Back pain (also known "dorsalgia") is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine.
The pain may have a sudden onset or it can be a chronic pain, it can be felt constantly or intermittently, 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 symptoms other than pain, such as weakness, numbness or tingling.
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.[A.T. Patel, A.A. Ogle. "Diagnosis and Management of Acute Low Back Pain". American Academy of Family Physicians. Retrieved March 12, 2007.]
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.
Associated conditions
Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:
- 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 occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition.
- 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 spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention.
In general, however, back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are 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.
A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and degenerative disc disease may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.[Borenstein DG, O\'Mara JW, Boden SD, et al (2001). "The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study". The Journal of bone and joint surgery. American volume 83-A (9): 1306-11. PMID 11568190. ][Savage RA, Whitehouse GH, Roberts N (1997). "The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males". European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 6 (2): 106-14. PMID 9209878. ][Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994). "Magnetic resonance imaging of the lumbar spine in people without back pain". N. Engl. J. Med. 331 (2): 69-73. PMID 8208267. ][Kleinstück F, Dvorak J, Mannion AF (2006). "Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain?". Spine 31 (19): 2250-7. doi:10.1097/01.brs.0000232802.95773.89. PMID 16946663. ] Other studies suggest that for as many as 85% of cases, no physiological cause can be shown.[White AA, Gordon SL (1982). "Synopsis: workshop on idiopathic low-back pain". Spine 7 (2): 141-9. PMID 6211779. ][van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK (2004). "Evidence against the use of lumbar spine radiography for low back pain". Clinical radiology 59 (1): 69-76. PMID 14697378. ]
A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.[Burton AK, Tillotson KM, Main CJ, Hollis S (1995). "Psychosocial predictors of outcome in acute and subchronic low back trouble". Spine 20 (6): 722-8. PMID 7604349. ][Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005). "Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain". The spine journal : official journal of the North American Spine Society 5 (1): 24-35. doi:10.1016/j.spinee.2004.05.250. PMID 15653082. ][Hurwitz EL, Morgenstern H, Yu F (2003). "Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study". Journal of clinical epidemiology 56 (5): 463-71. PMID 12812821. ][Dionne CE (2005). "Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings". Journal of clinical epidemiology 58 (7): 714-8. doi:10.1016/j.jclinepi.2004.12.005. PMID 15939223. ]
Underlying causes
Transient back pain is likely one of the first symptoms of influenza.
Muscle strains (pulled muscles) are commonly identified as the cause of back pain, as are muscle imbalances. Pain from such an injury often remains as long as the muscle imbalances persist. The muscle imbalances cause a mechanical problem with the skeleton, building up pressure at points along the spine, which causes the pain.
Another cause of acute low back pain is a Meniscoid Occlusion.
The more mobile regions of the spine, such as the facet joints, have invaginations of their synovial membranes that act as a cushion to help the bones move over each other smoothly. The synovial membrane is well supplied with blood and nerves. When these become pinched or trapped sudden severe pain may result. The pinching causes the membrane to become inflamed, causing greater pressure and ongoing pain. Symptoms include severe low back pain that may be accompanied by muscle spasm, pain with walking, concentration of pain to one side, but no radiculopathy (radiating pain down buttock and leg). Relief should be felt with flexion (bending forward),and exacerbated with extension (bending backward).
When back pain lasts more than three months, or if there is more radicular pain (sciatica) than back pain, a more specific diagnosis can usually be made. There are several common causes of back pain: for adults under age 50, these include spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis; in adults over age 50, common causes also include osteoarthritis (degenerative joint disease) and spinal stenosis,trauma, cancer, infection, fractures, and inflammatory disease[1]. Non-anatomical factors can also contribute to or cause back pain, such as stress,[At the Root of Back Pain. WholeHealthMD.] repressed anger,[McGrath, Mike (2004-11-03). When Back Pain Starts in Your Head: Is repressed anger is causing your back pain?. Prevention.com. Rodale Inc.. Retrieved on 2007-09-12.] or depression. Even if there is an anatomical cause for the pain, if depression is present it should also be treated concurrently.
New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI and CT scans. One of the newer investigations looks into the role of the dorsal ramus in patient\'s pain that have normal radiographic evidence. See Posterior Rami Syndrome.
Treatment
The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual\'s ability to function in everyday activities; 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. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.
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. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery.
Conservative treatment
- Heat therapy is useful for back spasms or other conditions. A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.
[French S, Cameron M, Walker B, Reggars J, Esterman A (2006). "A Cochrane review of superficial heat or cold for low back pain.". Spine 31 (9): 998-1006. PMID 16641776. ] Some patients find that moist heat works best (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours). Cold therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases
- Use of medications, such as muscle relaxants,
[van Tulder M, Touray T, Furlan A, Solway S, Bouter L. "Muscle relaxants for non-specific low back pain.". Cochrane Database Syst Rev: CD004252. PMID 12804507. ] narcotics, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs)[van Tulder M, Scholten R, Koes B, Deyo R. "Non-steroidal anti-inflammatory drugs for low back pain.". Cochrane Database Syst Rev: CD000396. PMID 10796356. ] or paracetamol (acetaminophen). A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that injection therapy, usually with corticosteroids, does not appear to help regardless of whether the injection is facet joint, epidural or a local injection.[Nelemans P, de Bie R, de Vet H, Sturmans F. "Injection therapy for subacute and chronic benign low back pain". Cochrane Database Syst Rev: CD001824. PMID 10796449. ] Accordingly, a study of intramuscular corticosteroids found no benefit.[Friedman B, Holden L, Esses D, Bijur P, Choi H, Solorzano C, Paternoster J, Gallagher E (2006). "Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain". J Emerg Med 31 (4): 365-70. PMID 17046475. ] Herbal analgesics may also be effective.[citation needed]
- Exercises can be an effective approach, particularly when done under supervision of a professional such as a physical therapist. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is also effective for chronic back pain, but not for acute pain.
[Hayden J, van Tulder M, Malmivaara A, Koes B. "Exercise therapy for treatment of non-specific low back pain.". Cochrane Database Syst Rev: CD000335. PMID 16034851. ] Another study found that back-mobilizing exercises in acute settings are less effective than continuation of ordinary activities as tolerated.[Malmivaara A, Häkkinen U, Aro T, Heinrichs M, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V (1995). "The treatment of acute low back pain--bed rest, exercises, or ordinary activity?". N Engl J Med 332 (6): 351-5. PMID 7823996. ]
- 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. Physical therapy may be especially effective when part of a \'work hardening\' program, or \'back school\'.
[Heymans M, van Tulder M, Esmail R, Bombardier C, Koes B. "Back schools for non-specific low-back pain.". Cochrane Database Syst Rev: CD000261. PMID 15494995. ]
- Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.
[Furlan A, Brosseau L, Imamura M, Irvin E. "Massage for low back pain.". Cochrane Database Syst Rev: CD001929. PMID 12076429. ]
- Body Awareness Therapy such as the Feldenkrais Method has been studied in relation to Fibromyalgia and chronic pain and studies have indicated positive effects.
[Gard G (2005). "Body awareness therapy for patients with fibromyalgia and chronic pain.". Cochrane Database Syst Rev. PMID 16012065. ]. Organized exercise programs using these therapies have been developed.
- Manipulation, as provided by an appropriately trained and qualified chiropractor, osteopath, physical therapist, or a physiatrist. Studies of the effect of manipulation suggest that this approach has a small benefit similar to other therapies and superior to placebo.
[Assendelft W, Morton S, Yu E, Suttorp M, Shekelle P. "Spinal manipulative therapy for low back pain.". Cochrane Database Syst Rev: CD000447. PMID 14973958. ][Cherkin D, Sherman K, Deyo R, Shekelle P (2003). "A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.". Ann Intern Med 138 (11): 898-906. PMID 12779300. ]
- Acupuncture has a small benefit for chronic back pain. The Cochrane Collaboration concluded that "for chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and alternative treatments."
[Furlan A, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. "Acupuncture and dry-needling for low back pain.". Cochrane Database Syst Rev: CD001351. PMID 15674876. ]. More recently, a randomized controlled trial found a small benefit after 1 to 2 years.[Thomas K, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M, Roman M, Walters S, Nicholl J (2006). "Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain.". BMJ 333 (7569): 623. PMID 16980316. ]
- Education, and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.
[Ostelo R, van Tulder M, Vlaeyen J, Linton S, Morley S, Assendelft W. "Behavioural treatment for chronic low-back pain.". Cochrane Database Syst Rev: CD002014. PMID 15674889. ]
- 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 mattress or office chair, etc. Although this recommendation has not been tested, this intervention is a part of many \'back schools\' which do help.
[15494995]
Surgery
Surgery may sometimes be appropriate for patients with:
Emerging Treatments
- Vertebroplasty involves the percutaneous injection of surgical cement into vertebral bodies that have collapsed due to compression fractures. This new procedure is far less invasive than surgery, but may be complicated by the entry of cement into Batson\'s plexus with subsequent spread to the lungs or into the spinal canal. Ideally this procedure can result in rapid pain relief.
- The use of specific biologic inhibitors of the inflammatory cytokine tumor necrosis factor-alpha may result in rapid relief of disc-related back pain.
[Uceyler N, Sommer C. Cytokine-induced Pain: Basic Science and Clinical Implications. Reviews in Analgesia 2007;9(2):87-103.]
Treatments with uncertain or doubtful benefit
- Injections, such as epidural steroid injections and facet joint injections, may be effective when the cause of the pain is accurately localized to particular sites. The benefit of prolotherapy has not been well-documented.
[Nelemans P, de Bie R, de Vet H, Sturmans F. "Injection therapy for subacute and chronic benign low back pain.". Cochrane Database Syst Rev: CD001824. PMID 10796449. ][Yelland M, Mar C, Pirozzo S, Schoene M, Vercoe P. "Prolotherapy injections for chronic low-back pain.". Cochrane Database Syst Rev: CD004059. PMID 15106234. ]
- Cold compression therapy is advocated for a strained back or chronic back pain and is postulated to reduce pain and inflammation, especially after strenuous exercise such as golf, gardening, or lifting. However, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded "The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain"
[French S, Cameron M, Walker B, Reggars J, Esterman A (2006). "A Cochrane review of superficial heat or cold for low back pain.". Spine 31 (9): 998-1006. PMID 16641776. ]
- Bed rest is rarely recommended as it can exacerbate symptoms,
[Hagen K, Hilde G, Jamtvedt G, Winnem M. "Bed rest for acute low-back pain and sciatica.". Cochrane Database Syst Rev: CD001254. PMID 15495012. ] and when necessary is usually limited to one or two days. Prolonged bed rest or inactivity is actually counterproductive, as the resulting stiffness leads to more pain.
- Electrotherapy, such as a Transcutaneous Electrical Nerve Stimulator (TENS) has been proposed. Two randomized controlled trials found conflicting results.
[Cheing GL, Hui-Chan CW (1999). "Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain". Archives of physical medicine and rehabilitation 80 (3): 305-12. PMID 10084439. ][Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S (1990). "A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain". N. Engl. J. Med. 322 (23): 1627-34. PMID 2140432. ] This has led the Cochrane Collaboration to conclude that there is inconsistent evidence to support use of TENS.[Khadilkar A, Milne S, Brosseau L, et al (2005). "Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain". Cochrane database of systematic reviews (Online) (3): CD003008. doi:10.1002/14651858.CD003008.pub2. PMID 16034883. ] In addition, spinal cord stimulation, where an electrical device is used to interrupt the pain signals being sent to the brain and has been studied for various underlying causes of back pain.
- Inversion therapy is useful for temporary back relief due to the traction method or spreading of the back vertebres through (in this case) gravity. The patient hangs in an upside down position for a period of time from ankles or knees until this separation occurs. The effect can be achieved without a complete vertical hang ( 90 degree) and noticeable benefits can be observed at angles as low as 10 to 45 degrees.[citation needed]
See also
References
External links
v • d • e Diseases of the musculoskeletal system and connective tissue (M, 710-739) |
|---|
| Arthropathies | Arthritis (Septic arthritis, Reactive arthritis, Rheumatoid arthritis, Psoriatic arthritis, Felty\'s syndrome, Juvenile idiopathic arthritis, Still\'s disease) - crystal (Gout, Chondrocalcinosis) - Osteoarthritis (Heberden\'s node, Bouchard\'s nodes)
acquired deformities of fingers and toes (Boutonniere deformity, Bunion, Hallux rigidus, Hallux varus, Hammer toe) - other acquired deformities of limbs (Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula)
patella (Luxating patella, Chondromalacia patellae)
Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte |
|---|
Systemic connective
tissue disorders | Polyarteritis nodosa - Churg-Strauss syndrome - Kawasaki disease - Hypersensitivity vasculitis - Goodpasture\'s syndrome - Wegener\'s granulomatosis - Arteritis (Takayasu\'s arteritis, Temporal arteritis) - Microscopic polyangiitis - Systemic lupus erythematosus (Drug-induced) - Dermatomyositis (Juvenile dermatomyositis) - Polymyositis - Scleroderma - Sjögren\'s syndrome - Behçet\'s disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility |
|---|
| Dorsopathies | Kyphosis - Lordosis - Scoliosis - Scheuermann\'s disease - Spondylolysis - Torticollis - Spondylolisthesis - Spondylopathies (Ankylosing spondylitis, Spondylosis, Spinal stenosis) - Schmorl\'s nodes - Degenerative disc disease - Coccydynia - Back pain (Radiculopathy, Neck pain, Sciatica, Low back pain) |
|---|
| Soft tissue disorders | muscle: Myositis - Myositis ossificans (Fibrodysplasia ossificans progressiva)
synovium and tendon: Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain\'s syndrome) - Irritable hip - Ganglion cyst
bursa: bursitis (Olecranon, Prepatellar, Trochanteric) - Baker\'s cyst
fibroblastic disorders (Dupuytren\'s contracture, Plantar fasciitis, Nodular fasciitis, Necrotizing fasciitis, Fasciitis, Fibromatosis)
shoulder lesions: Adhesive capsulitis - Rotator cuff tear - Subacromial bursitis
enthesis: enthesopathies (Iliotibial band syndrome, Achilles tendinitis, Patellar tendinitis, Golfer\'s elbow, Tennis elbow, Metatarsalgia, Bone spur, Tendinitis)
other, NEC: Muscle weakness - Rheumatism - Myalgia - Neuralgia - Neuritis - Panniculitis - Fibromyalgia |
|---|
| Osteopathies | disorders of bone density and structure: Osteoporosis - Osteomalacia - continuity of bone (Pseudarthrosis, Stress fracture) - Monostotic fibrous dysplasia - Skeletal fluorosis - Aneurysmal bone cyst - Hyperostosis - Osteosclerosis
Osteomyelitis - Avascular necrosis - Paget\'s disease of bone - Algoneurodystrophy - Osteolysis - Infantile cortical hyperostosis |
|---|
| Chondropathies | Juvenile osteochondrosis (Legg-Calvé-Perthes syndrome, Osgood-Schlatter disease, Köhler disease, Sever\'s disease) - Osteochondritis - Tietze\'s syndrome |
|---|
| See also congenital conditions (Q65-Q79, 754-756) |
This article is licensed under the GNU Free Documentation License. It uses material from Wikipedia
HOME WEB NEWS IMAGES CLASSIFIEDS YELLOW PAGESPOLLS - SURVEYS WIKI COUNTRIES PHOTOS US UK INDIA
Cities Stocks Weather Movies Coupons Travel Blogs Health Horoscope Maps ASIA EUROPE Classifieds Yellow Pages
1
