Summary for HealthiNation's Back Pain

Hosted by Dr. Paul Knoepflmacher, Internal Medicine

What Is Back Pain?

The back plays a large role in most physical activity. When there is pain in the back, however minor, it can have a profoundly negative impact on our daily lives. There are many type of back pain. Symptoms can range from muscle stiffness to sharp jabbing pain.

What Happens With Back Pain?

The back is made up of four primary tissues; muscle, bone (vertebrae), shock-absorbing disks and nerves. Nerves come out of the spinal cord. The cord is protected by a boney canal that runs through the vertebrae. It's the main pathway for sending messages to and from the brain to all parts of the body. Most back pain can be traced to a problem with one of these parts of the back. Rare cases of back pain can be due to infection or other disease.

Causes of Back Pain

There are many types of causes of back pain. It's important to know the specific cause of back pain in order to determine the proper treatment.

Injury. The most common cause of back pain is injury to the muscle and ligaments that surround and connect the bones and disks. It can be due to over-exertion, heavy lifting, sudden movements, or falls or blows to the body.

Slipped Disk. This happens when one of the soft disks between the vertebrae extends out over the edge. In some cases, the nerve is pressed right up against bone. This is called a pinched nerve.

Arthritis. Some forms of arthritis cause the disks to lose the ability to absorb shock. This causes the bones to rub together causing pain. That friction can cause the bones to grow extensions called bone spurs. These spurs may cause even more pain.

Osteoporosis. Osteoporosis is a loss of bone mass that causes the bones to become brittle. In people with osteoporosis, small breaks or collapse can occur in the weakened bone. These are called compression fractures, and can be very painful.

Sciatica. This occurs when a pinched nerve in the back causes a sharp pain radiating down the legs. A pinched nerve in the neck can cause sharp pain in the arms.

Fibromyalgia. This is a muscular skeletal condition that causes pain in many areas of the body, including the back.

Referred Pain. Sometimes pain you feel in the back may originate in another part of the body. For example, a kidney infection, called pyelonephritis, or even kidney stones can cause severe pain low back or groin. Gallbladder disease can cause shoulder pain.

Pregnancy. The back muscles compensate for the extra weight of the baby. It helps to know that most women say this pain goes away almost immediately after the baby is born.

Preventing Back Pain

Back pain can happen to anyone, but you may be at more risk if you do a lot of heavy lifting and physical work. Here are steps to prevent back pain.

• Exercise. This will help strengthen and build endurance in the muscles that line the back, and torso. These core muscles act as a natural support system for the back, and the stronger they are, the better the support will be. Weight training will also help improve strength and support.
• Lose Weight. Shedding extra pounds will help lighten the load your back has to carry everyday.
• Practice Good Posture. If you're standing for long periods of time, shift your weight from one leg to the other. If you can, place one leg on a footrest. While sitting, use a good chair with armrests. It may also be helpful to keep a rolled towel, or small pillow between your lower back and the chair for support. Make sure to keep your knees and hips level.
• Lift The Smart Way. When lifting something heavy, squat down then stand up holding the object. This forces you to do more of the work with you legs versus putting strain on your back. Keep your back straight, and find someone to help if you can.
• Sleep On Your Side. Use pillows that support your head, neck. You can even try a pillow under your knees for support.

When to See the Doctor

Most forms of back pain should begin to go away after a few days of treatment. You should see a doctor if the pain lasts longer than 72 hours, or you experience any of the following symptoms:

• Constant pain, especially pain that worsens when lying down
• Pain that moves into one or both legs
• Feelings of numbness, tingling, or weakness of a limb
• Pain that follows a traumatic injury
• Bowel or bladder problems that develop along with back pain
• Unexplained weight loss

Treating Back Pain

Before prescribing treatment, your doctor will take a careful history and examine you. Occasionally some routine tests are used to determine the source of your pain. These may include an X-Ray or MRI, which will help your doctor find the right treatment for you. Here are some common treatment options:

Non-Medication Options

• Physical Therapy. The plan may include stretching and exercises you can do with a therapist, or at home. This can last a few weeks, or a few months.
• Cold or Hot Compresses. Cold compresses help to reduce swelling while hot compresses help stimulate circulation in the area of pain.
• Limited Bed Rest. Your doctor may recommend some time at rest, but it's important not to stay in bed too long. Too much bed rest can actually worsen back pain and make you weaker.

Medication Options

• Over-The-Counter. These include acetaminophen, ibuprofen, naproxen or aspirin.
• Antibiotics. These may be prescribed if your back pain is caused by an infection.
• Stronger Back Pain Medications. These can include pills to relax muscles and decrease inflammation and pain. An epidural is an injection in the back used to relieve some types of severe back pain. These usually involve anesthetics and steroids.

Surgery Options

If your back pain persists and these methods aren't working, you may be referred to an orthopedist or neurosurgeon. He or she may recommend surgery, but usually after all other treatments have failed to stop the pain.

• Laminotomy. During this procedure, the doctor will remove a small portion of the vertebrae bone. This relieves pressure on the nerve from a bulging or herniated disk. In some cases a portion of the disk may be removed.
• Laminectomy. During this surgery a large portion of the vertebrae is removed. Typically the part removed has grown bone spurs, which irritate the nerve and cause pain.
• Fusion Surgery. This type of surgery permanently joins two or more vertebrae to limit painful movements.
• IDET, or Intradiscal Electrothermal Therapy. This treatment uses a hot needle to seal off any bulging or fluid leaks in the disks between vertebrae.

Remember that most back pain will go away after a few days of treatment, but always listen to your body and speak to your doctor if you have questions.

HealthiNation offers health information for educational purposes only; this information is not meant as medical advice. Always consult your doctor about your specific health condition.