What Is Back Pain? | Neurology

Back Pain

Overview of back pain

Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide.

Fortunately, you can take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional. Surgery is rarely needed to treat back pain.

Symptoms of back pain

The main symptom is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs.

Some back issues can cause pain in other parts of the body, depending on the nerves affected.

The pain often goes away without treatment, but if it occurs with any of the following people should see their doctor:

  • Weight loss
  • Fever
  • Inflammation or swelling on the back
  • Pain down the legs
  • Pain that reaches below the knees
  • A recent injury, blow or trauma to the back
  • Urinary incontinence
  • Difficulty urinating
  • Numbness around the genitals
  • Numbness around the anus
  • Numbness around the buttocks

Causes

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions may include:

  • Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back can cause painful muscle spasms.
  • Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
  • Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  • Osteoporosis. Your spine’s vertebrae can develop painful fractures if your bones become porous and brittle.

Treatment options

Back pain usually resolves with rest and home remedies, but sometimes medical treatment is necessary.

Home treatments

Over-the-counter (OTC) pain relief medication, usually nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen, can relieve discomfort. Applying a hot compress or an ice pack to the painful area may also reduce pain.

Resting from strenuous activity can help, but moving around will ease stiffness, reduce pain, and prevent muscles from weakening.

Medical treatment

If home treatments do not relieve the pain, a doctor may recommend the following medication, physical therapy, or both.

Medication: Back pain that does not respond well to OTC painkillers may require a prescription NSAID. Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by the doctor. In some cases, muscle relaxants may be used.

Antidepressants, such as amitriptyline, may be prescribed, but research is ongoing to their effectiveness, and the evidence is conflicting.

Risk factors

Anyone can develop pain, even children and adolescents. These factors can put you at higher risk:

  • Age. Back pain is more common as you age, starting in your 30s or 40s.
  • Lack of exercise. Weak and unused muscles within the back and abdomen can cause back pain.
  • Overweight. Excess weight puts extra pressure on your back.
  • Diseases. Some sorts of arthritis and cancer can contribute to back pain.
  • Psychological conditions. People susceptible to depression and anxiety seem to be at higher risk.
  • Smoke. Smokers have higher rates of back pain. this will happen because smoking causes more coughing, which may cause herniated discs. Smoking also can decrease blood flow to the spine and increase the danger of osteoporosis.

Prevention

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

  • Exercise: Regular exercise helps build strength and control body weight. Guided, low-impact aerobic activities can boost heart health without straining or jerking the back. Before starting any exercise program, talk to a health care professional.

There are two main types of exercise that people can do to reduce the risk of back pain:

  • Core-strengthening exercises work the abdominal and back muscles, helping to strengthen muscles that protect the back.
  • Flexibility training aims at improving core flexibility, including the spine, hips, and upper legs.

Diagnosis

A physical exam is typically all that’s needed to diagnosis. During the physical exam, your doctor may test your:

  • Ability to stand and walk
  • Spine’s range of motion
  • Reflexes
  • Leg strength
  • Ability to detect sensations in your legs

If a serious condition is suspected, your doctor might order other tests, including:

  • Blood and urine tests to check for underlying conditions.
  • X-rays of the spine to show the alignment of your bones and check for breaks.
  • Computed tomography (CT) scan or magnetic resonance imaging (MRI) to assess your disks, muscles, ligaments, nerves, and blood vessels.
  • Bone scan to look for abnormalities in the bone tissue.
  • Electromyography (EMG) to test nerve conduction.

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