CONDITIONS

What Is Back Pain

Your back is they key structural support for your entire body.  Together with your muscles and joints, it allows you to move and bear weight—but it’s a finely balanced structure that can be easily injured if not cared for properly.  Understanding the basics of back care can make the difference a healthy back and an aching one.

The back—or spinal column—is comprised of 24 moveable bones called vertebrae.  Between each vertebra is a cushion-like pad—called a disc—that absorbs shock.  Your vertebrae and discs are supported by muscles and ligaments, which keep your back in proper alignment.  A healthy back has three balanced curves—the cervical (neck) curve, thoracic (chest) curve, and the lumbar (lower back) curve.  When any part of the system that comprises your back is out of alignment, or experiences disease or injury, then back problems and pain generally follow.

A healthy back is a balanced back—which is to say your cervical, thoracic, and lumbar curves are all properly aligned.  So what does “properly aligned” mean? Your back is said to be in proper alignment when your ears, shoulders, and hips are “stacked” in a straight line.

Now that we have a bit of background on what makes for a healthy back, we can better understand the mechanics behind back pain. The majority of backaches are caused by both poor posture and weak supporting muscles.  Poor posture places excess stress on the spinal column, which, over time, can lead to sudden acute back pain, as well as chronic back pain.  Weak muscles are often responsible for poor posture.  This is one of the first places to look to when thinking preventively about back pain—strengthening key muscles can make a big difference for those that are prone to back pain. As well, there are various conditions, such as scoliosis, arthritis, and herniated or ruptured discs that can also cause back pain—many of which can also be helped by the strengthening of back muscles and improvement in posture.

What Causes Back Pain

There are many different causes of back pain. Common causes include:

  •  Muscle spasms
  •  Tense muscles
  •  Disk degeneration/breakdown
  •  Ruptured Disks
  •  Sprains/injuries from falls and/or accidents
  •  Fractures
  •  Existing conditions such as:
    • Scoliosis
    • Spondylolisthesis
    • Arthritis
    • Spinal stenosis
    • Pregnancy
    • Kidney Stones
    • Infections
    • Endometriosis
    • Fibromyalgia

 

 

Risk Factors For Back Pain

There are many different factors that can affect your risk of developing back pain. According to the National Institute of Health, the following are the most common risk factors for back pain:

  • Age. Back pain most typically develops during a person’s 30s and 40s, and the chances of developing back pain increase with age.
  • Fitness level. Regular exercise helps to tone and strengthen the muscles of the back, which provide support to the spinal cord. Lack of exercise can lead to weakened back muscles, increasing the amount of stress placed on the spinal cord, and increasing the chance of developing back pain.
  • Obesity. The excess body weight that characterizes obesity can place extra stress on the spinal cord, increasing the risk of developing back pain.
  • Heredity. Certain conditions that increase the risk of back pain (i.e. arthritis) can be more likely in families.
  • Race. Certain conditions that can cause back pain are more common among specific races. (ie. Spondylolisthesis, a condition in which the lumbar spine becomes misaligned, is most common among African American women.)
  • Heavy exertion. Those who have placed a lot of physical stress on their backs are more likely to develop back pain. Athletes, professional movers, demolition workers, and other high-impact and repetitive occupations can increase the risk of developing back pain
  • Smoking. Smoking increases the risk of sciatica, a condition that is caused by nerve compression. It also lengthens recovery time from injuries and operations, increasing the risk of developing back pain.
  • Pregnancy. The added weight of the developing fetus places additional strain on the lower back and increases the likelihood of developing back pain or exacerbating chronic back pain.

 

Diagnosing Back Pain

Diagnostic procedures for the underlying causes of back pain vary. If you are experiencing back pain, see a doctor. He or she will be able to conduct the proper set of diagnostic tests to determine the cause of your back pain. Tests that your doctor may conduct include:

  • Medical history/family history. A complete medical history, including a list of symptoms and a family history of disease, will help your doctor better understand your risk of certain illnesses/conditions.
  • Physical exam to look for physical signs of back injury including discoloration, abnormal shape, swelling, and warmth.
  • Imaging techniques, which help provide doctors with images of the spinal column. These include:
    • X-rays
    • MRI (magnetic resonance imaging)
    • CT (computed tomography)
  • Blood tests to rule out the presence of certain disease-specific proteins.

Living With Back Pain

The following tips can help you manage living with back pain:

  • Seek proper treatment.  It may be tempting to delay a doctor’ s visit by taking over the counter medications, but if you are experiencing back pain that lasts more than a couple of days, you should see a doctor. It is also important to see a doctor after a fall or slip if you are experiencing any pain. A minor fracture, sprain, or ligament tear can become more serious if not treated correctly.  Doctors can also help you find the right treatment pathway for conditions underlying back pain, such as arthritis.
  • Give yourself time to rest. If your back pain is the result of an injury, rest is essential to the healing process. If you have a chronic condition, pace yourself, making sure to not overexert yourself or your joints.
  • Talk to your doctor about your treatment plan and any effects of it that you feel. If a certain treatment method isn‘ t working or is causing unfavorable side effects, he or she will be able to help you find a plan that better suits your body and needs.
  • Don’ t fall for scams. Back pain is a common problem – so common that many people try to capitalize off of faulty treatment methods. Do your research on treatment methods and technologies to save your wallet.
  • Consider physical therapy. Physical therapy combines a variety of movements that help decrease pain and increase mobility.
  • Don’ t be afraid to ask for help. It can be difficult to accept that you could use help, especially if it’ s just with day-to-day activities like driving, carrying the groceries, or walking to the Laundromat. If you feel that you need assistance, ask family or friends to lend a helping hand or consider hiring an aide service.

Prevention

The following tips can help you prevent back pain:

  • Exercise regularly. Regular exercise helps to strengthen the supporting muscles of the back, reducing the stress on the spinal column.
  • Don’t overexert yourself. Be mindful of your back when engaging in heavy exercise or labor.
  • Stretch regularly, to keep muscles loose and flexible. Regular stretching helps to reduce the risk of injury and can help to improve athletic performance. Practices such as yoga that incorporate stretching into routine can be especially useful in maintaining flexibility.
  • Visit the chiropractor regularly for alignments and tune-ups. Maintaining proper spinal alignment is key to reducing your risk of back pain.

Medication And Treatment

Back pain can be treated with a variety of medications and treatments.


Chiropractic. 

Many sources of back pain can be relieved by a chiropractic care. The most common therapeutic procedure performed by chiropractors (doctors who specialize in chiropractic medicine) is typically called a “chiropractic adjustment,” but is also referred to as “spinal manipulation.” Injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for the sufferer. The purpose of an adjustment is to restore joint mobility and relieve pain.  Manipulation, or adjustment of the affected joint and tissues helps restore mobility, which alleviates pain and muscular tension, allowing the inflamed tissue to heal.

 


Pain relief medications.

These medications come in different forms and strengths. They are available as prescription or over-the-counter (OTC) medications and can treat various type of pain, including acute and chronic conditions and post-surgical discomfort. All medications have side effects, and many pain-relieving medications can be highly addictive. Speak with your doctor about what side effects you can expect from the medications you are taking.

Over-the-counter (OTC) pain medications include:

  • Acetaminophen (Tylenol, aspirin-free Excedrin). Acetaminophen works on the parts of the brain that receive the “pain messages.”
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Motrin/ Advil) or naproxen (Aleve and Naprosyn). NSAIDs also reduce inflammation (swelling and irritation) and are also available in prescription strength.
  • Topical pain relievers are also available without a doctor’s prescription. These products include creams, lotions, or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Topical pain relievers may be especially effective in dealing with the pain of arthritis in joints (including knee) back pain, and even headache pain.  These include:
    • Counterirritants, such as menthol and camphor, which create a burning or cooling sensation to distract from the pain
    • Salicylates, which relieve pain using the same ingredients as aspirin.
    • Capsaicin, the substance responsible for the spice of hot chili peppers, which relieves pain topically in an unknown manner.

Prescription pain relievers include:

  • Corticosteroids. Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching, and allergic reactions. These include:
    • Bethamethasone (Celestone)
    • Prednisone
  • Opioids. These are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery. MedlinePlus, a service of the U.S. National Library of medicine warns that these drugs can be abused, can be addictive, and have been associated with accidental overdose deaths. Always take opioids precisely as prescribed.  Typically, prescriptions should not last more than three or four months:
    • Codeine
    • Fentanyl (Duragesic) — available as a transdermal patch
    • Hydrocodone (Vicodin)
    • Hydromorphone (Dilaudid)
    • Meperidine (Demerol)
    • Morphine (MS Contin)
    • Oxycodone (Oxycontin, Percocet, Percodan)
    • Tramadol (Ultram)

Surgery. 

Some cases of back pain may require surgical intervention. Commonly performed surgical procedures include:

  • Minimally invasive spine surgery (MISS). This is a procedure that uses specially designed surgical instruments to access the spinal column through small incisions. Procedures that can be performed through minimally invasive spine surgery (MISS) include:
    • Discectomy, in which a damaged lumbar disk, the cartilaginous cushioning between two vertebrae, is removed.
    • Fusions, in which vertebrae and disks are fused to reduce the stress placed on the spinal nerve by movement.
  • Endoscopic surgery. Endoscopic surgeries are minimally invasive procedures performed with the use of a video probe that allows surgeons to see the affected spinal area through a small incision. Procedures that can be performed endoscopically include:
    • Scoliosis surgery
    • Kyphosis surgery
    • Discectomies
    • Fusions
  • Foraminectomy/Foraminotomy, in which the foramen, a natural tunnel found in vertebrae is widened through the removal of surrounding bone and/or tissue.
  • Intradiscal Electrothermal Therapy (IDET), in which low levels of heat are delivered to damaged vertebral discs through a fine wire in order to relieve disc-related pain.
  • Kyphoplasty, in which bone cement is used to reinforce the vertebral column.
  • Laminectomy/Laminoplasty, in which the lamina, a portion of the vertebrae, is partially or fully removed in order to free up space for the spinal nerves.

Complementary and Alternative Treatment

According to the National Center for Complementary and Alternative Medicine (CCAM) the currently available evidence is not strong enough to allow definite conclusions to be reached about whether any complementary approach is effective for chronic pain. However, a growing body of scientific evidence suggests that several approaches may help to manage some painful conditions including low back pain, headaches, rheumatoid arthritis (including in the knee) and osteoarthritis.

These approaches are:

  • Acupuncture. Acupuncture is a form of traditional Chinese medicine in which small needles are inserted into the body at specific points designed to restore the flow of bodily energy. Studies have shown that acupuncture treatments are effective at stress relief and pain relief.
  • Massage. Studies show that massage therapy can help reduce pain and stress levels.
  • Mind and body techniques such as yoga, tai chi, and meditation. These may help strengthen the body and mind to better handle the stresses of pain.
  • Marijuana (Cannabis) has recently been in the spotlight as a possibly effective remedy for chronic pain sufferers. Several clinical studies have shown Marijuana’s ability to provide relief to chronic pain sufferers. Though opinion is changing, use of medical marijuana may be seen as controversial due to the substance’s reputation as a recreational drug. A growing number of states, however, are legalizing medical marijuana.  The substance still remains illegal in the majority of the country—but the landscape for legal use is changing quickly.

When To Contact A Doctor

If you are experiencing unexplained back pain, schedule an appointment with your doctor.

If you are taking pain medication and experience any of the following symptoms, call your doctor immediately:

  • Nausea/vomiting
  • Stomach pain
  • Dizziness
  • Changes in sleep habits
  • Irregular heart rate
  • Chest pain**
  • Sudden weight loss/gain
  • Rapidly worsening pain

** If you experience chest pain, call emergency services. This may be a sign of heart attack.

Questions For A Doctor

You may want to ask your doctor the following questions:

  • What is causing my pain?
  • How long will the pain last?
  • What treatments are available?
  • What are the side effects?
  • How long will treatment last?
  • Should I consider surgical options?
  • What surgical options are available to me?
  • What are the benefits and risks of surgery?
  • What can I do to manage my pain?
  • Should I be concerned about developing other conditions as a result of my pain?
  • How will my condition limit my mobility?