WHAT IS CHRONIC BACK PAIN?
The bones of the back, also called the spinal column, support a person's upper body and give it flexibility. The spine is divided into 3 main sections; the neck or cervical region, the middle region or thoracic region which is the back of the chest cavity, and the lumbar region or lower back. The bones of the spine allow for free and easy twisting and bending movement. The spine consists of 24 bones called vertebrae (pronounced ver-te-bray). There are seven vertebrae in the neck, 12 in the upper (thoracic – pronounced thor-a-sic) spine, and five in the lower (lumbar) spine.
A triangular bone called the sacrum is immediately below the lumbar vertebrae. The sacrum is actually comprised of five bones fused together. The sacrum and the two pelvic bones form the base of the trunk and are called the pelvis. The tailbone (coccyx – pronounced cahk-sics) is actually made of three or four very small bones. All the bones in the back are kept in good alignment by support of the muscles attached to the spinal bones and are also supported by the strong muscles of the abdomen. A healthy back is straight, strong, flexible and free of pain.
Back pain is usually defined as either acute or chronic. Doctors may diagnose low back pain as acute if it lasts less than a month. Most cases clear up in a few days without medical attention, although recurrence after a first attack is common. If the pain persists for over 3 months, it is considered chronic back pain, this constitutes only 1% to 5% of back pain cases.
The most common area of back pain is the lumbar spine. A lumbar strain is said to occur when the muscles of the low back become tense and develop spasm. This may occur after even a minor strain or injury.
Herniated (pronounced her-nee-a-ted) discs are also a common source of back pain. Small cushions called intervertebral discs, separate vertebrae in the back from each other. Eeach disc is made up of a jelly-like substance that is surrounded by a firm fibrous sheath and 80% of the disc is water, which makes it very elastic. A disc does not contain any blood, and relies on nearby blood vessels to keep it nourished. A herniated disc occurs when the fibrous sheath between the vertebrae tears and the jello-like substance leaks out.. The gelatinous extrusion can cause pressure on the nerves in the area. This may produce muscle spasm at the site, or pain or weakness in the leg as the nerve.
HOW COMMON IS CHRONIC BACK PAIN?
Back pain is the most prevalent medical disorder in industrialized societies.
WHAT ARE THE WARNING SIGNS OF CHRONIC BACK PAIN?
Back pain can develop anywhere from the neck to the lower spine. The pain can be localized or spread across a wide area and radiate from a central point. Muscle spasms are commonly associated with back pain arising from any cause. Some people also get pain or weakness in a leg as a result of back injury.
WHAT CAUSES CHRONIC BACK INJURY?
Poor posture and weak supporting muscles are a common cause of back pain. The most common reason for poor muscle strength is lack of physical exercise. As we get older, the jello structure of the discs have a reduced water content, the discs reduce in size, loose some of their elasticity and cause the bones of the spine to settle on each other more snugly. This increased pressure between the bones can be an irritant that can be a cause of pain. The resulting pain may first appear as stiffness that disappears when you get up and move around. After months the pain and stiffness may last for longer periods.
Stressors to the spine such as can occur when lifting heavy objects without attention to keeping the back straight and bending knees, is also a frequent cause of back pain. When you lift a heavy object increased pressure is put on your lumbar spine. If you lift the weight incorrectly and have it positioned far in front of your spine, your back muscles have to exert a tremendous force to lift the body into an upright position. This can cause the muscles to strain or a disc to herniate.
It is believed that as much as 80% of back pain can be attributed to lack of exercise and poor physical fitness. Strong muscles, especially the abdominal muscles, support the back and help distribute weight when you lift something heavy. Back and abdominal muscles that lack strength and tone cause more stress to be placed on the ligaments.
Excess body weight, which often is carried in a person's abdomen, also puts extra strain on the low back. Being overweight can make it more difficult for you to exercise and keep the muscles in your back and abdomen strong and flexible.
Emotional stress is usually felt in the part of the body that is weakest. If your back is weak, it may hurt when you experience stress.
Certain activities that result in repeated deep bending or heavy lifting without attention to good back care may be associated with back pain.
Diseases such as osteoarthritis, ankylosing spondylitis (pronounced ankle-low-zing spond-ill-eye-tiss) and compression fractures may also be a source of chronic back pain. Only about 10% of back pain is caused by an illness or disease.
WHAT CAN YOU DO ABOUT CHRONIC BACK PAIN?
If you have back pain your doctor will probably perform a physical examination and ask you questions about what you were doing before and when the pain started. The exact cause of pain may be difficult to identify, since it can come from soft tissue, a bone, disc or the nerves.
If the back pain persists and does not settle in a few months your doctor may order x-rays, but it is important not to have too many x-rays done . Other more complex tests, such as an MRI or magnetic resonance imaging may be done if the condition persists for a very long time and your doctor wants to identify more specifically the exact cause of the pain. It is important to note that most people over the age of 40 years will have abnormality reported on MRI, and most people over the age of 50 will have some evidence of degenerative disc disease or disc herniation. A finding on x-ray or MRI must be interpreted in the context of the age and symptoms of a patient. Many findings on these tests are present in people without any symptoms at all.
Back pain will often go away on its own. A variety of treatments can help to lessen pain and stiffness and to make movement easier. Your active involvement in developing your prescribed treatment plan is essential.
Medicine
For mild to moderate back pain doctors often recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc.). Acetaminophen is a pain reliever, but has no anti-inflammatory properties. For this reason it can usually be safely taken along with most prescription medications, should these also be needed. However, there are daily limits of acetaminophen that can be taken, so caution should be exercised, particularly if other medications that contain acetaminophen (for example, it's found in many cold remedies) are being used. A serious overdose of acetaminophen can cause liver damage.
NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).
You may find general information in Arthritis Medications: A Consumer's Guide [PDF] even if your disease is not specifically addressed.
Exercise
Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint looses its strength and stability. Moderate stretching exercises and core fitness and strengthning will help relieve the pain due to musle tension and keep the muscles and tendons around the affected joint more flexible and strong. Group format may encourage you to keep up with the exercise program. Exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility. Always consult a doctor before beginning an exercise program.
Heat and Cold
Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. Cold helps numb the area blocking painful nerve impulses.
Protect Your Joints
Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. There are several techniques to protect your joints:
Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest. Avoid any activity that increases the pain.
Position your joints wisely so you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.
When you lift a heavy item be sure to keep it as close to your body as possible. Keep your back straight and use your legs to do the lifting. The leg muscles are strong and designed for heavy work, unlike the back, which is designed for flexibility. Make sure that your feet are apart and firmly placed so that you do not slip.If the object is too heavy for you to lift, get help.
Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.
Staying at your recommended weight or losing weight helps lessen pain and prevent back injury by reducing stress on the joints. If you plan to lose a lot of weight, discuss the best program for you with your doctor and a dietician.
Be aware of your posture and be sure to stand straight. To have good posture when standing, your head should be lifted (not leaning forward) and your chin pulled back, and your buttocks should be 'tucked in' so that your stomach is flat. To ensure good posture when you are sitting, use a chair that allows you to have both feet on the floor with your knees higher than your hips. Sit firmly with your back against the chair. If necessary, use a lower back support cushion to allow your back to maintain its natural curve.
If you suffer from back pain you should wear proper walking shoes that support your feet and help keep your posture properly aligned. With each step you take, your body absorbs a shock that is about three times your body weight – this can place excess pressure on your lumbar spine.
Sleep on a firm mattress that gives your back support. If you sleep on your back make sure your pillow supports your neck and head, but does not lift your head and shoulders too high. If you sleep on your side make sure that your pillow supports your neck and head so that your spine is in a straight line. Sleeping on your stomach forces your neck into an awkward position and is not recommended if you have chronic back or neck pain.
Relaxation
Developing good relaxation and coping skills can give you a greater feeling of control over your pain and a more positive outlook.
Surgery
Surgery is almost never required for chronic back pain, but may be considered if there is evidence of important pressure on nerves or the spinal cord.
Outcomes
Seventy percent of people with back pain recover within a month. Back pain that persists for more than six months occurs in only 1% to 5% of the chronic back pain cases. About half of the people with long-term back pain return to work.