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Clinical Specialties
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Back Pain

DEFINITION

Most people in the United States will experience back pain in their lives. Back pain is the second most common reason that patients go to the doctor and a very common reason that people miss work. Back pain can originate from the many parts of the back: the muscles, bones, disks, ligaments, tendons, and even the organs that lie toward the back of the abdomen. The most common cause of back pain is strain of the muscles or ligaments involved in movement. Muscle strain is most commonly arises from improper use of the back with heavy lifting or unusual straining. Strain may present with both pain and muscle spasm. Another cause of back pain is the disks in the back which sit between the vertebrae (the bones that make up the spinal column). These disks are designed to cushion the movement of the spinal column. If these disks bulge in the wrong direction or rupture, they can press on a nerve which causes pain. Sometimes people with a bulging or slipped disks will have no symptoms at all. However, if the disk pushes on a nerve such as the sciatic nerve which runs down your leg, you could have a shooting electric pain down the leg or sciatica. Another source of back pain is spinal stenosis, which is caused by joint inflammation (arthritis) happening between the vertebrae in the spine. Other causes of back pain include abnormal curvatures of the spine (scoliosis, kyphosis or lordosis). Another cause of pain is compression fracture of the spine caused by weakening of the bone that occurs with age or osteoporosis. More serious conditions causing back pain are generally those that can cause impingement of the spinal cord like cauda equina syndrome, cancer in the spine, or infection in the spine. Risk factors that increase low back pain include being overweight or obese, being older, smoking, being a woman, doing physically demanding jobs, having a stressful or sedentary job, and having anxiety or depression. Back pain is extremely common, but some symptoms can indicate a more serious problem including pain that is constant or severe, pain that is worse when lying down, pain causing weakness in the legs, loss of bowel or bladder control with back pain, back pain with fever, back pain causing a throbbing sensation in the abdomen, pain spreading down both legs, an back pain associated with weight loss. It is as important to treat ongoing back pain as it is to prevent the causes of back pain which can lead to healthier, more active lives. Most of the time, exercises and medications along with proper lifting techniques can heal back pain. In some cases, surgery is necessary to cure back pain.

SYMPTOMS
Back pain, muscle ache, shooting pain, pain radiating down the leg, stabbing pain, decreased flexibility of the neck

DIAGNOSIS
Your doctor will begin by talking to you about the history of the back pain and doing a physical exam. Your doctor will likely check your back for tender spots and test your strength. Your doctor may want to look at how you walk and test your reflexes. Your doctor may also do other special tests that involve moving your legs to see if that movement causes pain. Most of the time, your doctor will not need to do any further testing. In some cases, however, your doctor may want to take pictures of your back with x-rays, CT scans or MRIs. Your doctor may also want to check some blood or urine tests for infection or other problems. If your doctor suspects a problem with the nerves in you back or the spinal cord, he or she may want to do specific nerve and muscle testing called electromyography or EMG.

TREATMENT
There are many options to treat back pain. Of course, the treatment for the back pain depends on the cause. Most of the time, muscle and bone-related back pain will go away with over-the-counter pain medication and careful use of your back. Resting for a day or two can do a little good, but resting for too long makes the muscles in the back heal more slowly. Over-the-counter medications are generally tried first for back pain including acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or naproxen (Aleve). For pain not relieved by these medications, your doctor may prescribe muscle relaxers or narcotics. In addition to pain medication, you doctor may recommend doing physical therapy or exercises to stretch your muscles and improve your pain and increase your healing. The exercises learned in physical therapy can be done regularly to help prevent future episodes of back pain. If your pain is not helped by the above techniques, a pain specialist can do local injections of medications like steroids that can reduce inflammation or numbing medications like lidocaine that can improve pain. For ongoing problems, injection treatments generally need to be repeated every few months in order to continue working. Some problems that cause back pain are fixed only with surgery. Usually, your doctor will recommend trying all of your other, more conservative options before considering surgery. Several surgical options for back pain exist. Fusion is a surgery where a surgeon joins two vertebrae together to stabilize the disks and relieve pain caused by the disk between them. Your surgeon may also recommend a partial removal of the disk or the vertebrae that may be pressing on the local nerves to help relieve the pain. Your doctor will discuss your treatment options and help you make a treatment decision.

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