Back Pain

Nearly everyone has back pain at some time. About 20% of people have some form of back pain each year. Back pain is the most common cause of disability for people under the age of 45. Back pain can be in different locations. Pain can be in the neck, upper back and shoulders, and the lower back. Often nonspecific back pain results from stresses on the muscles and ligaments that support the spine. Sometimes it is hard to find the cause of the pain.

Low back pain may involve the muscles, joints, or nerves of the lower back. It may also be referred pain, which means the pain is actually coming from another organ, such as the kidneys.

Kidneys and Adrenal Glands

1. Adrenal Gland
2. Artery
3. Vein
4. Kidney
5. Ureter

Diagnosing Back Pain

Diagnosis of low back pain begins with a medical history and physical exam. Depending on the suspected cause of the problem, the provider may order diagnostic tests, such as:

• blood and urine tests
• a bone scan
• CT or MRI scans
• an electromyogram, or EMG, which measures muscle response to nerve stimulation
• a myelogram, which uses a contrast agent and X-rays to detect abnormalities along the spine
• a nerve conduction velocity test, or NCV, which measures transmission along the nerve

Causes and Risks of Back Pain

The exact cause of back pain may be hard to find. Pain can come from muscles, ligaments, nerves, discs, or bones. People who are inactive are especially at risk. Inactive people are not conditioned. They are prone to strains when they use their back. Other risk factors include the following:

• advancing age
• frequent or heavy lifting
• overweight or obesity
• poor posture
• repetitive movements, including twisting
• smoking

Low back pain may be caused by a number of spinal disorders. Following are some common causes:

• fibromyalgia, a condition that causes trigger points in body tissues, including the low back
• osteomyelitis, or bone infection
• ruptured disks, which involve the soft disks between the vertebrae of the spine
• spinal degeneration, which may involve arthritis
• spinal stenosis, or narrowing of the disk spaces with aging
• sprains or strains of the muscles and other soft tissue in the back
• tumors of the spine

1. Compression Fracture of the Vertebrae

A person with disorders of certain body organs may experience referred pain in the low back. These disorders include:

• aneurysms
• appendicitis
• kidney disease
• ovarian disorders
• pelvic inflammatory disease, and other infections in the pelvic area
• urinary tract infection

• Following are risk factors that increase a person's risk for low back pain:

• activities, such as driving a car, that pass vibrations along the spine
• lack of physical activity
• obesity
• old age
• smoking

Signs and Symptoms of Back Pain

Low back pain may range from a dull ache to severe, disabling pain. The individual may have related symptoms, including the following:

• decreased ability to flex the knee
• decreased ability to move the foot and toes in certain directions
• numbness, burning, or tingling in the leg
• pain that travels down the leg to the back of the thigh and calf

Other specific symptoms include:

• muscle spasms
• pain in the lower or upper back
• pain that radiates to the thighs, buttocks, or arms tenderness when the back is touched

Back pain can be unbearable. It can also be just a nagging annoyance. A healthcare provider should be seen if the pain is severe, lasts more than a few days, or keeps a person from daily activities.

Long-Term Effects of Back Pain

Low back pain is a leading cause of disability and missed work in developed countries. Those affected may be unable to perform activities they enjoy. Chronic pain can result in depression, lack of productivity, and drug abuse. If there is nerve damage, the person may have weakness, numbness, and loss of muscle mass. Low back pain is not contagious and poses no risk to others.

Prevention of Back Pain

Proper lifting techniques are important to avoid a ruptured disk. These techniques can be enhanced by the use of an abdominal support belt. Other preventive measures are as follows:

• regular physical activity
• rest breaks to interrupt long periods of vibration, such as driving a car
• smoking cessation for individuals who smoke
• weight management for people who are obese

Back Pain Treatment

Low back pain caused by strains or sprains will get better on its own within four weeks, with or without treatment. People with more serious conditions, such as a ruptured disk, may benefit from treatment. A ruptured disk is generally treated conservatively at first. Following are some initial treatments that may be used:

• anti-inflammatory pain medication, such as ibuprofen, ketoprofen, flurbiprofen, or naproxen
• activity limitations
• application of heat
• massage
• muscle relaxants, such as carisoprodol
• a specialized exercise program

If conservative treatment is not successful, the healthcare provider may recommend surgery. The following operations may be helpful for people who have a ruptured disk:

• diskectomy or laminectomy, which allows the surgeon to remove the ruptured disk and relieve nerve pressure
• injection of chymopapain, an enzyme, into the disk to dissolve it
• nucleoplasty, which involves inserting a needle into the disk and applying heat with a special instrument
• spinal fusion, which involves the joining of two or more vertebrae

Treatment Side Effects

Side effects of medicines include allergic reactions and stomach upset. Surgery is associated with a risk of infection, bleeding, and allergic reaction to anesthesia.

After conservative treatment of a ruptured disk, a person can usually resume activity as tolerated. Symptoms may recur every now and then, requiring repeated treatment. Ninety percent of the time, surgery relieves symptoms and the person can slowly resume normal activities. Physical therapy can be helpful to teach appropriate body mechanics and lifting techniques. Any new or worsening symptoms should be reported to the healthcare provider.