There is finally Relief for Back Pain!

INTRODUCTION

Considering the fact that the majority or between 70 and 90 percent of the population will experience some sort of back pain at one time or another, knowledge about back pain relief is certainly welcome, appreciated and a popular topic. One of the best ways to begin learning about back pain relief is by understanding the basics of back pain: what causes it, how it’s diagnosed, what treatments are available, how to manage the pain, etc.

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And this article series will cover the bases for you. We have in the works 15 articles in this series, and plan on publishing about two a month. People that sign up for our newsletter, will receive free of charge the series in its entirety in one easy to read document, that they can download and read or print it out to take with them.

Note that the contents here are not presented from a medical practitioner, and that any and all health care planning should be made under the guidance of your own medical and health practitioners. The content within only presents an overview of back pain relief research for educational purposes and does not replace medical advice from a professional physician.

FACTS vs MYTHS ABOUT BACK PAIN

Let’s begin by learning some facts in order to separate truth from myth with regards to back pain. First of all, under one percent of acute lower back pain is the result of a serious infection or condition like cancer or a spinal injury. For those under 50, the rate is even lower.

Back pain is the number one disability for those under age 45. And it runs second, after the common cold, as the top reason for visiting a healthcare provider in the United States.

“There is nothing really wrong with you.” Myth!

Chronic pain sufferers report that doctors generally tell this to about 90 percent of them and it is incorrect. In reality, the majority of low back pain cases or some 90 percent generally come from an unknown cause, like an infection or a particular injury. And the duration of the pain runs generally from four to six weeks.

“People don’t die from chronic back pain.” Wrong!

The pain combined with depression and anxiety in long-term cases places sufferers at risk for suicide, which does happen from time to time.

“Most back pain requires surgery.” Myth!

On the contrary, under two percent of patients with back pain need surgery. However, back pain is the third top reason for surgery.

“Only a small percentage of workers suffer back pain on the job.” Wrong!

The top occupational hazard in the USA is back pain.

“Lie down and rest for back pain.” Wrong again.

Contrary to popular believe, bed rest can hinder recovery. Health care providers recommend remaining active to decrease down time for patients.

“Men suffer back pain more than women.” Not!

With regards to gender issues and back pain, it is a myth that men suffer back pain more than women. In reality, the only main difference is with secondary pain to disk disorders during middle age. However, with regards to race, low back pain is reported more frequently among Caucasians than other races including African Americans.

“If a patient’s pain description lacks a regular, consistent pattern, it’s probably imagined or exaggerated.” Myth!

No two people, no two cases are totally 100 percent identical. Activities, events, pain and people themselves vary from day to day and there is no 100 percent correct way to describe pain in words to fit a perfectly accurate diagnosis.

TYPES & TERMS OF BACK PAIN

To learn more about specific types of back pain, it helps to identify the “type” of pain present, similar to a doctor visit when asked, “Is it a stabbing pain or dull ache?” These are helpful healthcare term associated with back pain

ACUTE – Most back pain sufferers fall into this category. With acute low back pain, certain movement ranges for activities may be limited due to pain. But most people recover within about four weeks on their own.

CHRONIC – Also referred to as recurrent low back pain or when acute pain episodes recur for more than three months. This is most generally when medical treatment is sought. Note one can suffer acute and chronic pain at the same time. As secondary health problems be involved. In other words, chronic pain sufferers can be susceptible to acute pain.

ONSET - When the pain began. Acute onset means it occurred suddenly. Insidious onset means it gradually developed over a period- could be days or longer.

DURATION / FREQUENCY – Some common questions asked with regards to this area are how often does the worse pain occur and how long does it last.

RECURRENCE – When the back pain occurs from time to time with intervals of no pain in between.

PERSISTENCE – When the pain is always present.

LOCATION – A printed body diagram is usually used to that the patient can refer to the place or location where pain is felt.

MOVEMENT – Where the back’s pain movement is located. Most generally it is centrally located in the middle of the spine or an injury to either side of the spine. Pain that reaches beyond, for example to legs, is known as peripheral. Other terms associated with movement are twisting, lifting, bending, straightening, arching, vibrating, sneezing, coughing and posture.

ASSOCIATED SYMPTOMS – When discussing back pain, other symptoms that can come up include, but are not limited to, itching, burning, tingling, weakness or numbness, bladder control loss or change in habit, nausea.

INTENSITY LEVEL – A verbal measurement used to quantify pain on a scale rating from zero that signifies “no pain” to 10, referring to your “worst pain ever.” Other criteria to help with understanding this pain indicator are does the scale vary; i.e. does the pain intensify and if so with each occurrence? And within what range on the scale?

CAUSES OF BACK PAIN

Most references to back pain focus on lower back pain in the lumbar spinal region. However, back pain causes in no particular order are:

Accidents or injuries leaving muscle pain

Osteoarthritis with deteriorating cartilage

Osteoporosis with bone loss / fracture

Fibromyalgia

Major conditions like cancer

Muscle, ligament and tendon problems are generally at the root of the pain problems along with some weakness in the lower back. Other body parts in the region can also be associated like bones and small joints.

When no specific cause is apparent, the term NSLBP (nonspecific low back pain) is used. Any number of reasons for this pain can include degenerative disk disease, psychological issues, systemic disease, facet syndrome (similar to pinched nerves symptoms), herniated disk, spondylolisthesis or the forward displacement of one of the lower lumbar vertebrae over the vertebra below it or on the sacrum. Other factors could be spinal stenosis or constriction or spondyloarthropathy (disease affecting spinal joints).

Let’s take a look at each of these and what pain relief solutions are available.

DEGENERATIVE DISK DISEASE

The degeneration of vertebral disks is a natural part of the aging process. What often happens though, is that when the narrowing of the disk space combines with the nociceptors, sensory receptors that respond to pain, in the outer annulus (in the disk space outside the nucleus) or dorsal root ganglion (spinal nerves) that become heightened, the result can be pain, although not always. Sometimes pain can be felt by some people, and other times not. A minor accident like missing a step and landing a little harder than usual on your feet might cause back pain. Certain activities can aggravate degenerative disks, like yard work or house cleaning movements. But overall, pain associated with degenerative disk disease generally heals within a few days at most. Preventative measures like strengthening muscle groups to lessen future traumas are usually recommended along with an analgesic or medication that helps relieve pain. Only in some cases are epidurals or injections, blocks or surgery needed.

PSYCHOLOGICAL ISSUES

If acute back pain turns into chronic stages, factors of depression, fear and anxiety could increase discomfort and pain. And the longer the chronic pain persists, the more these factors tend to play a role, an increased role over time. So treatment strategies may need to include learning coping skills and alternative lifestyle enhancements to deal with the psychological factors present.

SYSTEMIC DISEASE

This disease is the cause for up to 10% of back pain and largely among the elderly. Causes could be cancer-related or related to reduced bone mass or simply the aging process. Increasing or decreasing activities as well as switching positions all may have no affect on pain relief. Alternative therapies may be indicated.

FACET SYNDROME

Similar to pinched nerves symptoms, this is believed to be associated with pain in the back’s side joints and the main cause of up to 20 percent of back pain cases, with buttocks and upper leg pain increasing with long-term standing, and when switching sitting / standing / lying positions. An injection of local anesthetic into the facet joint helps determine the diagnosis. However, since the anesthetic relieves the pain at the same time and is used as a short-term solution, an x-ray doesn’t help with imaging the pain results. Recommended treatment includes rigorous lumbar activities and body mechanics exercises to learn proper or more beneficial posture and movement techniques.

HERNIATED DISK

Also known as a ruptured or protruding disk, a herniated disk extends beyond its own area into a surrounding region. Compression of the nerve root can cause pain. And pressure on the fibers in surrounding ligaments can cause pain. Although an accident involving lifting could be the cause of a herniated disk, it’s not necessarily so. For many, the cause is unknown; pain can occur suddenly or gradually over time. Relief for the pain can come from walking instead of sitting or standing, and surgery is rarely required right away, if at all in the event relief from pain happens within a limited amount of time. During this time (up to several weeks) any of the following might be effective to use, depending upon your healthcare provider: medication, physical therapy or non-frequently, steroid spinal injections.

SPONDYLOLISTHESIS

Is the forward displacement or slippage of one of the lower lumbar vertebrae (generally the fourth or fifth) over the vertebra below it or on the sacrum. This state of health is diagnosed by x-ray. Pain is believed to occur where the displacement is, at or below the displacement, or from spinal stenosis, discussed next. Depending upon the patient, strengthening exercises or a back support may be all that’s required. In others, surgery may be an option.

SPINAL STENOSIS

The constriction or narrowing of the vertebral canal is referred to as spinal stenosis. Mainly due to aging, as the gradual lessening of disk space and changes in ligaments advance upon the nerve roots below the lumbar vertebra or L2, pain can result. It’s often accompanied by numbness in the legs and is not aided any by walking. Different vertebra and varied physical activities can affect the pain’s location, intensity, recurring and duration. To help diagnose this condition, healthcare providers can use myelography, or an x-ray of the spinal cord after injection of air or a radiopaque substance into the subarachnoid space, with a post-CAT scan. And depending upon the patient, treatments can vary and be minor with medication if the pain gradually disappears, to epidural corticosteroid injections in the epidural, to blocks or surgery.

SPONDYLOARTHROPATHY

This term refers to a variety of diseases affecting spinal joints; arthritis variations- psoriatic arthritis and ankylosing spondylitis, the more common of the two and in males more often than women; and sacroiliitis, accompanies inflammatory bowels. Diagnosis consists of a physical exam, history and testing including x-rays, CAT or MRI, as the disease progresses slowly long-term fusing sacroiliac joints together and joints between vertebrae together. To relieve pain, there is treatment with exercises and physical therapy to promote better enhanced posture and mobility and some arthritic medications. More...

Next week we will be adding a section on How Back Pain is Diagnosed and How the Way it is done can effect the outcome for you. Bookmark this page to read about it next week.