Article: Back pain

Back pain (also known as "dorsopathy") is pain felt in the human back that may come from the muscles, nerves, bones, joints or other structures in the spine. The pain may be constant or intermittent, stay in one place or refer or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be felt in the neck (and might radiate into the arm and hand), in the upper back, or in the low back (and might radiate into the leg or foot), and may include weakness or numbness.

Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for all physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year [1].

Much of this epidemic of back pain may be caused by tension myositis syndrome, a mindbody disorder discovered by John E. Sarno, MD of the Rusk Institute of Rehabilitation Medicine, for which he has developed an educational treatment program, with which he has cured more than ten thousand of his patients over the past three decades, as well as many more through his books [2].

The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities. Also, back pain is sometimes experienced when no underlying anatomical problem is apparent. Much of this can be attributed to tension myositis syndrome, a mindbody disorder.

While it is rare, back pain can be a sign of a serious medical problem:

• Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs. Patients with these symptoms should seek immediate medical care.

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

• Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a fracture or other injury.

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

In general, however, back pain is not usually a sign of a serious medical condition. The vast majority of episodes of back pain are benign, self limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months.

Underlying causes

Muscle strains (pulled muscles) are by far the most common cause of low back pain, and pain from such an injury will usually subside within two to six weeks.

When low back pain lasts more than three months, or if there is more leg pain than back pain, a more specific diagnosis can usually be made. There are several common causes of low back pain and leg pain: for adults under age 50, these include disc prolapse or herniation (slipped disc) and degenerative disc disease; in adults over age 50, common causes also include osteoarthritis (degenerative joint disease) and spinal stenosis. However, Dr. Sarno believes that 90% of such back pain is actually tension myositis syndrome and is caused by underlying emotional stress [3].

Treatment

The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore function; to help the patient cope with residual pain; to assess for side effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. People with severe back pain sometimes have reduced sitting- and walking ability and need to use a wheelbench for moving around.

Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. Only a minority (most estimates are 1% - 10%) require surgery.

Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. Bed rest is rarely recommended, and when necessary is usually limited to one or two days. In addition, most people will benefit from assessing any ergonomic or postural factors that may contribute to their back pain, such as improper lifting technique, poor posture, or poor support from their bed or office chair, etc.

Surgery

There are a number of different types of spine surgery to treat a variety of back conditions. Some of the more common forms are:

• Artificial disc replacement, a relatively new form of surgery in the U.S. but has been in use in Europe for decades, primarily used to treat low back pain from a degenerated disc.

• Discectomy/microdiscectomy, usually used to treat pain (especially pain that radiates down the arm or leg) from lumbar disc herniations.

• Kyphoplasty and Vertebroplasty, minimally invasive procedures designed to treat pain from osteoporotic compression fractures.

• Spinal cord stimulation, where an electrical device is used to interrupt the pain signals being sent to the brain.

• Spinal fusion, usually to treat chronic, severe pain from degenerative disc disease, spondylolisthesis, or deformity from scoliosis.

Non-surgical treatments

There is a wide variety of non-surgical treatments for back pain, including:

• Ice and heat application, such as application of an ice pack after certain activities or following an injury, or application of a heating pad to relax the muscles.

• Injections, such as epidural steroid injections or facet joint injections.

• Medications, such as muscle relaxants, narcotics, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs) or paracetamol (acetaminophen).

• Physical therapy and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine), often learned with the help of a health professional, such as a physical therapist.

• Manipulation, as provided by a physical therapist, osteopathic physician, or a chiropractic physician.

See also

• Ergonomics
• Low back pain
• Lumbago
• Tension myositis syndrome
• Chronic pain
• Lumbar disc herniation
• Sciatica
• Upper back pain