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AUTHOR: Joe
T. Minchew, MD CONTENTS
Low back pain is an extremely common
condition. Four out of five people will have low back pain at
some time during their life.
| What Is The Pain Coming From? |
Pain that is felt in the back
can come from many different sources. It can even come from structures
that do not really seem to be in the back, such as the kidneys,
etc. As some of these conditions can be quite serious, one of
the roles your doctor plays is to try to recognize these other
conditions so that they can be treated.
Pain which actually comes from the back can result from injuries
to any of the complex structures which make up the back. Whatever
the origin of the pain, almost every back problem is made worse
by spasms in the muscles.
The most common cause of back pain is injury to the disks. The
disks are cushion-like structures with soft centers which hold
the bones (vertebrae) apart. Injuries to the disks are commonly
called slipped, ruptured, or herniated disks. These terms imply
that the soft center of the disk has pushed out of the disk and
is pinching a nearby nerve. Pressure on the nerve causes pain
to extend (radiate) down the leg (a condition known as sciatica).
The disk, however, can be injured without pinching a nerve. In
this case, the pain usually stays in the low back and buttocks,
although it may extend into the posterior thigh.
The other structures in the back which can also be sources of
pain include the bones (fractures), the joints (arthritis), the
muscles (pulled, strained), and the ligaments (sprains).
First, you should have a history
taken and physical examination done by your doctor. Through this,
the doctor will try to determine whether you have other conditions
(such as a kidney infection) and whether the nerves to your legs
are being pinched. If you hurt you back in a fall or a motor
vehicle accident, x-rays may be done to be certain that you don't
have a fracture. X-rays really only tell us about the bones,
not the disks, nerves, muscles, or ligaments. Because x-rays
are usually normal, they are frequently not done on the first
visit. If you don't recover, x-rays may be done later to look
for arthritis, deformity, infection, or a tumor.
Long experience has shown that most patients get over their back
pain with rest, some medication to help with the inflammation
of the injured tissues, and the simple passage of time. Therefore,
once your doctor is relatively certain that you don't have other
serious conditions, it may be recommended that you follow that
course.
If your back pain persists, further diagnostic studies may be
undertaken. These include bone scans or special x-rays, such
as CT scans, to look for other causes of your pain. If you have
evidence of a pinched nerve on physical examination, a myelogram
or MRI may be used.
| What Treatment Should I Have? |
Generally, treatment starts with
rest and nonsteroidal anti-inflammatory medications (NSAIDs).
Occasionally, severe pain may be treated with narcotic pain medicines
for a short period, but no one should take these types of medications
for more than a few days. Muscle relaxants are sometimes prescribed
to help with spasms, but these tend to cloud the mind and also
should not be taken for more than a short period of time. Application
of heat, gentle stretching, and massage can help relax spasmodic
muscles.
As the disk is thought to be the source of the majority of back
pain, it is frequently recommended that you spend a good deal
of time in bed. It has been shown that pressure in the disk is
lowest when you are lying down. Interestingly, disk pressure
is much higher when you are sitting than when you are standing,
so, if you are told to rest, please avoid sitting as it is harder
on your back than standing and walking.
Although most patients get over their episode of back pain, some
patients develop chronic, persistent pain in their low back.
There is no magic pill or treatment to help these patients. Chronic
back pain is usually coming from badly degenerated disks or from
an arthritic joint in the spine. Neither of these conditions
are susceptible to easy cure. The most important thing for these
patients to recognize is that they themselves are the only ones
who can do much to improve their condition. Most importantly,
overweight patients benefit greatly from weight loss, which takes
the extra stress off their painful back. Secondly, modifications
of their lifestyle to avoid excessive bending and to limit long
periods of sitting can be helpful. Finally, accepting the fact
that they have chronic pain, learning to live with it, finding
employment that does not worsen their pain, and simply getting
on with their lives with a positive attitude is very helpful.
A visit to the self-help section of the bookstore can be quite
rewarding.
Surgical procedures are relatively
good at relieving pressure on pinched nerves from herniated disks
and in older patients with nerves pinched by swollen, arthritic
joints. Even pinched nerves frequently get better with rest and
anti-inflammatory medications, so it is usually recommended that
this be tried prior to an operation.
The history of surgical procedures in the treatment of back pain
(without pinched nerves) has been poor, and so it is generally
recommended that such surgery only be undertaken as a last resort.
| Once My Back Is Better, How Can I Prevent
Future Episodes? |
Statistics show that most
patients who have had one episode of low back pain are destined
to have more episodes in the future. The most effective, preventative
measure for future episodes is simply to be in good physical
condition. It has been demonstrated that people who are not overweight
and who participate in a regular daily aerobic exercise program
have a much lower incidence of back pain. Exercises specific
to the back have not been very effective. You should be cautious
about sit-ups and leg lifts, as they often bring on back pain.
Certainly, you should be cautious about exercises that require
you to bend over and lift things, such as free weights and rowing
machines.
In addition, you should practice good body mechanics. This means
using your knees (instead of your back) and squatting (rather
than bending over) to pick things up. When you do have to bend
over, try to place one hand on your knee or another low object
to keep the stress off your back.
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