Back Pain

What Is Back Pain?

Back pain is a very common complaint. According to recent statistics, approximately 80% of adults in the United States will experience some form of back pain during their lifetime. Back pain is a common reason for missed time from work and is a leading cause of work-related disability claims.

Back pain can be classified as either acute or chronic in nature, depending on the duration of a patient’s symptoms.

Short-lived symptoms, lasting less than three months, are classified as acute back pain. Conversely, symptoms lasting longer than three months are classified as chronic back pain. The symptoms of back pain can range from mild to severe, and can be intermittent or constant. In addition to the physical symptoms of back pain, there are also psychological symptoms, including depression. The symptoms associated with back pain can be so severe for some patients that their quality of life is negatively affected.

Causes Of Back Pain

The back is a complex structure that is comprised of muscles, tendons, ligaments, bones, and intervertebral discs. Problems in any of the structures that make up the spine can result in back pain. The spine is divided into four regions: cervical (neck), thoracic (upper back), lumbar (lower back), and sacral region. The most common causes of upper and lower back pain are due to strained muscles and ligaments, which can result from heavy lifting, improper lifting, abrupt or awkward movements, poor posture, or muscle spasms. However, there are numerous other causes of back pain that result from structural issues in the thoracic and lumbar spine, including:

• Disc herniation: Between each vertebrae in the spine is an intervertebral disc. When the outer layer of the disc weakens, the inner layer can rupture, resulting in inflammation and irritation of surrounding spinal nerves, which can cause back pain.
• Disc bulging: Similar to disc herniation, when the inner layer of the disc bulges outward, it can result in increased pressure on surrounding spinal nerves, which can cause back pain.
• Sciatica: A herniated or bulging disc may create a sharp, shooting pain that travels from the back, through the buttock and down the back of the leg.
  Arthritis: Osteoarthritis is a common condition that can affect multiple joints of the body, including the joints of the spine. When this happens, the degeneration that occurs can lead to back pain.
• Abnormal curvatures of the spine: Scoliosis and kyphosis are two types of abnormal spinal curvatures that can result in back pain.
• Osteoporosis: This condition can lead to a weakening of the bones that make up the spine, which increases the risk of compression fractures, when this type of fracture occurs, back pain can result.

More serious causes of back pain include: cauda equina syndrome, spinal cancer, spinal infection, other types of infections (e.g. bladder or kidney), spinal fractures, and shingles. A variety of risk factors have been identified that increase an individual’s risk of developing back pain, including:

• A sedentary lifestyle
• Obesity
• Increasing age
• Mental health issues (e.g. anxiety or depression)
• Smoking
• Strenuous physical job
• Strenuous physical exercise (especially when it is not performed correctly)
• Pregnancy

Treatments For Back Pain

Most healthcare practitioners will assess patients suffering from back pain symptoms by carrying out a detailed history and physical examination.

Occasionally, imaging tests including X-rays, magnetic resonance imaging (MRI), or computed tomography may be ordered. If infection is suspected, blood tests may be ordered as well. Once the source of pain is identified, treatment can be targeted to address the underlying issue.

From a pharmacological perspective, patients suffering with back pain symptoms may be prescribed analgesic and anti-inflammatory medications, including non-steroidal anti-inflammatory drugs (NSAIDs).

For patients who suffer from back pain that is unresponsive to these medications, opioids may be prescribed for short-term use; however, long-term use is not advised as there is the risk of misuse and abuse of opioid medications.

Furthermore, antidepressants may be prescribed for patients suffering from back pain.

Epidural steroid injections and facet joint injections may also be recommended to patients suffering from back pain. Epidural steroid injections entail injecting a corticosteroid and a local anesthetic into the epidural space, which is the space surrounding the spinal cord. Facet joint injections entail injecting a corticosteroid and a local anesthetic into the facet joints of the spine. These injections help to reduce pain as the corticosteroid helps to reduce inflammation in the affected area, while the local anesthetic helps to numb the affected area.

Alternative treatment options such as physical therapy, chiropractic treatment, acupuncture, and biofeedback training may also be beneficial for patients suffering from back pain.

Surgery may be required for patients that suffer from pain that is unresponsive to conservative treatment options. Depending on the source of pain, different spinal surgical procedures may be recommended. Spinal fusion involves joining two vertebrae to each other by utilizing metal plates, screws, or cages. However, there is an increased risk of arthritis development in the adjoining vertebrae after this type of intervention. A discectomy involves removing part of the intervertebral disc that is believed to be causing a patient’s pain.

Conclusion

Back pain is a very common condition, experienced by many adults in the U.S. Back pain can be acute or chronic in nature, and symptoms can vary in severity, ranging from mild to severe.

Back pain can be debilitating and can have a detrimental impact on a patient’s personal and professional life.

There are a variety of effective treatment options available to back pain sufferers, ranging from conservative treatment methods including analgesic and anti-inflammatory medications to physical therapy, chiropractic care, biofeedback training, and acupuncture.

Additional treatment options include epidural steroid injections and facet joint injections. For patients who have back pain that is unresponsive to conservative treatment options, surgery may be recommended. Patients suffering from back pain should speak with their physicians about potential treatment options that may provide effective pain relief for their condition.