Back pain is one of the most common reasons people seek medical help or miss work and is among the leading cause of disability worldwide.
Back pain can range from a muscle ache to a shooting, burning or stabbing sensation.
The pain can radiate down a leg and bending, twisting, lifting, standing or walking can make it worse!!!
When to consult a Neurologist?
Consult a Neurologist for back pain that:
- Lasts longer than a few weeks.
- Spreads down one or both legs, especially if the pain goes below the knee.
- Causes weakness, numbness, or tingling in one or both legs.
- Is severe and doesn’t improve with rest.
- Causes bowel or bladder problems.
- Is paired with unexplained weight loss.
- Is accompanied by a fever.
- Follows a fall, blow to the back or other injury
What are the common causes of back pain?
- Bulging or ruptured disks. Disks act as cushions between the bones in the spine and a disk can bulge or rupture and press on a nerve. Disk disease is diagnosed with spine X-rays, CT scans or MRIs.
- Muscle or ligament strain. Repeated heavy lifting or a sudden turning/bending can strain back muscles and spinal ligaments.
- Osteoporosis. The spine’s vertebrae can develop painful breaks if the bones become porous and brittle.
- Arthritis. Osteoarthritis can affect the lower back which can lead to a narrowing of the space around the spinal cord.
- Ankylosing spondylitis (axial spondyloarthritis). This inflammatory disease can cause bones in the spine to fuse, which makes the spine less flexible and more painful.
- Cauda equina syndrome: The cauda equina is a bundle of spinal nerve roots that arise from the lower end of the spinal cord and its compression causes a dull pain in the lower back and upper buttocks, numbness in the buttocks, genitalia, and thighs. Bowel and bladder function disturbances can occur.
- Cancer of the spine: A tumour on the spine may press against a nerve, resulting in back pain.
- Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
- Other infections: Pelvic inflammatory disease and kidney or bladder infection may also lead to back pain.
- Sleep disorders: Individuals with sleep disorders are more likely to experience back pain than others.
Risk factors
Anyone can develop back pain, even children and teens. These factors can increase the risk of developing back pain:
- Age. more common with advancing age, starting around age 30 or 40.
- Lack of exercise. Weak, unused muscles in the back and abdomen might lead to back pain.
- Excess weight. Excess body weight puts extra stress on the back.
- Diseases. Some types of arthritis and cancer can contribute to back pain.
- Improper lifting. Using the back instead of the legs can lead to back pain.
- Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
- Smoking. Smokers have increased rates of back pain. Smoking causes coughing, which can lead to herniated disks. Smoking also can decrease blood flow to the spine and increase the risk of osteoporosis.
What are the treatment options available?
Medical treatment
A doctor may recommend the following medication, physical therapy, or both:
Medication
Over-the-counter (OTC) pain relief medication — usually, nonsteroidal anti-inflammatory drugs (NSAIDs)— can relieve discomfort.
Applying a hot compress or an ice pack to the painful area may also reduce pain.
Back pain that does not respond well to OTC pain relief medication may require a prescription NSAID.
Physical therapy
Applying 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 improves, a physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help.
It is advisable to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence.
Cortisone injections
If other options are not effective, these may be injected into the epidural space, around the spinal cord.
Cortisone is an anti-inflammatory drug that helps reduce inflammation around the nerve roots.
Surgery
Surgery for back pain is the last resort. If an individual 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:
- Diskectomy: a portion of a disk is removed if it is irritating or pressing against a nerve.
- Fusion: two vertebrae are joined and a bone graft is inserted between them. The vertebrae are splinted together with metal plates, screws, or cages. There is a significantly greater risk of arthritis to subsequently develop in the adjoining vertebrae.
- Partially removing a vertebra: a small section of a vertebra is removed if it is pinching the spinal cord or nerves.
- Artificial disk: an artificial disk that replaces the cushion between two vertebrae is inserted.