and strengthen the spine can also be effective in preventing a recurrence of back pain. Strong back and stomach muscles

are necessary to support your spine properly. A physiotherapist can provide guidance on the appropriate exercises to tone and strengthen these muscles.

The Canadian Physiotherapy Association offers the following tips to help you prevent back pain:

• Lifting - with your feet shoulder-width apart bend your hips and knees keeping your back as straight as possible. Grip the load firmly and hold it close to your body tighten your stomach muscles and use the strong muscles of your legs as you lift the object. Keep your back straight and avoid twisting - point your feet in the direction you want to go.
• Posture - think tall with your chest lifted shoulders relaxed chin tucked in and level. Posture should be stable balanced and relaxed when sitting walking or standing.
• Sitting - don't sit for long periods of time; stand up stretch and walk around. Use a back support in your chair if necessary but make sure it fits you.
• Exercise - a healthy body-weight puts less strain on your back.
• Driving - position your car seat so your back is supported and your legs are relaxed and slightly bent. If you need extra lower back support use a lumbar roll or a rolled-up towel.
• Sleeping - your mattress should be firm enough to support your spine in a neutral position - no sagging! Consider adding a layer of foam for added support. Try sleeping on your side and flexing or bending your legs. If you sleep on your back put a pillow underneath your knees.