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herniated_disc

A herniated disc occurs when small tears form in the wall of an injured disc. Damaged pieces of the nucleus (which can harden and break apart with age) push through the tears and out of the disc wall. The herniated disc often compresses a nerve root, causing pain.

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backpain_begins

 

Back pain is an extremely common complaint, with statistics suggesting that approximately 80% of adults in the United States will suffer from back pain at some point during their lifetime. Back pain can be experienced anywhere in the spine, but is most commonly found in the lower back. Back pain is the number one cause of job related disability and is one of the main reasons individuals miss time from work.

Back pain is typically categorized as either acute or chronic, which is dependent on the duration of pain symptoms. Acute pain refers to back pain that has lasted less than three months; whereas, chronic pain refers to back pain that has persisted for a period longer than three months. Back pain can develop suddenly or over time and can be persistent or intermittent. Back pain can range in severity from mild to severe and may have accompanying symptoms, such as radiating pain, numbness, tingling, and/or weakness of an extremity. Often, back pain is worsened with certain activities and movements such as walking, bending, twisting and lifting. Furthermore, prolonged positions such as sitting or standing may worsen pain symptoms.

Back pain can severely impact the physical and emotional health of affected individuals and can have a significant negative impact on their quality of life.

Spine Anatomy Basics

Understanding the basic anatomy of the spine may help patients to better understand back pain and why it occurs. The spine is a vital structure as it protects the fragile spinal cord. Additionally, it holds up the head, shoulders, and upper body allowing an individual to stand upright while still allowing for a wide range of movements.

The spine is divided into the cervical spine, thoracic spine, lumbar spine, sacrum, and coccyx. The spine is comprised of vertebrae, which are stacked on top of one another to create the normal spinal curvature. The vertebrae connect to create the spinal canal, which houses and protects the delicate spinal cord.

The spinal cord extends from the base of the skull to the lumbar region and travels through the spinal canal. Nerves branch out from the spinal cord between the vertebral openings and transmit messages between the muscles and brain. The bundle of nerve roots that extend below the lumbar spine is called the cauda equina. One of the main nerve groups in the pelvis that extends down the leg is called the sciatic nerve. In between each vertebrae are flat, round, intervertebral discs. The intervertebral discs act as shock absorbers for the spine. The facet joints are located between the back of the vertebrae and help the spine move, allowing for rotation to occur. Muscles and ligaments surrounding the spine act to provide stability and support.

Causes Of Back Pain

Damage or deterioration of any of the structures that make up the spine can result in back pain. Thoracic and lumbar pain is most often the result of strained muscle and ligaments in the back, which can be caused by heavy or improper lifting technique, awkward movements, muscle spasm, or poor posture.

However, there are other causes of back pain, including: intervertebral disc bulging or herniation, sciatica, arthritis, osteoporosis, or abnormal curvatures of the spine (i.e. kyphosis and scoliosis).

Intervertebral disc herniation occurs when the outer layer of the intervertebral disc weakens, allowing the inner layer to rupture. The herniated disc material can lead to irritation and inflammation of the spinal nerves, resulting in back pain.

Intervertebral disc bulging is similar to disc herniation and occurs when the inner layer of the intervertebral disc bulges outwards, resulting in increased pressure on the spinal nerves, which can lead to back pain.

Sciatica involves a shooting type pain that radiates through the buttock and down the affected leg. Sciatica may be caused by a bulging or herniated intervertebral disc.

Osteoarthritis is a common condition that affects various joints in the body, including those of the spine. When the spine is affected by osteoporosis, the degeneration that results can lead to back pain.

Scoliosis and kyphosis are two abnormal curvatures that can occur in the spine, which can lead to back pain.

Osteoporosis can lead to a weakening of the spinal bones, which can increase the risk of compression fractures in the spine. When a compression fracture occurs, back pain can result.

There are more serious causes of back pain, including: cauda equina syndrome, infection of the spine, cancer of the spine, herpes zoster infection (shingles), other infections (i.e. kidney or bladder infection), and spinal fractures.

A number of risk factors have been identified which may increase an individual’s risk of developing back pain, including: increasing age, obesity, mental health disorders, smoking, leading a sedentary lifestyle, having a strenuous job, participating in excessive exercise, and pregnancy.

Back Pain Treatment Options

Once the underlying cause of a patients care has been identified, treatment can be focused on the root cause in an effort to provide the most effective pain relief.

Initial treatment for back pain typically begins with over-the-counter pain medications and non-steroidal anti-inflammatory drugs (NSAIDs). If these medications do not produce the desired effects, opioids may be recommended for short-term pain relief. Anti-depressants, including amitriptyline, may be recommended for some patients with back pain.

Steroid injections may be recommended to patients that do not respond to typical pharmacologic management of back pain. Epidural steroid injections and facet joint injections are two types of steroid injections that are commonly used for back pain. They involve injection of a steroid, often combined with an anesthetic, into either the epidural space or the facet joint of the affected area. The steroid medication helps to reduce inflammation while the anesthetic helps to numb the area, thereby helping to reduce pain.

Various alternative treatment options are available for back pain, including: chiropractic care, physical therapy, acupuncture, and biofeedback training.

Rarely, surgery may be necessary for some patients that do not respond to more conservative treatment methods.

Summary

Back pain is experienced by many individuals in the United States. Back pain may be acute or chronic in nature and symptoms can vary drastically among individuals. Back pain can be severe and can have a significant negative impact on an individual’s physical and emotional health, which can ultimately lead to a reduced quality of life.

There are various causes of back pain, ranging from sprains and strains to structural issues within the spinal components, to more ominous conditions such as spinal cancer and infection. In order for back pain treatment to be effective, the underlying cause of an individual’s back pain must first be accurately be identified by a thorough history, physical exam, and possibly imaging tests.

There are numerous treatment options available for back pain including pain medication, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, injection therapy, and a multitude of alternative treatment options. A combination of therapies often leads to the most effective results. Patients suffering from back pain should speak with their physicians about the potential treatment options that may help to reduce their pain symptoms.

References

Deyo RA, Mirza SK, Martin BI.. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31(23):2724-2727.

Laxmaiah M, Boswell MV, Singh V, Pampati V, Damron KS, Beyer C. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskeletal Disorders

Luo X, Pietrobon R, Sun S, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004;29(1):79-86. 2004;5:15.

Revel M, Poiraudeau S, Auleley GR, Payan C, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia: propsed criteria to identify patients with painful facet joints. Spine. 1998;23(18):1972-1976.

Shiri E, Karppinen J, Leino-Arjas P, Solovieva A, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. American Journal of  Epidemiology. 2010;171(2):135-154.

van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22(18):2128-2156.

Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine. 2003;28(3):292-297.

 

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spinal_s

Spinal stenosis results from new bone and soft tissue growth on the vertebrae, which reduces the space in the spinal canal. When the nerve roots are pinched, a painful burning, tingling and/or numbing sensation is felt from the lower back down to the legs and sometimes all the way to the feet.

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facetjoint

Facet joint arthritis is first treated conservatively with rest, ice, heat, anti­inflammatory medications, and physical therapy. In addition, facet joint blocks may be administered not only to diagnose facet joint pain but also to treat it. If non­surgical methods fail to relieve pain, a facet rhizotomy or bone fusion may be performed.

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