Back Pain

Back pain is one of the most common pain complaints that almost everyone has had at some point in their lives. This pain is felt in the back of the body, stretching from the shoulders to the hips.

Symptoms #

• Back inflammation

• Fever

• Warm area on the back

• Swelling on the back

• Loss of control

• Numbness and tingling sensation

• Chills

• Weakness

• Increased sensitivity towards pain

• Difficulty in walking without support

• Bowel or bladder changes

• Nerve pain

• Muscle spasm

• Unexplained weight loss

• Pain awakening the patient from sleep

Causes #

Strain #

Excessive strain or trauma can cause damage to the back. For example, improperly lifting something or lifting something too heavy. Other causes that can strain the back include:

• Poor posture

• Excessive exercise

• Prolonged sitting and lying down

• Sleeping in an uncomfortable position

• Obesity

• Pregnancy

• Muscle or ligament strain

• Spasm of a muscle

• Muscle tenseness

• Damages disks

• Falls or fractures

Structural problems #

A variety of structural issues can also cause back pain. They include:

• Ruptured discs: Each vertebra is cushioned by discs. If the disc ruptures, there will be increased pressure on a nerve, resulting in back pain.

• Bulging discs: A bulging disc can put more pressure on a nerve, causing back pain.

• Sciatica: It is a sharp and shooting pain usually caused by a bone spur or herniated disc pressing on the nerve and radiating through the buttock, down the back of the leg along the sciatica nerve.

• Arthritis: It can cause pain in the lower back, joints of the hips, and other areas.

• Scoliosis: It is a condition in which the spine curves to the side resulting in back pain.

• Osteoporosis: Brittle and porous bones, including those of vertebrae of the spine, can cause compression fractures resulting in back pain.

Inflammation #

Inflammation can cause back pain localized to the axial spine (lower back) and sacroiliac joints (situated where the lower spine and pelvis connect). It is usually chronic in nature. Conditions that can cause this include:

• Ankylosing spondylitis: It is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse.

• Sacroiliitis: It is an inflammation of one or both of the sacroiliac joints. Sacroiliitis can cause pain in the lower back or buttocks and can extend down one or both legs.

• Tuberculous spondylitis: Also known as Pott disease, it is a rare disease associated with the gradual onset of progressive back pain.

Tumors #

Patients experience intense back pain in malignancies (cancer) that have metastasized (spread) to the spine like:

• Lung cancer

• Stomach cancer

• Breast cancer

• Prostate cancer

• Certain tumors in the spinal cord like:

• Multiple myeloma (cancer of white blood cells)

• Neuromas (tumor in the nerves)

• Angiomas (tumor in the blood vessels)

Infections #

Some infections can also lead to back pain. These include:

• Infection of the spine and discs

• Epidural abscesses (the fluid-filled cavity between the bones of the spine)

• Muscular/soft tissue abscesses

Pregnancy #

Studies have shown that the majority of women experience back pain, which affects their daily activities, quality of life, and ability to work. It is due to weight gain during pregnancy, an increase in the size of the stomach, and the consequent shifting of the body gravity center that increases the strain, especially on the lower back.

Diagnosis #

Physical examination #

The doctor examines the back to check if one can walk, sit, stand and lift your legs. The intensity of the pain is rated on a scale of one to ten. The doctor may further advise one or more of the following tests to diagnose the condition.

Imaging tests #

• X-rays: They are done to evaluate any fractured bones, or arthritis.

• CT scan: It is used to detect any issues with the bones, muscles, tissue, nerves, ligaments, and blood vessels of the back.

• MRI: It is used to identify any structural abnormalities.

• Electromyography: This test can confirm nerve compression caused by herniated disks or narrowing of the spinal canal.

Blood tests #

The following tests are done if an infection is suspected to be causing back pain:

• Complete blood count

• Urinalysis

• Erythrocyte sedimentation (ESR)

Treatment #

Heat and cold treatments #

These treatments are recommended to relieve aching pain by applying a hot compress or an ice pack to the sore spot. To stimulate blood flow and healing, use a cold pack for the first 24 to 48 hours after an injury, then switch to heat therapy. Packs should not be worn for longer than 20 minutes at a time.

Medications #

Pain relievers sold over the counter (OTC) and various non-steroidal anti-inflammatory drugs may help provide relief.

• Ibuprofen

• Codeine

• Hydrocodone

Topical pain medications/creams #

Come in the form of gels, gel patches, sprays, or foams that can be applied directly to the affected area of your back. They include:

• Topical diclofenac: This is a topical NSAID used to treat arthritis symptoms such as pain, swelling, inflammation, and stiffness.

• Trolamine salicylate: This topical pain reliever cream is frequently prescribed for arthritis pain. It has a chemical structure that is similar to aspirin and has a mild anti-inflammatory effect.

Transcutaneous electric nerve stimulation (TENS) #

A TENS machine is a small, battery-operated device that has leads connectd to sticky pads called electrodes. It sends electrical impulses to specific nerves, blocking pain signals.

Surgery #

Surgery may be beneficial in case of unrelenting pain with radiating leg pain or developing muscle weakening as a result of nerve compression. These procedures are usually reserved for pain that hasn’t responded to prior treatments and is caused by structural issues such as the constriction of the spine (spinal stenosis) or a ruptured disc.