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Back Pain
Overview

Back pain is a miserable and often debilitating condition suffered by 8 out of every 10 people. You may be fine one day and wake up one morning with a sharp pain that leaves you down in bed. You may also develop and slow growing dull pain that is bothersome. Acute back pain may last anywhere from a few days, to weeks, or even months. Back pain over three months is then considered “chronic.”
You may be lucky enough to care for back pain with some over-the-counter anti-inflammatories and/or pain relievers and a little extra rest. They even say that too much rest and not enough movement can increase the problem.
If you are suffering back pain and it’s been longer than a few days, give your doctor a call. A sudden injury to your back should always be evaluated by a doctor right away. Your doctor is the best resource for diagnosis and treatment of back pain. This article is for informational purposes only and will give you the causes of back pain and what your doctor can do to diagnose and treat your condition. It also gives helpful lifestyle changes and home remedies to help you manage the pain.
Back Pain Overview
Back pain is a very common problem that can be just a mild nuisance or keep you in bed for days. The pain ranges from dull throbbing, to sharp stabbing pains when you move. You may have suffered an injury, or have back pain for no explainable reason. It can affect the upper back and neck, the middle back and the lower back. Lower back pain can even cause sciatic nerve pain that runs down your leg.
Anyone can suffer back pain young and old, although it is more common in middle aged to older adults. It is often temporary and relieved by rest, but can also become long-term and chronic.

Back Pain Risk Factors

The risk factors for back pain include:
Age
Lack of Exercise/Poor Muscle Strength
Obesity
Genetics
Arthritis
Cancer
Careers that include physical labor
Smoking
Ethnicity – African American women seem to have more incidence of slipped disk

Types of Back Pain

There are different types of back pain based on how you describe it to your doctor. Once the doctor diagnoses the cause of your back pain, your type of pain helps them decide which treatment will be best for you. Types of back pain include:
Radicular Back Pain. Sciatic nerve pain and spinal stenosis cause radicular pain. It is described as deep pain in the extremity closest to the area. There is also a feeling of “pins and needles” and you may have numbness. This is a sign of spinal nerve compression, inflammation or an injury.
Axial Back Pain. This type of pain is described as either dull and constant or sharp pain that comes and goes “stabbing.” It is usually caused by an injury, problem with back muscles, or mechanical issue.
Referred Back Pain. Referred pain is any type of pain that is felt in one area, but caused by something going on in another area. Referred back pain is an achy, dull pain that tends to radiate to another area like; buttock to thigh, or lower back to the pelvic area. This is usually caused by a nerve injury in the lower back area. Degenerative disc disease may cause back pain to show up in the thigh or hip area.

Back Pain Causes

The different causes of back pain include:
Injury. An acute injury to your back can cause a sudden acute pain that goes away in a short while or lasting chronic pain. Injuries can cause a fracture to the spine or a sprain (tear) to the ligaments in your back. Heavy lifting or turning the wrong way can sprain your back. Severe accidents or osteoporosis can cause fractures.
Poor Back Mechanics. Your spine may not move properly and cause you pain when you do certain things. Problems that cause poor back mechanics are; degenerative disc disease that weakens the cushion between the vertebrae, weakening of joints between the vertebrae, muscle spasms, ruptured discs and muscle tension.
Back Conditions. Back conditions that are not due to injury can cause back pain. These include; scoliosis, arthritis, spinal stenosis, osteoporosis, pregnancy, kidney stones, and fibromyalgia.
Cancer or Infection. These aren’t often attributed to back pain, but may be related in some cases. A kidney infection can cause flank or upper back pain. An infection in the bones of the spine (osteomyelitis) can cause back pain. Cancer in areas near the back can cause back pain if the tumor grows and puts pressure on the spine.
Non-Physical Causes. Emotional stress, tension, anxiety, and depression can also cause back pain. Insomnia has also been linked to back pain.

Diagnosing Back Pain

The doctor will take a full medical history and ask you if you have had any recent injury or history of lifting something heavy. You will need to tell the doctor any medications you are taking for pain or inflammation. Also give your doctor a detailed medication list and allergies to medications.
Next you will be given a physical exam. Your doctor will want to see how you move your legs, stand up, sit down, and walk. Tell your doctor what your pain level is on a scale of 1 to 10. Let your doctor know what your pain level is at rest and when you are moving around.
Your doctor may send you for the following tests:
X-Ray. An x-ray is an easy way to see minor injuries, arthritis, and crooked alignment of the back. X-rays aren’t very detailed however, so nerve issues, muscles, tendons, and ligaments need to be looked at with a scan.
CT and MRI Scan. What an x-ray can’t pick up, can be seen on either a CT or MRI scan. These will show deeper issues on the muscles, nerves, joints, and other soft tissues in the back.
Bone Scan. If your doctor sees a fracture, you may need to have a bone scan to check for osteoporosis. This can also check for tumors in the bones of the back.
Lab Testing. To rule out infection or other internal issue, your doctor may do blood tests.
Nerve Conduction Studies. If the doctor thinks you may have compression of your spinal nerves, you may need to have nerve conduction test to check how your muscles respond. You are hooked up to electrodes to check the electrical impulses coming from the nerves and muscles.

Back Pain Treatment

If the doctor doesn’t find anything serious, you may just be advised to rest and use over-the-counter anti-inflammatories and pain relievers. You may also be advised to stay out of bed, contrary to what you might think.
Continuing normal activity as tolerated may help you recover faster. Listen to your body and don’t do anything that causes you pain, but continue with light activity. Be sure to get in touch with your doctor if the pain does not resolve after a few weeks. If you have to go back to the doctor they may recommend further treatment with:
Muscle Relaxers – Side-effects include; dizziness and sleepiness.
Narcotic Pain Relievers
Anti-depressants – Some anti-depressants may help back pain.
Cortisone Injections
Topical Medications

Physical Therapy
A physical therapy program can help you learn better ways to protect your back, exercises, to do at home, and proper posture. During therapy treatments you may receive massage, heat therapy, and ultrasound. They may also put you on machines to work to strengthen your core muscles to prevent further injury.
Surgical Intervention
While it is rare unless you have a severe problem, surgery may be needed to repair damage to your back. This is common with disk rupture, nerve compression, and spinal stenosis. It is usually a “last resort” if other treatments have not worked for you.

Living with Back Pain

If you have back pain, you may need to make a few lifestyle changes to help minimize your pain and increase your ability to do the things you need to do every day. This means coming up with a treatment plan that includes:
Seeing your doctor for follow-up visits
Keeping your physical therapy appointments
Ask about occupational therapy to learn better ways of doing daily tasks
Learn relaxation, deep breathing, and ways to manage stress
Don’t overdo things. Listen to your body’s clues and rest when you need to
Stop smoking. Smoking can lead to certain back disorders like, degenerative disk disease.
Take your medications as directed by your doctor and report any side-effects.

Alternative Medicine for Back Pain

If your doctor gives the okay, there are a few natural and alternative remedies that may help back pain. These include:
Massage. Massage therapy can help with muscle strains and tension in your back and neck.
Chiropractor. Chiropractor’s use spinal manipulation to put the spine back into place. They take an x-ray and find places of curvature and “pop” the spine and neck.
Yoga. There are gentle Yoga techniques that can help you stretch your muscles and do deep breathing to help relieve back pain.
Acupuncture. Needles are placed at different locations on your skin. These are points of energy flow for the body and people have reported that it can lessen back pain.
Glucosamine/Chondroitin. Taking between 500 and 1,500 mg daily may help to reduce joint pain. It should not be taken by people who are allergic to shellfish. Do not use if you are on blood thinners or suffer from asthma.
MSM. Taking 3,000mg of MSM two times a day may help protect you from degenerative joint and connective tissue disease. It may help reduce joint pain.
Bromelain. This enzyme is a natural anti-inflammatory and is found in pineapples. Take 250mg twice daily, but use caution if you are at risk for bleeding.
Turmeric. Herbalists recommend 300mg three times daily to help relieve inflammation and pain naturally. This can also be used in combination with bromelain to increase the effects. Use caution if you are at risk of bleeding.
Capsaicin. This natural pain reliever comes from chili peppers. It is used in a cream and applied topically to the skin, but must be used consecutively over a number of days to feel the effects. Studies have shown that it really is effective.

Back Pain Prevention Tips

Strengthen Core Muscles. Make sure you do exercises that strengthen your core muscles. This helps to hold your back stable. You can ask your physical therapist for examples.
Keep your Weight in a Healthy Range. If you are overweight, all the muscles and joints in your body experience extra stress. Losing just a few pounds helps to relieve stress and pressure.
Use Proper Posture. Using good body mechanics can relieve stress to your back. Here are a few tips:
Stand with one foot on a footstool and alternate feet. Keep your pelvis tucked in a neutral position when standing.
Use a chair with lower back support that swivels at the base. Make sure you keep your knees and hips in line and level. Get up and walk after sitting two hours.
Lift with your knees and not your back. Always keep heavy objects close to your body and never twist while lifting. Ask for help.

Bibliography

Mayo Clinic. (2015, June 17). Back Pain: Tests and Diagnosis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/back-pain/basics/tests-diagnosis/con-20020797
National Institute of Arthritis, Musculoskeletal and Skin Diseases. (2014, November). What is back pain? Retrieved from National Institute of Health: https://www.niams.nih.gov/Health_Info/Back_Pain/back_pain_ff.asp
U.S. National Library of Medicine. (2015, September 21). Back Pain: Summary. Retrieved from MedLine Plus: https://www.nlm.nih.gov/medlineplus/backpain.html
University of Maryland. (2012, January 20). Low Back Pain. Retrieved from University of Maryland Medical Center: https://umm.edu/health/medical/altmed/condition/low-back-pain
WebMD. (2014, October 21). Causes of Back Pain. Retrieved from WebMD: https://www.webmd.com/back-pain/guide/causes-of-back-pain

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