Back Pain

How to Manage Back Pain

Introduction

Back pain is a very common problem nowadays. It is the most common cause of chronic pain. The human back is composed of many complex structures like muscles, bones, tendons, ligaments, and discs which work in a group to support our body. Our back pain can be divided into neck pain (cervical), Middle back pain (thoracic), Lower back pain (lumbar) or Coccydynia (sacral pain). The lumbar area is the most common area which is affected.

Causes of Back Pain

There can be various causes of back pain which are as follows

  • Degenerative or traumatic changes to the discs and facets joints
  • Diseases and inflammation of gallbladder, pancreas, aorta, and kidneys
  • Tumors of the vertebrae, neural tissues, and adjacent structures
  • Osteoarthritis
  • Sciatica
  • Pain due to poor movement and posture, constipation, pelvic condition
  • Strain
  • Ankylosing Spondylitis
Back Pain

Classification of Back Pain

Depending upon duration it can be

  1. Acute Pain – Lasts for less than 6 weeks.
  2. Sub-acute Pain – Lasts between 6-12 weeks.
  3. Chronic Pain – Lasts for greater than 12 weeks.

Symptoms

Symptoms associated with back pain are

  • Numbness around anus, genitals, and buttocks
  • Inflammation or any recent injury on the back
  • Fever
  • Loss of weight
  • Pain below knees and legs
  • Back pain causing difficulty in lying down

Risk Factors

They can be as follows

  • Lack of exercise
  • Smoking
  • Heavy lifting
  • Obesity
  • Sedentary lifestyle
  • Poor posture
  • Weight gain in pregnancy

Diagnosis of Back Pain

The initial assessment is proper History taking and Physical examination of the patient. It includes

1. History

History taking includes the age of the patient, location, duration, intensity, severity, any previous trauma, any history of cancer, fever and urine incontinence.

2. Physical Examination

Palpation is done usually to localize the area. It is used for assessing any posture defect or any other deformity.

3. Other Methods

Like a Blood test, X-Ray, CT scan, MRI scan, Bone scan, Electromyography, diagnosis by Chiropractor, Physical therapist and Osteopath.

4. Laboratory Tests

They are used to detect any autoimmune causes. These tests include – WBC count, ESR and C Reactive Protein. ESR gets elevated in conditions like – any infection, malignancy, inflammation, chronic disease, and type of trauma. CRP levels get elevated in the presence of any infection.

4. Red Flags

In initial cases, imaging is not directly advised however some symptoms are noted which are called “Red Flag Symptoms” present –X-Ray, CT scan, and MRI scan may be recommended. These red flag symptoms include –

  • Back pain not improved with conservative management
  • History of any trauma
  • Prolonged use of corticosteroid drugs
  • Unexplained weight loss
  • History of Cancer
  • Immunosuppression
  • History of urinary infection

Management of The Back Pain

The main goal of management when treating back pain is to restore the individual’s ability to function in everyday activities, achieve a maximal reduction in pain intensity as rapidly as possible, assess for side-effects of therapy, to help the patient cope with residual pain. In some cases, the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while in some other cases surgery may be the quickest way to feel better. Three treatment modalities can be – Non-medical management, Medication management, and Surgery-

1. Non-Medical Management

This is the most commonly used method of treating back pain. In this method, no medications are used in treating back pain. Methods used in Non -medical management can be –

  • Heat Therapy – it is mainly useful in the acute and sub-acute type of back pain.
  • Acupuncture – it also helps in giving relief in case of back pain.
  • Exercise – In un-complicated back pain cases, regular activity and gentle stretching exercises are advised, and they usually have better long-term outcomes.
  • Massage Therapy – It gives relief for a short period of time especially in cases of acute back pain but can also give relief in sub-acute lower back pain.
  • Spinal Manipulation – it is similar to other discussed recommended methods.
  • Back School – It consists of both education and physical exercises but there is no strong evidence noted in treating acute, sub-acute and chronic pain.

2. Medical Management

This method of treatment includes medications to improve back pain, not resolved by using non-medical management. Medications used can be – NSAIDs, Opioids, Skeletal muscle relaxants, and Epidural Corticosteroid Injection-

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) – They are usually tried first. They are effectively more effective than placebo and are usually more effective than Paracetamol (Acetaminophen).
  • Opioids – If pain is not relieved by the use of NSAIDS, then opioids can be started but they may not be as effective in severe back pain cases.
  • Skeletal Muscle Relaxants – They may also be used. Their short-term use has been proved effective against acute back pain. It does have side effects also.
  • Epidural Corticosteroid Injection (EPI) – It is used for diagnosis and treatment of back pain. In this procedure, the steroids are injected in the epidural space. These steroids help in decreasing pain and inflammation and thus helps in improving function.

3. Surgical Methods

It mainly comes as a last option. If back pain does not resolve by using non-medical and medical management then surgery comes as the next step. It is useful in people with Severe myelopathy, Cauda equine syndrome. Various surgical options can be

  • Laminectomy – If the herniated disc is compressing the nerve roots so that the compressing agent is removed. It can be Hemi or Partial.
  • Foraminotomy – This method is used if vertebrae are compressing the nerve root.
  • Discectomy – It is performed when the intervertebral disc is herniated or torn.
  • Total Disc Replacement – In this method the source of pain (damaged disc) is removed.
  • Spinal Fusion – It is the procedure in which bone grafts are used to fix 2 or more vertebrae.

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