Understanding Back Pain

Back pain is the most common complaint in more than 70% of adult Americans at some point in their lives. Some individuals only experience a single episode of back pain, but quite a number of individuals have back pain for a significant part of their life. Infact back pain is one of the most common reasons why individuals go to see their health care provider. In North America, back pain still remains one of the most common causes of missed work.

In the majority of cases, back pain is a preventable disorder. In any case, the treatment of back pain is simple and can be done at home. Self supportive measures can help heal the back in a few weeks and keep the individual functioning. Surgery for back pain is never the first choice of treatment.

The causes of back pain are many. The back is a complex structure composed of integrated set of tendons, ligaments bones, discs and nerves running in the midline. In between each set of vertebrae are cartilage pads which play a vital role in support and cushioning the back against compression injuries. Back pain can occur from any number of reasons and may be due to any one of the above mentioned structures.

Back pain in most cases is due to strained muscles and ligaments and not from the bones.

The most common cause of sudden onset back pain in young individuals is lifting heavy equipment or using an improper technique of lifting. Others develop back pain from sudden change of position or muscle spasms. However, in the majority of individuals no cause of back pain is ever found.

Disks in between the vertebral column play a role as shock absorbers. Often the material in between the discs ruptures or becomes very soft and the bones may compress the nerve. When the disc bulges out, it commonly compresses the nerve. However, one should also know that a great many people have bulging disks but have no pain symptoms at all.

Arthritis is a common cause of back pain. Arthritis can affect both young and old. The major problem in osteoarthritis is that the bone growth is uneven and leads to formation of bone spurs and narrowing of the spinal canal. This eventually leads to compression of the nerves.

In some individuals deformity of the vertebral column may also cause back pain. Deformity of the back such as scoliosis and lordoisis may be seen at childbirth and the condition generally progresses with age. Most of these individuals present with varying degrees of back pain in the 2^nd or 3^rd decade of life.

Another common cause of back pain in elderly females after the 5^th decade of life is osteoporosis. In this condition, the bone becomes soft and is prone to fractures. The pain is not from the nerves but from the brittle bones.

One other cause of back pain is due to cancers of the spine. While primary cancers of the spinal canal are rare, many other tumors can spread to the vertebral column. A classic example of a common tumor which spread to the spinal column and causes back pain is prostate cancer.

A rare cause of back pain is infection. This can occur in patients with tuberculosis and is often seen in immigrants.

In most cases of back pain, the cause is unknown. In individual with first time onset of back pain, the investigations are minimal and the treatment is essential supportive.

References

Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. Apr 1991; 22(2):181-7

Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, et al. Evidence- based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. Jan 2003; 6(1):3-81. .

Wheeler Ah, Murrey DB. Spinal pain: pathogenesis, evolutionary mechanisms and management. In: Pappagallo M, ed. The Neurological Basis of Pain. 421-52. New York: McGraw-Hill; 2003.

Lippitt AB. The facet joint and its role in spine pain. Management with facet joint injections. Spine. Oct 1984; 9(7):746-50. .

Vroomen PC, de Krom MC, Slofstra PD, Knottnerus JA. Conservative treatment of sciatica: a systematic review. J Spinal Disord. Dec 2000; 13(6):463-9.

Pinzon EG. Treating lumbar back pain. Practical. Pain Manag. April/May: 2001; 14-20.