Back Pain
What is
Back Pain?
Most back pain is caused by muscle strain, trauma or spinal deformity.
Only about 10 percent of back pain is caused by a systemic illness. Back
pain can develop anywhere from the neck to the lower spine. The pain can
be localized or spread across a wide area and radiate from a central
point.
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Known Causes
Back pain has many causes, including overuse, trauma, degeneration of
vertebrae, infection, or tumor. The exact cause of pain may be difficult
to identify, since it can come from soft tissue, bone, disc or nerves.
Risk factors for low back pain include cigarette smoking, jobs that
require repetitive or heavy lifting, and exposure to vibration produced by
vehicles or industrial machinery. Certain sports, such as cross-country
skiing, and prolonged vehicle driving are also associated with back pain.
Diseases such as spinal osteoarthritis, spondylitis and compression
fractures can also cause pain. Some of these diseases are more prevalent
in the elderly, consequently older people are at higher risk for back
pain.
Health Impact
- Back pain is the most prevalent medical
disorder in industrialized societies.
- Low back pain disables 5.4 million
Americans and costs at least $16 billion each year.
- Two-thirds of all adults will experience
at least one episode of back pain in their lifetime.
- Seventy percent of people with back pain
recover within a month. Symptoms persist for more than six months in
only 4 percent of the cases, but this group accounts for 85 percent of
the money spent on treatment and compensation for low back pain.
- About half of the people with chronic
back pain return to work.
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Diagnosis
Physicians should determine whether pain is musculoskeletal, neurological
or from one of the organs. This diagnosis is based on a careful history
and physical examination. Injection of a local anesthetic and/or steroid
into soft tissue or joint spaces can be helpful in diagnosing and treating
back pain. Imaging procedures that assist in identifying the pain source
include the x-ray, bone scan, computerized tomography (CAT scan) and
magnetic resonance imaging (MRI). Expensive imaging procedures are
generally reserved for patients whose diagnosis is not apparent with more
conventional diagnostic techniques.
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Conventional
treatments
Over-the-counter pain relievers, such as aspirin, acetaminophen and
non-steroidal anti-inflammatory drugs, are often the only treatment
necessary for back pain. Patients should avoid any activity that increases
the pain. For persistent pain, assistance from a rheumatologist should be
obtained. Treatment should be directed at the specific cause of pain.
Management techniques include analgesics, anti-inflammatories,
antidepressants, muscle relaxants and rehabilitation exercises. Mechanical
back supports are usually recommended for limited periods of time in
certain situations, such as post-operative patients. If these techniques
fail within a reasonable time, injections with local anesthetics and
steroids can be helpful. Surgery can be very helpful when comprehensive
nonoperative therapy fails. Physical and occupational therapy are
important forms of treatment.
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