Dr. (Prof.) Shankar Acharya

M.B.B.S., M.S. (Ortho), DNB (Ortho), FRCS (Edinburgh), FRCS (Glasg.), M.Ch(Ortho) Liverpool. , FRCS (Ortho) U.K,
Senior Consultant : Endoscopic, Microscopic
and Minimal Invasive Ortho & Spine Surgeon
Scoliosis and Severe Deformity Correction Surgery Specialist

 

Back Pain

Back pain is frequent complaint. It is the commonest cause of work-related absence in the world. Although back pain may be painful and uncomfortable, it is not usually serious. Even though back pain can affect people of any age, it is significantly more common among adults aged between 25 and 55 years.

Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.

The risk factors for back pain?

• A mentally stressful job
• A sedentary lifestyle
• Age – older adults are more susceptible than young adults or children
• Gender – back pain is more common among females than males
• Obesity
• Smoking
• Strenuous physical exercise
• Strenuous physical work

What are the symptoms of back pain?

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs.

If any of the following symptoms accompanies a back pain your should see your doctor:

• Weight loss
• Elevated body temperature (fever)
• Swelling on the back
• Persistent back pain – lying down or resting does not help
• Pain down the legs
• Pain reaches below the knees
• Arecent injury, blow or trauma to your back
• Difficulty urinating – passing urine is hard
• Loss of bowel control
• Numbness around the buttocks

What are the causes of back pain?
The most common causes of back pain are:

• Strained muscles
• Strained ligaments
• Lifting something improperly
• Lifting something
• Amuscle spasm

The following structural problems may also result in back pain:

 

Ruptured disc – each vertebra in our spine is cushioned by a disc. If the disc ruptures there will be more pressure on a nerve, resulting in back pain.

Bulging discs – in much the same way a ruptured disc, a bulging disc can result in more pressure on a nerve.

Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg.

Arthritis – patients with osteoarthritis commonly experience problems with the joints e.g. hips, back, knees and hands.

Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis.

Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous,making compression fractures more likely.

Cauda equina syndrome – the cauda equina is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equina syndrome feel a dull pain in the lower back and upper buttocks. Bowel and bladder disturbances are the main problems in cauda equina.

Spinal Tumor – Tumers of spine for bone and spinal cord may cause Neurological symptoms and weakness.

Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.

Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.

Bad mattress – if a mattress does not support specific parts of the body to keep the spine straight, there is a greater risk of developing back pain.

Poor posture

• Bending awkwardly
• Pushing something
• Pulling something
• Carrying something
• Lifting something
• Standing for long periods
• Bending down for long periods
• Twisting
• Coughing
• Sneezing
• Over-stretching
• Sitting in a hunched position for long periods

What are the treatment options for back pain?

1. Medication

2. Physical Therapy – the application of heat, ice, ultrasound and electrical stimulation, as well as some functional therapy techniques to the back muscles and soft tissues may help alleviate pain.

TENS (transcutaneous electrical nerve stimulation) – a popular therapy for patients with chronic (long-term) back pain. The TENS machine delivers small electric pulses into the body through electrodes that are place on the skin.

3. Cortisone injections – if the above-mentioned therapies are not effective enough, or if the pain reaches down to the patient’s legs, cortisone may be injected into the epidural space. Cortisone is an anti-inflammatory drug; it helps reduce inflammation around the nerve roots. the pain-relief effect will wear off after six weeks. Injections may also be used to numb areas thought to be causing the pain

4. Surgery – surgery for back pain is rare. If a patient has a herniated disc, surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness.

Examples of surgical procedures include:

• Fusion – two or more vertebrae are joined together, with a bone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages.

• Artificial disc – an artificial disc is inserted; it replaces the cushion between two vertebrae.
• Discectomy (partially removing a disc) – a portion of a disc may be removed if it is irritating or pressing against a nerve.
• Partially removing a vertebra – a small section of a vertebra may be removed if it is pinching the spinal cord or nerves laminectomy.

Prevention of back pain

Exercise – regular exercise helps build strength as well as keeping your body weight down. Core-strengthening exercises; exercises that work the abdominal and back muscles, help strengthen muscles which protect your back.

Flexibility – exercises aimed at improving flexibility in your hips and upper legs may help too.

Smoking – a significantly higher percentage of smokers have back pain compared to non-smokers of the same age, height and weight.

Body weight – the fatter you are the greater your risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable.

Posture when standing – make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet – keep your legs straight.

Posture when sitting – a good seat should have good back support, arm rests and a swivel base Lifting things – use your legs to do the lifting, more than your back.

Moving things – remember that it is better for your back to push things across the floor, rather than pulling them.

Driving – it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks – get out of the car and walk around.

When to contact a medical professional

Call your health care provider right away if you have:

• Back pain after a severe blow or fall
• Burning with urination or blood in your urine
• History of cancer
• Loss of control over urine or stool (incontinence)
• Pain traveling down your legs below the knee
• Pain that is worse when you lie down or that wakes you up at night
• Redness or swelling on the back or spine
• Severe pain that does not allow you to get comfortable
• Unexplained fever with back pain
• Weakness or numbness in your buttocks, thigh, leg, or pelvis

Treatment

• Discectomy
• Foraminotomy
• Laminectomy
• Spinal fusion

Some people with low back pain may also need:

• Job change
• Job counseling
• Job retraining
• Occupational therapy

Outlook (Prognosis)

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures will allow you to get better.