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Back pain is a very common complaint.

According to the Mayo Clinic, approximately 80% of all


Americans will have low back pain at least once in their lives.
Back pain is a common reason for absence from work and doctor visits. Although back pain may be
painful and uncomfortable, it is not usually serious.
Even though back pain can affect people of any age, it is significantly more common among adults
aged between 35 and 55 years. Experts say that back pain is associated with the way our bones,
muscles and ligaments in our backs work together.
Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments
around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal
organs, and the skin around the lumbar area. Pain in the upper back may be due to disorders of the
aorta, tumors in the chest, and spine inflammation.
Contents of this article:

Risk factors for back pain

Signs and symptoms of back pain

Causes of back pain

Diagnosing back pain

Treatments for back pain

Preventing back pain

You will also see introductions at the end of some sections to any recent developments that have been
covered by MNT's news stories. Also, look out for links to information about related conditions.

Risk factors for back pain


A risk factor is something which increases the likelihood of developing a condition or disease. For
example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk
factor for diabetes type 2.
The following factors are linked to a higher risk of developing low back pain:

A mentally stressful job

Pregnancy - pregnant women are much more likely to get back pain

A sedentary lifestyle

Age - older adults are more susceptible than young adults or children

Anxiety

Depression

Gender - back pain is more common among females than males

Obesity/overweight

Smoking

Strenuous physical exercise (especially if not done properly)

Strenuous physical work.

Signs and symptoms of back pain

A symptom is something the patient feels and reports, while a sign is something other people, such as
the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and
sometimes all the way down to the buttocks and legs. In most cases signs and symptoms clear up on
their own within a short period.
If any of the following signs or symptoms accompanies a back pain your should see your doctor:

Weight loss

Elevated body temperature (fever)

Inflammation (swelling) on the back

Persistent back pain - lying down or resting does not help

Pain down the legs

Pain reaches below the knees

A recent injury, blow or trauma to your back

Urinary incontinence - you pee unintentionally (even small amounts)

Difficulty urinating - passing urine is hard

Fecal incontinence - you lose your bowel control (you poo unintentionally)

Numbness around the genitals

Numbness around the anus

Numbness around the buttocks.

According to the National Health Service (NHS), UK, the following groups of people should seek
medical advice if they experience back pain:

People aged less than 20 and more than 55 years

Patients who have been taking steroids for a few months

Drug abusers

Patients with cancer

Patients who have had cancer

Patients with low immune systems.

Causes of back pain


The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones
- the segments of our spine are cushioned with cartilage-like pads. Problems with any of these
components can lead to back pain. In some cases of back pain, its cause is never found.
Strain - the most common causes of back pain are:

Lifting something in an improper manner is a common cause of back pain.

Strained muscles

Strained ligaments

Lifting something improperly

Lifting something that is too heavy

The result of an abrupt and awkward movement

A muscle spasm.

Structural problems - the following structural problems may also result in back pain:

Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk ruptures there
will be more pressure on a nerve, resulting in back pain.

Bulging disks - in much the same way as ruptured disks, a bulging disk can result in more
pressure on a nerve.

Sciatica - a sharp and shooting pain that travels through the buttock and down the back of the
leg, caused by a bulging or herniated disk pressing on a nerve.

Arthritis - patients with osteoarthritis commonly experience problems with the joints in the hips,
lower back, knees and hands. In some cases spinal stenosis can develop - the space around the
spinal cord narrows.

Abnormal curvature of the spine - if the spine curves in an unusual way the patient is more
likely to experience back pain. An example is scoliosis, when the spine curves to the side.

Osteoporosis - bones, including the vertebrae of the spine, become brittle and porous, making
compression fractures more likely.

Below are some other causes of back pain:

Cauda equina syndrome - the cauda equine is a bundle of spinal nerve roots that arise from
the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower
back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia and thigh.
There are sometimes bowel and bladder function disturbances.

Cancer of the spine - a tumor located on the spine may press against a nerve, resulting in
back pain.

Infection of the spine - if the patient has an elevated body temperature (fever) as well as a
tender warm area on the back, it could be caused by an infection of the spine.

Other infections - pelvic inflammatory disease (females), bladder or kidney infections.

Sleep disorders - individuals with sleep disorders are more likely to experience back pain,
compared to others.

Shingles - an infection that can affect the nerves.

Bad mattress - if a mattress does not support specific parts of the body and keep the spine
straight, there is a greater risk of developing back pain.

Everyday activities or poor posture.


Back pain can also be the result of some everyday activity or poor posture. Examples include:

We live in a world of computers. Adopting a very hunched sitting position when using computers can result in
increased back and shoulder problems over time.

Bending awkwardly

Pushing something

Pulling something

Carrying something

Lifting something

Standing for long periods

Bending down for long periods

Twisting

Coughing

Sneezing

Muscle tension

Over-stretching

Sitting in a hunched position for long periods (e.g. when driving)

Long driving sessions without a break (even when not hunched).

Diagnosing back pain


Most GPs (general practitioners, primary care physicians) will be able to diagnose back pain after
carrying out a physical examination, and interviewing the patient. In the majority of cases imaging
scans are not required.
If the doctor and/or patient suspect some injury to the back, tests may be ordered. Also, if the doctor
suspects the back pain might be due to an underlying cause, or if the pain persists for too long, further
tests may be recommended.
Suspected disc, nerve, tendon, and other problems - X-rays or some other imaging scan, such as
a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a
better view of the state of the soft tissues in the patient's back.

X-rays can show the alignment of the bones and whether the patient has arthritis or broken
bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.

MRI or CT scans - these are good for revealing herniated disks or problems with tissue,
tendons, nerves, ligaments, blood vessels, muscles and bones.

Bone scan - a bone scan may be used for detecting bone tumors or compression fractures
caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive
substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems
with the aid of a special camera.

Electromyography or EMG - the electrical impulses produced by nerves in response to


muscles is measured. This study can confirm nerve compression which may occur with a herniated
disk or spinal stenosis (narrowing of the spinal canal).

The doctor may also order a blood test if infection is suspected.


Chiropractic, Osteopathy and Physical Therapy (UK: Physiotherapy)

A chiropractor manipulates and adjusts the back of a patient.

A chiropractor - the chiropractor will diagnose by touching (palpation) and a visual inspection.
Chiropractic is known as a direct approach, with a strong focus on the adjustments of the spinal
joints. Most good chiropractors will also want to see imaging scan results, as well as blood and urine
tests.

An osteopath - the osteopathic approach also diagnoses by touching and a visual inspection.
Osteopathy involves slow and rhythmic stretching (mobilization), pressure or indirect techniques and
manipulations on joints and muscles.

A physical therapist (UK: physiotherapist) - a physical therapist's training focuses on


diagnosing problems in the joints and soft tissues of the body.

Treatments for back pain


In the vast majority of cases back pain resolves itself without medical help - just with careful attention
and home treatment. Pain can usually be addressed with OTC (over-the-counter, no prescription
required) painkillers. Resting is helpful, but should not usually last more than a couple of days - too
much rest may actually be counterproductive.
Usually back pain is categorized into two types:

Acute - back pain comes on suddenly and persists for a maximum of three months.

Chronic - the pain gradually develops over a longer period, lasts for over three months, and
causes long-term problems.

A considerable percentage of patients with back pain experience both occasional bouts of more
intense pain as well as more-or-less continuous mild back pain, making it harder for the doctor to
determine whether they have acute or chronic back pain.
Injecting cells to regenerate spine discs - scientists from Duke University, North Carolina, developed
new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effective
eliminating pain caused by degenerative disc disease.
If home treatments do not give the desired results, a doctor may recommend the following:
Medication - back pain that does not respond well to OTC painkillers may require a prescription
NSAID (nonsteroidal anti-inflammatory drug). Codeine or hydrocodone - narcotics - may also be
prescribed for short periods; they require close monitoring by the doctor.
Some tricyclic antidepressants, such as amitriptyline, have been shown to alleviate the symptoms of
back pain, regardless of whether or not the patient has depression.
Physical Therapy (UK: physiotherapy) - the application of heat, ice, ultrasound and electrical
stimulation, as well as some muscle-release techniques to the back muscles and soft tissues may help
alleviate pain. As the pain subsides the physical therapist may introduce some flexibility and strength
exercises for the back and abdominal muscles. Techniques on improving posture may also help. The
patient will be encouraged to practice the techniques regularly, even after the pain has gone, to
prevent back pain recurrence.
Cortisone injections - if the above-mentioned therapies are not effective enough, or if the pain
reaches down to the patient's legs, cortisone may be injected into the epidural space (space around
the spinal cord). Cortisone is an anti-inflammatory drug; it helps reduce inflammation around the nerve
roots. According to The Mayo Clinic, the pain-relief effect will wear off after less than six weeks.
Injections may also be used to numb areas thought to be causing the pain. Botox (botulism toxin),
according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm.
These injections are effective for about three to four months.
Surgery - surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option,
especially if there is persistent pain and nerve compression which can lead to muscle weakness.
Examples of surgical procedures include:

Fusion - two vertebrae are joined together, with a gone graft inserted between them. The
vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater
risk for arthritis to subsequently develop in the adjoining vertebrae.

Artificial disk - an artificial disk is inserted; it replaces the cushion between two vertebrae.

Discectomy (partially removing a disk) - a portion of a disk may be removed if it is irritating or


pressing against a nerve.

Partially removing a vertebra - a small section of a vertebra may be removed if it is pinching


the spinal cord or nerves.

CBT (Cognitive Behavioral Therapy) - according to some studies, CBT can help patients manage
chronic back pain. The therapy is based on the principle that the way a person feels is, in part,
dependent on the way they think about things. People who can be taught to train themselves to react
in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as
well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to
become more active and do exercise, resulting in a lower risk of back pain recurrence.
Complementary therapies
A large number of patients opt for complementary therapies, as well as conventional treatments; some
opt just for complementary therapies.
According to the National Health Service (NHS), UK, chiropractic, osteopathy, shiatsu and acupuncture
may help relieve back pain, as well as encouraging the patient to feel relaxed.

An osteopath specializes in treating the skeleton and muscles.

A chiropractor treats joint, muscle and bone problems - the main focus being the spine.

Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is
applied along energy lines in the body. The shiatsu therapist applies pressure with his/her fingers,
thumbs and elbows.

Acupuncture, which originates from China, consists of inserting fine needles and specific
points in the body. Acupuncture can help the body release its natural painkillers - endorphins - as
well as stimulating nerve and muscle tissue.

Studies on complementary therapies are have given mixed results. Some people have experienced
significant benefit, while others have not. It is important, when considering alternative therapies, to use
a well qualified and registered therapist.
TENS (transcutaneous electrical nerve stimulation) - a popular therapy for patients with chronic
(long-term) back pain. The TENS machine delivers small electric pulses into the body through
electrodes that are place on the skin. Experts believe TENS encourages the body to produce
endorphins, and may possibly block pain signals returning to the brain. Studies on TENS have
provided mixed results; some revealed no benefits, while others indicated that it could be helpful for
some patients.

A TENS machine should be used under the direction of a doctor or health care professional.
Pregnant women, people with epilepsy, people with a pacemaker, and patients with a history of heart
disease should not use a TENS machine.

Recent developments on treating back pain from MNT news


Acupuncture back pain success determined by psychological factors
According to new research, people being treated for lower back pain with acupuncture are likely to
gain less benefit from the treatment if they have low expectations of how effective it is.
The study, published in The Journal of Clinical Pain, also suggests that patients who are positive about
their back pain and feel in control of their symptoms go on to experience less back-related disability
while receiving acupuncture.
High-frequency spinal cord stimulation 'more effective for chronic pain'
According to a study published in the journal Anesthesiology, a new high-frequency form of spinal cord
stimulation therapy has the capacity to deliver more effective pain relief without any unwanted side
effects.
Motor control exercise may help lower back pain
Targeting exercises to muscles that support and control the spine may help to reduce pain and
disability caused by lower back pain, says research published in the Cochrane Review.

Preventing back pain


Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.
Exercise - regular exercise helps build strength as well as keeping your body weight down. Experts
say that low-impact aerobic activities are best; activities that do not strain or jerk the back. Before
starting any exercise program, talk to a health care professional.

Core-strengthening exercises; exercises that work the abdominal and back muscles, help
strengthen muscles which protect your back.

Flexibility - exercises aimed at improving flexibility in your hips and upper legs may help too.

Smoking - a significantly higher percentage of smokers have back pain incidences compared to nonsmokers of the same age, height and weight.
Body weight - the fatter you are the greater your risk of developing back pain. The difference in back
pain risk between obese and normal-weight individuals is considerable.

Posture when standing - make sure you have a neutral pelvic position. Stand upright, head facing
forward, back straight, and balance your weight evenly on both feet - keep your legs straight. Posture
when sitting - a good seat should have good back support, arm rests and a swivel base (for working).
When sitting try to keep your knees and hips level and keep your feet flat on the floor - if you can't, use
a footstool. You should ideally be able to sit upright with support in the small of your back. If you are
using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.
Lifting things - the secret for protecting your back when lifting things is to think "legs not back". In
other words, use your legs to do the lifting, more than your back. Keep your back as straight as you
can, keep your feet apart with one leg slightly forward so you can maintain balance, bend only at the
knees, hold the weight close to your body, and straighten the legs while changing the position of your
back as little as possible. Bending your back initially is unavoidable, when you bend your back try not
to stoop or squat, tighten your stomach muscles so that your pelvis is pulled in. Most important, do not
straighten your legs before lifting; otherwise you will be using your back for most of the work.
Do not lift and twist at the same time. If something is particularly heavy, see if you can lift it with
someone else. While you are lifting keep looking straight ahead, not up nor down, so that the back of
your neck is like a continuous straight line from your spine.
Moving things - remember that it is better for your back to push things across the floor, rather than
pulling them.
Shoes - flat shoes place less of a strain on the back.
Driving - it is important to have proper support for your back. Make sure the wing mirrors are properly
positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are
on a long journey, have plenty of breaks - get out of the car and walk around.
Your bed - you should have a mattress that keeps you spine straight, while at the same time
supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck
into a steep angle.