Back Pain, Chronic Print E-mail

What is chronic back pain?

spine within body form Back pain is a wide-spread problem affecting four out of five American adults sometime during their lives and is one of the most common reasons for healthcare visits and missed work.  Symptoms can range from a dull, constant ache to a sudden, sharp, crippling pain.  It can be the result of trauma - a sudden accident, cough/sneeze, sports injury, fall, or lifting something too heavy or improperly – or it can develop slowly, almost imperceptibly as with age-related changes to the spine.  Pain may accompany simple movement; jarring movement, such as coughing or sneezing; or with no provocation at all.  You may also experience pain, numbness or tingling in your legs often referred to as sciatica.  Whatever the cause, when there is recurring or lasting back pain over time it is often referred to as "chronic back pain."

The back is comprised of the spine, surrounding soft tissue, and ribs.  The spine is a marvelous piece of human architecture.  It is unique in its ability to bear great weight, yet also bend and flex while conforming to the rigors of performance.  Because it is a multi-jointed bony structure, with numerous surrounding muscles, tendons, and ligaments, and houses our spinal cord and delicate nerve routes, the spine contains many protential sources of pain.  Because the spine is such a workhorse, its proper function is essential.

The spine is a highly complex structure usually made up of 33 individual bones called vertebrae.   In between each vertebra is a cartilaginous disc which acts as a shock absorber, allows considerable movement and flexibility, and prevents the vertebral bones from rubbing together.  The discs are made up of a jelly-like core enveloped by a tough, fibrous outer casing. spine with detailed section

Other important supporting structures of the back are the facet joints, muscles, ligaments, and tendons, and in the mid-back, the ribs.

Damage or disease to any of the above mentioned structures can cause back pain.  Some of the more common causes are muscle strain, degenerative discs , arthritis of the facet joints, and compression fractures.  Degenerative discs are very common with age and frequently are revealed by x-ray or MRI.

The most important tools for proper diagnosis are the patient history and physical exam.  In addition, tests such as simple x-rays, CT (computerized tomography), MRI (magnetic resonance imaging), myelography (injecting contrast dye into the spinal fluids) or bone scans can provide more objective information and verification of specific pathology.

What are the causes of back pain?

Because of anatomic complexity, determining the back pain generator can be quite difficult, requiring considerable patience and detective work.  Back pain can be caused by injury to, or irritation/inflammation of, muscles or ligaments, arthritis of facet joints, vertebral fractures, spinal nerve root compression, disc degeneration / protrusions/ herniations, and by tumors. 

What role does obesity play in your back's health?  

Your spine supports a great bulk of your weight.  Being overweight puts extra pressure, stress, and strain on the back (especially the lower back) thus aggravating unhealthy conditions such as scoliosis, osteoporosis (weak bones), facet joint and SI joint osteoarthritis, degenerative disc disease, spinal stenosis, and spondylolisthesis (slippage of discs).

Is back pain preventable? 

To some extent, yes.  Educating yourself in how to prevent back pain is essential.  There are several things you can do to maintain as healthy a back as possible:

  • Use proper lifting techniques: Bend your knees; squat and lift using your thigh muscles, not your back. Never bend over with your knees straight and lift with the upper torso.  Move slowly and avoid sudden movements.  Try to avoid lifting loads in front of you above the waist line.  For example, avoid bending over or leaning forward to lift heavy objects from a car trunk as this places considerable strain on low back muscles.
  • Avoid poor posture while sitting.  Generally speaking, it is better to pick a hard-backed chair over a soft chair, and one with a curvature that conforms with the normal lower back curve.  If possible, elevate the knees slightly higher than the hips while sitting in an automobile.  At work, adjust your chair to give yourself the most comfort and support; don't adjust yourself to the chair.  Sit all the way back in the chair with spine in full supportive contact.
  • Use a mattress that is the most comfortable for you; whether soft or firm, comfort is THE most important factor.
  • Maintain a consistent daily exercise program:  Back pain is more prevalent and much more disabling in people who are not physically fit.  Weak back and abdominal muscles do not support your spine optimally, thus promoting abnormal spinal stress and setting you up for potential future injury.  Regular exercise strengthens muscle groups and is an integral part of good back health. Start with minimal exercise at a level you know you can handle and increase slowly from there.

What treatment options are available?

Once a pain diagnosis has been made, there are a variety of treatments that may be indicated, including any of the following:  

Medications:

  • Anti-inflammatory medications :  
    • NSAIDS (non-steroidal anti-inflammatories): e.g., asprin, ibuprophen, naproxen, Celebrex
    • Steroids: medrol, prednisone
  • Analgesics: acetaminophen, Tylenol, narcotics
  • Antidepressants /anticonvulsants :  Often used to alter pain perception and "processing."
Nerve "blocks":
Joint injections :
  • facet - steroids
  • SI (sacroiliac) - steroids
Nerve ending ablation:
Trigger point injections:
Intradiscal procedures:
Implantable devices:
  • peripheral neuromodulation (e.g. occipital)
  • dorsal column stimulation (aka spinal cord stimulation)
  • implantable pumps/catheter
 
Complementary therapies:
  • acupuncture
  • craniosacral therapy
  • massage therapy
  • manipulation
  • hypnosis
  • TENS

When should I call PainCare? 

Often, acute back pain will gradually improve with rest and time.  If you do not notice some improvement within the first 72 hours of self-care, see your primary care provider.

If, despite conservative medical care and a reasonable amount of time, your symptoms do not improve, contact us directly or through your primary care provider.

In some cases, acute or changing back pain can be a sign of a more serious medical condition that requires more urgent attention.  See a doctor immediately if your back pain:

  • causes bowel or bladder incontinence (lack of control)
  • is associated with abdominal pain or throbbing, or if you have an accompanying fever
  • is particularly constant or intense, especially despite lying down or at night
  • spreads down into one or both legs, especially below the knees
  • causes weakness, numbness or tingling in one or both legs
  • follows an injury or accident
  • is accompanied by unexplained weight loss or a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

 
[ Back ]

Get the Flash Player to see this player.
Flash Image Rotator Module by Joomlashack.
Image 1 Title
Image 2 Title
Image 3 Title
Image 4 Title
Image 5 Title