Back pain

Janet D. Pearl, MD, MSc

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Back Pain

What is it?

Back pain is a catch all term for a variety of problems that cause pain anywhere along the spine. Some conditions that cause back pain include arthritis, disc herniation, spondylolisthesis, kyphosis, and scoliosis. Arthritis is the break down in the facet joints of the back, and this can cause pain on movement. Disc herniation is the rupture of the protective discs between the vertebrae. It can affect the nerve roots and lead to pain that shoots into the arms or legs. Spondylolisthesis is when the vertebrae are out of alignment. For instance, one bone can slip forward over another, and this stresses the muscles and ligaments and can put pressure on nerve roots. Kyphosis describes the forward curvature of the spine that occurs from compression fractures in the vertebrae. Its most common sign is a rounded neck and back, and it can cause pain on movement. Finally, scoliosis is the side to side curvature of the back, and it can cause pain and stiffness if it is not treated in early childhood.

The natural curves of the spine
natural curves of the spine
Back disc problems
back disc problems
Spinal curvature problems
spinal curvature problems
Stages of disc herniation
stages of disc herniation

Who gets it?

Anyone is at risk for back pain. Older adults are more susceptible to osteoarthritis in the back, and kyphosis is generally seen in older females. Anyone who leads a sedentary life is also at risk. The deconditioning of the spine can lead to problems with the support musculature, and this can lead to disc herniation. Disc herniation leads to nerve root pain, such as sciatica. However, even those who are active are at risk for back pain. Those who play sports are more likely to receive a trauma to the back that can rupture disc or misalign vertebrae. If you work in a job that requires lifting, you are far more likely to develop back pain from any of the causative factors. In addition, carrying extra weight can put strain on the back, particularly the lumbar region, because it can lead adisc rupture.

What kind of pain results?

Back pain can cause a number of painful feelings. First, you may feel muscle strain in your back if you have strained or sprained the complex musculature of the spine. Second, you may feel stiffness on moving your back, and this is particularly true if you have arthritis, kyphosis, or scoliosis. These conditions keep the back from moving smoothly against itself, and this can cause a stiff feeling in the joints that support the back. One of the primary causes of back pain arises from nerve problems. When discs herniate, they often press on the nerves that run close to the spine. This can cause shooting pain down an extremity, weakness, numbness, and tingling. Some people experience problems with their bowel or bladder when the nerves are involved, but this is an advanced symptom and should be immediately evaluated by a physician.


Treatment of Back Pain

Pain management physicians are experts in treating back pain, and they can provide you with a number of services for the treatment of this condition. While all doctors can prescribe pain medications, pain doctors know all of the available treatments and how to use them in concert. Back pain responds well to non-steroidal anti-inflammatory medications, but antidepressants and anti-seizure medications are also important in treatment. When medications are less than fully effective, injections into the spine are used to decrease inflammation and reduce pain. Lumbar, cervical, and transforaminal steroid injections bring the medication directly to the site of inflamed discs or impinged nerves. Facet joint injections are helpful for facet joint arthritis, and radiofrequency lesioning can be performed to cauterize the small nerves that transmit sensation from the arthritic joints. Furthermore, trigger point injections can assist with easing muscle spasms around the spine. Finally, electrothermal therapy can be applied to cracked or bulging discs and cauterize them with heat. Besides pain management physicians, back pain should be treated by team of professionals, with a patient plan tailored to each individual patient. Primary care physicians are usually the first to diagnose back pain. Chiropractors can be quite helpful in restoring the back to health through stretching and manipulations when the pain does not radiate. Physical therapists are another vital piece of the back care puzzle, and their expertise can help you to overcome your back pain through strength and flexibility exercises. Spinal surgeons are referred to if the back pain is accompanied by weakness in an extremity or if the back pain is severe and has not improved with conservative treatment.

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