Back pain is experienced along the structures in the spine; muscles, nerves, bones or joints. It is extremely common and the fifth most common reason for physician visits. Approximately nine out of ten adults experience back pain at some point in their life and five out of ten working adults have back pain every year. Low back pain is the most common cause of work related disability and the leading cause of missed work, costing at least $50 million to the US population.
Acute low back pain is generally short term in nature lasting from a few days to a few weeks. It is mostly mechanical in nature, brought on by trauma or arthritis. Pain from trauma can occur due to a sports injury, working around the house or garden, a sudden jolt as in a car accident or any other event which creates stress on spinal bones and tissues. Chronic low back pain is defined by duration. Any pain that persists longer than three months is considered chronic.
The spinal column consists of 30 bones or vertebrae, stacked one on top of the other and interspersed with round, spongy pads of cartilage known as intervertebral discs. Over time, the discs of the back lose fluid and flexibility, which decrease their ability to cushion the vertebrae. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward and put pressure on one or more of the 50 nerve roots. This nerve root compression will result in back pain.
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In addition to trauma, chronic low back pain may be a result of arthritis, disc disease, osteoporosis or other primary bone disease, viral infections, irritations to joints and discs or a congenital abnormality. Factors such as obesity, smoking, weight gain during pregnancy, stress, poor physical conditioning, posture inappropriate for the activity being performed and a poor sleeping position will also contribute to the experience of low back pain.
Men and women are equally at risk for developing low back pain. It most commonly occurs between ages 30 and 50, in part from the aging process but also as a result of intermittent episodes of too little or too much exercise. The risk of back pain from disc disease or spinal degeneration increases with age.
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The most conventional test to assist in diagnosing the cause and site of back pain is the x-ray. The x-ray will evaluate for any broken bones or injured vertebrae contributing to the problem. A discography involves injecting dye into a disc and obtaining an x-ray, which shows damage to the area. A myelogram, on the other hand, involves injecting dye into the spinal canal to outline any spinal chord or nerve compression cause by a herniated disc or fracture. The MRI is the most comprehensive test in that it will evaluate the lumbar region for bone degeneration or injury, disease in tissues, nerves, muscles, ligaments and blood vessels.
Most low back pain is treated without surgery. The standard of care involves pain control, reducing inflammation, restoring function to the back and preventing recurrence of an injury. Ice and heat have not shown to quickly resolve a low back injury, but immediately applying ice following an injury will reduce inflammation and applying heat after 2-3 days of cold will relax muscles and increase blood flow to the area. Bed rest is not as effective as exercise, which has been shown to strengthen back and abdominal muscles and facilitate a more rapid recovery.
Medications are often used to treat acute and chronic back pain, with anti inflammatory agents used in both cases. For chronic back pain; anticonvulsants, antidepressants and narcotics will be used to control symptoms. There are new laws in Washington State effective January 1, 2012 prohibiting physicians from prescribing narcotic agents on a long term basis for non cancerous chronic pain. Those patients will be required to see a pain management specialist.
Spinal manipulation by a chiropractor, acupuncture, biofeedback, nerve blocks, traction, transcutaneous electrical nerve stimulation (TENS) units, ultrasound are all non surgical techniques to approach chronic back pain. In certain situations, more invasive techniques will need to be employed such as; kyphoplasty whereby a balloon is inserted into a vertebrae just before a vertebroplasty is performed which involves the injection of a glue-like epoxy into the vertebrae itself. In the most serious cases one of the following will be employed; discectomy, excision of part of the disc, foraminotomy, a cleaning out of the bony hole ‘foramen’ at the site where the nerve root exits the canal or a spinal fusion, discs between two or more vertebrae are removed and the adjacent vertebrae are fused together by bone grafts or metal screws.
The best way to prevent back pain is through regular stretching and exercise of the back and abdominal muscles. Stand tall, throw your shoulders back and walk with authority!
Dr. Ballard is a Board Certified Internist and Geriatrician with a special interest in Women’s Health. She practices in Enumclaw, 360-825-1389. Dr. Ballard’s comments are informational only and not to be construed as medical advice. Consult your personal physician for any medical issues.