Back Pain

What is back pain?

Lower back pain, often referred to as lumbago, is not a distinct disease diagnosis but rather a symptom associated with various medical issues. This discomfort typically arises from issues with different components of the lower back, including:

• Ligaments and muscles
• Discs
• Intervertebral discs
• Nerves
• The bony structures forming the spine, known as vertebral bodies or vertebrae.

In addition, lower back pain may be attributed to problems in adjacent organs, such as the kidneys.

What are the symptoms of back pain?

Back pain can manifest through various symptoms, including:

• A dull, aching sensation in the lower back
• Sharp or shooting pain that may radiate down the leg to the foot.
• Difficulty standing up straight without experiencing pain.
• Decreased range of motion and limited ability to flex the back.

When back pain results from strain or misuse, the symptoms are typically short-lived but can persist for days or weeks. Chronic back pain is identified when these symptoms endure for more than three months.

However, certain symptoms may indicate a more serious underlying medical issue, such as:

• Loss of bowel or bladder control
• Numbness, tingling, or weakness in one or both legs
• Onset of back pain following trauma (injury), such as a fall or a blow to the back
• Persistent, intense pain that worsens at night.
• Unexplained weight loss
• Back pain associated with a throbbing sensation in the abdomen.
• Presence of fever

What are some causes of back pain?

• Lower back pain often stems from strain and issues with back structures.
• Strained muscles, commonly induced by improper lifting of heavy objects or sudden awkward movements, are frequent culprits.
• Overactivity, such as prolonged yard work or sports, can also lead to strain, resulting in soreness and stiffness.

Structural problems

Structural problems involving the vertebrae and discs contribute to back pain. The vertebrae, the interconnected bones forming the spine, and the discs, tissue areas that cushion the spaces between each vertebra, can be sources of discomfort. Disc injuries, including bulging, herniation, or rupture, may lead to nerve compression, causing conditions like sciatica with leg pain, tingling, or numbness.

Arthritis

Arthritis, specifically spinal osteoarthritis, can contribute to back pain by causing damage and deterioration in the cartilage of lower back joints. This condition may progress to spinal stenosis, narrowing the spinal column.

Osteoporosis

Osteoporosis, characterized by the loss of bone density and thinning of bones, can result in small fractures in the vertebrae, known as compression fractures, leading to significant pain.

After excluding more common causes of back pain, doctors may conduct tests to explore rarer possibilities, including:

• Vertebrae displacement onto a nearby vertebra, known as degenerative spondylolisthesis.
• Loss of nerve function in the lower spinal cord, termed cauda equina syndrome (a medical emergency).
• Fungal or bacterial infections of the spine, such as Staphylococcus, E. coli, or tuberculosis.
• The presence of cancerous or noncancerous (benign) tumors in the spine.
• Kidney infection or kidney stones.

How is back pain diagnosed?

A diagnosis of back pain typically involves a comprehensive physical examination. During this examination, your doctor may assess:

• Your ability to stand and walk.
• The range of motion in your spine
• Reflexes
• Leg strength.
• Sensation detection in your legs

If a more severe condition is suspected, additional tests may be ordered, including:

• Blood and urine tests to identify underlying conditions.
• X-rays of the spine to visualize bone alignment and detect fractures.
• CT scans or MRI scans to evaluate discs, muscles, ligaments, nerves, and blood vessels.
• Bone scans are used to detect abnormalities in bone tissue.

What are some tips to prevent back pain?

These recommendations can provide relief from back pain when it occurs and contribute to preventing its onset:

• Lighten your load: Heavy bags exert unnecessary stress on your neck and spine. Reduce the amount you carry, or opt for bags that distribute weight more evenly, such as a backpack.
• Mind your posture: Poor posture can place undue pressure on your spine, leading to pain and damage over time. Regularly remind yourself to straighten your rounded shoulders and sit upright in your chair.
• Choose supportive footwear: opt for comfortable, supportive shoes with minimal elevation whenever possible.
• Incorporate regular stretching: Stretching helps enhance circulation in your muscles, reducing the risk of back pain and potential damage.

Individuals may be at a higher risk for back pain if they:

• Work in a sedentary (inactive) environment
• Lack regular exercise
• Engage in high-impact activities without proper stretching or warm-up.
• Are older
• Have obesity
• Smoke
• Have been diagnosed with a specific condition like arthritis

What is the treatment for back pain?

Many individuals may find relief from back pain with simple measures, and over-the-counter pain medications are often sufficient. Muscle relaxants can be considered, particularly if muscle spasms accompany the pain, as these medications act on the central nervous system to alleviate discomfort. In some cases, antidepressants and other medications may be used off-label for back pain treatment.

For severe back pain, your healthcare provider may prescribe amitriptyline, a tricyclic antidepressant that targets various aspects of the pain response and may be more effective for nerve-related pain. Cortisone steroid injections may also be recommended for specific causes of back pain, particularly when nerve involvement is present.

In instances of more intense pain, opioids like tramadol or a combination of acetaminophen and tramadol (Doreta) may be prescribed. However, caution is advised in their use due to the potential for addiction. Surgery is typically considered for individuals with structural abnormalities who haven’t responded to nonsurgical treatments like medication and therapy.

It may be an option for those experiencing severe, constant pain with identifiable structural issues, muscle weakness due to nerve compression, or spinal cord compression impacting daily activities. Before exploring alternative therapies such as massages or chiropractic adjustments, it’s essential to consult with your doctor.