“Oh my aching back” can signal mechanical and, on occasion, even systemic
illnesses that generate very real pain. In fact, back pain is associated
with over 60 illnesses, and can result in serious disability and escalating
medical bills. The good news is most individuals with low back pain improve
within a week or two, and 90 percent of these episodes are resolved in
eight weeks.
Fast Facts
-
Back pain is second only to the common cold as an affliction
of mankind.
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Low back pain disables 5.4 million Americans
and costs at least $90 billion in medical and non-medical
expenses.
-
The diagnosis of low back pain is determined by a medical
history and physical examination, and rarely requires expensive
or uncomfortable tests.
What
back pain is
 |
| Most episodes of back pain are caused by mechanical disorders. |
|
Back pain is just that—pain in the back. It can be localized to the lumbar
spine or may radiate into the legs below the knee (sciatica).
What causes back pain
As a rule, most episodes of back pain are caused by mechanical disorders
associated with overuse of the back and spine, or the gradual changes
associated with aging. In about 10 percent of the cases, back pain is
caused by a systemic illness.
The disorders affecting the low back can be divided into mechanical and
systemic disorders. Mechanical disorders that can result in back pain
include:
-
Muscle strains usually related to sustained physical activity
such as shoveling snow or prolonged gardening. Acute strain may
also occur when completing a common task from a twisted posture.
-
Osteoarthritis resulting from the narrowing of the intervertebral
discs located between the vertebrae of the spine. The adjacent vertebrae
grow spurs in response to the increasing pressure placed on them.
The bony growths can cause localized pain in the low back or leg
pain related to nerve impingement.
-
A herniated intervertebral disc may cause back pain associated
with muscle spasms, but is more commonly severe leg pain related
to pinching of the spinal nerve in the low back. The pain radiating
down the leg is called sciatica. Disc herniation may cause a loss
of function of the nerve that may include a loss of reflex, sensation,
or muscle strength.
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Spinal stenosis is a narrowing or the canal or space that
the spinal cord occupies. This narrowing has many causes including
bone spurs growing around the spinal joints, thickening of spinal
ligaments, or bulging of a disc. The narrowed canal squeezes the
nerve roots causing leg pain, numbness, or weakness. The pain is
increased by standing and walking, and is relieved with sitting.
-
Diffuse Idiopathic Skeletal Hyperostosis (DISH) resulting from
excessive bone growth which can affect the vertebra from the neck
to the lower back.
Systemic disorders that can lead to back pain include ankylosing
spondylitis, osteoporosis,
tumors, and spinal infections.
Who gets back pain
In short, almost everyone. In fact, approximately 80 percent of the world's
population develops this symptom. In the U.S. alone, 10 percent of the
population will report back pain, women slightly more frequently then
men.
How back pain is diagnosed
Typically, only a medical history and physical examination are required
to diagnose low back pain. In some cases, individuals who do not respond
to initial therapy may undergo specialized radiographic tests, such
as magnetic resonance imaging (MRI) and computerized tomography to screen
for additional involvement of soft tissues, ruptured discs, spinal stenosis,
tumors or nerve injuries.
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| Forward bending exercises are helpful for back pain with standing. |
|
How back pain is treated
Back pain should not be equated with a need for bed rest. In fact, bed
rest should be kept to a minimum. Instead, patients should continue their
activities of daily living.
While excessive exercise should be discontinued until the pain is relieved,
there are exercises that can help reduce pain. These include flexion exercises
(bending forward) for pain with standing, and extension exercises (bending
backwards) for pain made worse with sitting.
Five- to ten-minute ice massages applied to a painful area within the
first 48 hours of pain onset can help relieve pain as can heat, which
relaxes the muscles Heat should be used for pains that last longer than
48 hours. Over-the-counter pain relievers such as aspirin, acetaminophen
and non-steroidal anti-inflammatory drugs (NSAIDS), are frequently adequate
to control episodes of back pain, and muscle relaxants may help those
with limited motion secondary to muscle tightness.
Massage therapy has proven helpful for those with chronic muscular pain,
and some patients with back pain localized to the lumbar spine have been
known to benefit from manipulation of the spine.
A small minority of low back pain patients, particularly those with leg
pain due to a herniated intervertebral disc, spinal stenosis, or tumors
affecting structures in the spine will require surgery.
Living with back pain
In most instances, individuals with low back pain will improve over a
two- to six-week period. The goal is to minimize recurrences and, while
being in good physical condition does not prevent all back pain episodes,
it will make the resolution of those episodes easier. If you smoke, stop.
Smoking is a predisposing factor for back pain. If you are overweight,
get into shape. Obesity does not cause back pain, but it does make it
harder to heal. (No particular diet is known to prevent episodes of low
back pain.) Bottom line, pay attention to your body and exercise, eat
right and maintain a healthy life style.
Points to Remember
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Low back pain is a common problem and rarely associated with a severe
illness.
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The vast majority of individuals heal back pain by remaining active
and taking pain-relieving drugs.
-
About 50 percent of individuals are healed in a week or two; over
90 percent are resolved in eight weeks.
To find a rheumatologist
For a listing of rheumatologists in your area, click
here.
Learn more about rheumatologists and rheumatology
health professionals.
For more information
The American College of Rheumatology has compiled this list to give you
a starting point for your own additional research. The ACR does not endorse
or maintain these Web sites, and is not responsible for any information
or claims provided on them. It is always best to talk with your rheumatologist
for more information and before making any decisions about your care.
Arthritis Foundation
www.arthritis.org
National Institutes of Health
www.nih.gov
Borenstein, D: Back In Control: A Conventional and
Complementary Prescription for Eliminating Back Pain. New York:
M Evans and Co. 2001, pp 208
Updated June 2005
Written by David Borenstein, MD, and reviewed by the American College
of Rheumatology
