Dr. Francis SANWO

 

Back pain is pain felt in the back. Episodes of back pain may be acute, sub-acute, or chronic depending on the duration. The pain may be characterized as a dull ache, shooting or piercing pain, or a burning sensation. The pain may radiate into the arms and hands as well as the legs or feet, and may include paresthesia (tingling with no apparent cause), weakness or numbness in the legs and arms.

The anatomic classification of back pain follows the segments of the spine: neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) with the lumbar vertebrae area most common for pain.

The pain may originate from the muscles, nerves, bones, joints or other structures in the vertebral column (spine). Internal structures such as the gallbladder and pancreas may also cause referred pain in the back.

Back pain is common with about nine out of ten adults experiencing it at some point in their life, and five out of ten working adults having it every year. However, it is rare for it to be permanently disabling. It is the single leading cause of disability worldwide.

Classification.

Back pain may be classified by various methods to aid its diagnosis and management.  Duration of back pain. Acute pain lasts up to 12 weeks, subacute pain is of duration between 6 to 12 weeks and chronic pain is pain which persists beyond 12 weeks.

 Non-specific back pain.  Back pain has several causes. Approximately 98 percent of back pain patients are diagnosed with nonspecific acute back pain in which no serious underlying pathology is identified. Nonspecific back pain is believed to be due from the soft tissues such as muscles, fascia, and ligaments.

There are a number of factors that can increase your risk of developing lower back pain, or make it worse once you have it. These include: staying in the same position for long periods of time, bending, twisting and lifting (especially heavy objects), being obese, vibration of the whole body (e.g. from driving heavy machinery) and an accident or injury, such as a car accident or fall.

Specific back pain. Sometimes, damage to parts of your spine can be the cause of back pain. Examples of this are: a slipped (herniated) disc – when a disc bulges and puts pressure on your spinal nerves, a fracture – a crack or break in one of the bones in your back.

Back pain can also be caused by a serious condition such as an infection or cancer, but this is very uncommon.

Nearly 2 percent of back pain are comprised by metastatic cancers, while serious infections such as spinal osteomyelitis and epidural abscesses account for fewer than 1 percent. The most common cause of neurologic impairment including weakness or numbness results from a herniated disc.

The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts from two weeks to three months

Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause.

Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition.

Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention. 

Causes of back pain.

One potential source of back pain is skeletal muscle of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles) and muscle spasm.

Another potential source of lower back pain is the synovial joints of the spine (e.g. zygapophysial joints/facet joints). These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. 

There are several common other potential sources and causes of back pain– these include spinal disc herniation, osteoarthritis (degenerative joint disease), lumbar spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.

Diagnosis.

In most cases of low back pain medical consensus advises not seeking an exact diagnosis but instead beginning to treat the pain. This assumes that there is no reason to expect that the person has an underlying problem. In most cases, the pain goes away naturally after a few weeks. 

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Management of back pain.

The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual's ability to function in everyday activities, to help the patient cope with residual pain and to assess for side-effects of therapy. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long-term pain relief.

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Heat therapy is useful for back spasms or other conditions. Heat therapy can reduce symptoms of acute and sub-acute low-back pain. ). Cold compression therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases.

Use of Medications in chronic back pain is controversial. The short term use of muscle relaxants is effective in the relief of acute back pain. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be more effective than placebo, and are usually more effective than paracetamol (acetaminophen). Massage may help for those who have had a relatively long period of low back pain.

Exercises can be an effective approach to reducing pain, but should be done under supervision of a licensed health professional. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is effective for chronic back pain, but not for acute pain.

Surgery may sometimes be appropriate for people with: Lumbar disc herniation  and compression fracture.

Surgery is usually the last resort in the treatment of back pain. It is usually only recommended if all other treatment options have been tried or in an emergency situation. The benefits of surgery often decline in the long term.

Chronic back pain

People with back pain lasting for 3 months or more are at risk of physical, psychological and social dysfunctions. Such individuals are likely to experience less pain and disability if they receive a multidisciplinary intervention. This typically involves a combination of physical, psychological and educational interventions delivered by a team of specialists with different skills.