Back pain is the second most common reason given for visiting the doctor, so here we explore what causes back pain and how to treat it.
Experts report that half of all American adults complain of back pain each year, and that as high as 80 percent will experience back pain in their lifetimes.
Americans spend at least $50 billion dollars each year for back pain treatment and relief, so here we explore what causes back pain and how to treat it.
Back pain may come from nerve and muscular issues, degenerative disc disease, arthritis, injuries or various other causes. Most pain comes from mechanical concerns or injury, with only rare instances of tumors or infections causing the discomfort.
“Mechanical” refers to the way the spine moves and the feeling when you move your spine. The most common mechanical cause for back pain is intervertebral disc degeneration, a typical deterioration that results from aging when the discs lose their ability to cushion the vertebrae and nearby nerves. Another mechanical cause of back pain is the wearing down of the facet joints that connect the vertebrae. Muscle or nerve spasms, muscle tension and ruptured, or herniated, discs may also cause the pain.
Injuries may also cause mild or severe back pain. A sprain involves tears in the ligaments that support the spine, and they may cause temporary discomfort. Fractures of the vertebrae themselves, often resulting from osteoporosis that leaves the bones brittle, may result in more severe and longer-lasting pain.
Certain diseases and conditions may also cause or contribute to back pain. The presence of kidney stones produces intense pain until they pass from the body. Scoliosis, a curving of the spine, is also quite painful. Osteoarthritis, rheumatoid arthritis and ankylosing spondylitis, all forms of inflammation, cause chronic pain ranging from mild stiffness to severe aches. The narrowing of the spinal column by spinal stenosis can cause intense hurting from the nerves being pinched in the contracted space. Spondylolisthesis, a condition in which one vertebra slides forward over another, can cause both pain and numbness along with weakness in the legs, as the spinal cord and nerve roots are squeezed and pinched.
Although they are rare, spinal tumors and infections, such as discitis or osteomyelitis, which is an infection of the vertebrae, include pain in their list of symptoms. Depression, anxiety and insomnia may intensify existing back pain, as well.
These are many of the examples of what causes back pain and how to treat it effectively will depend on the symptoms you have.
Symptoms may vary according to the cause of the back pain. Most often, they include one or more of these signs: – A persistent ache or stiffness along the spine – A sharp, localized pain in the neck, upper back or lower back, especially after heavy lifting or strenuous activity, which should be checked by medical personnel immediately, as pain in the upper back may also be a warning sign of heart attack – A chronic, dull ache in the middle or lower back that is especially uncomfortable after sitting or standing for a sustained period – A pain that radiates to the buttocks, thigh, calf and toes – The inability to stand upright without pain or muscle and nerve spasms – A limited range of motion and flexibility in the upper or lower back.
Most back pain clears up within a few weeks, so the prognosis is generally very positive. Doctors attempting to diagnose what causes back pain and how to treat it appropriately will begin by taking a detailed medical history. A physical exam that includes testing range of motion and nerve function will follow. During this exam, the physician may ask you to walk on your heels, toes and soles of your feet; he will probably test the reflexes at your knees and behind your ankles with a reflex hammer. He may ask you to lie on your back on the exam table and lift one leg at a time to check flexibility and range of motion, and he might test your sensation levels by poking different parts of your back with a pin or a pencil. He may also perform an abdominal and rectal exam.
If the pain persists longer than a month to six weeks, the doctor may also order other types of tests, as sometimes it can be hard to determine what causes back pain and how to treat it. These may include computed tomography (CT) or magnetic resonance imaging (MRI). He may ask for a myelogram, during which radio-opaque dye is injected into the spinal column and then a CT scan is performed. Another option is an electromyogram (EMG). Usually used for diagnosing chronic pain, this test involves very fine needles being inserted into the muscles to allow the monitoring of the electric activity in the muscles to identify what causes back pain and how to treat it based on the results of the test.
The doctor may also order traditional X-rays, depending on the suspected cause of the back pain. These would be especially common in the case of a fall or an accident.
What causes back pain and how to treat it are two variables which can range widely. In most cases, an over-the-counter back pain medicine, such as acetaminophen, ibuprofen or naproxen, will ease the discomfort. While the instinct may be to bed rest, spending more than one or two days in bed may actually worsen the situation. Stretching exercises and normal activity, resumed as soon as possible, will result in better flexibility than staying in bed, as long as you avoid movements that aggravate the pain.
While not particularly effective with back pain caused by sudden injury, hot and cold packs may reduce inflammation and improve mobility in patients with chronic pain.
When over-the-counter back pain medicine is not effective, a back pain doctor may prescribe other forms of back pain medication such as muscle relaxants or, for short-term use, narcotic/opioid painkillers like codeine, hydrocodone, oxycodone or morphine. In some cases, low doses of tricyclic antidepressants, such as amitriptyline, or serotonin and norepinephrine reuptake inhibitors, including fluoxetine, may also be effective as back pain medication. Anticonvulsants, such as gabapentin, may be prescribed, as well.
Physical therapy is often effective in relieving back pain, especially when it has become a chronic issue. The focus is usually core-strengthening exercises to build tone in the back and abdominal muscles and activities designed to improve posture. Therapists may employ heat, ultrasound and electrical stimulators, like a transcutaneous electrical nerve stimulation device, as well as muscle-release techniques, along with the exercises to improve flexibility.
If these less-invasive strategies are not effective, the back pain doctor may suggest cortisone injections into the epidural space or the area around the spine. While these injections often provide pain relief, they are not without risk, and the relief is generally temporary, lasting only a few weeks.
Surgery remains an option, as well, for serious injury or for nerve compression which is carried out by a back pain specialist. Among the more common surgeries is vertebroplasty, used to strengthen and stabilize bone damaged by osteoporosis. During the procedure, the back pain specialist, such as a surgeon uses 3D imaging to inject bone cement into the vertebral space.
Spinal laminectomy, or spinal decompression, is used to treat the narrowing of the column caused by spinal stenosis by removing the lamina, or boney walls, of the affected vertebrae and relieving the constriction.
Discectomy and microdiscectomy treat the pain caused by herniated discs by removing the damaged disc, while spinal fusion strengthens the spine when it is affected by degenerative disc disease or by spondylolisthesis. In that practice, the damaged disc is removed and the adjacent vertebrae are fused with bone grafts and, if necessary, by metal rods or devices held in place by screws.
Spinal manipulation by a chiropractor or back pain doctor may be effective in relieving many types of back pain not caused by conditions such as osteoarthritis or spinal cord compression. The doctor of chiropractic care realigns, massages or otherwise stimulates the spine to relieve the pain.
Biofeedback is often used to treat chronic pain, including that of the back. During therapy sessions, the patient is taught, through the use of an electromyography machine, to control her breathing and muscle tension through a variety of relaxation techniques. Research into the effectiveness of biofeedback therapy is still inconclusive.
Acupuncture is also a common alternative to traditional back pain treatment. Thin needles are inserted into various spots on the body, and a mild electrical current is passed through them. Some practitioners explain the relief as the opening of blockages in the body’s life force, or Qi, while others believe that the stimulation releases painkilling chemicals naturally present in the body, such as endorphins and serotonin.
Now that you know what causes back pain and how to treat it, you can prevent or reduce your likelihood of getting it based on your lifestyle choices. Regular low-impact exercise can prevent back pain and may relieve it, as well. Thirty minutes a day of speed walking, swimming or stationary bike riding will increase back strength and endurance. Core-strengthening exercises are also beneficial.
Maintain a healthy weight to reduce strain on the spine and the connecting muscles. A well-balanced diet that includes sources of calcium, phosphorus and vitamin D may also help prevent or improve back pain.
When standing, don’t thrust your hips out in any one direction; stand in a “pelvic neutral” position. Wear comfortable, low-heeled shoes and, if you must stand for prolonged periods, place one foot on a low stool and alternate feet every few minutes. Stand straight, with the proper posture.
Choose a chair that provides strong lumbar support and armrests. Place a pillow or a rolled towel behind your back to maintain its natural curve, if you must sit for a long time. Keep your knees and hips level, don’t slouch, and change positions at least every half-hour.
Sleep on your side with your knees drawn up on a firm surface. This helps to open up the joints in the spine, relieving the pressure from curving.
Stop smoking. Smoking reduces the blood flow to the lower spine and increases the risk of osteoporosis. In addition, hard coughing resulting from smoking can cause back pain.
Take care when lifting. Don’t try to lift overly heavy loads alone; find a lifting partner to help. Always use your legs when lifting, bending only at the knees and move straight up and down. Don’t twist your back and lift anything at the same time; lift first and then turn. Hold the load close to your body to reduce pressure and strain.
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