A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.
By Dr Raghu Sudarshan Thota, MD (Anaesthesiology)
If you’ve ever groaned, “Oh, my aching back!” you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. If you injure parts of your back, you may feel pain. You may not remember the injury – but your back does, and the pain is trying to tell you something.
Low back pain (LBP) is often described as a sudden, sharp, persistent, or dull pain felt below the waist.
Common causes
– Muscle strain
– Disc prolapse
– Spinal stenosis
– Arthritis of spine
– Spinal tumours
– Vertebral
fractures
Low back pain is either of short duration and sudden onset or long duration. Acute lower back pain may begin suddenly with intense pain usually lasting less than three months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may have episodes of acute pain.
Warning signs warranting medical opinion
– Pain worsens by the day
– Pain affects day to day activities
– Leg weakness or numbness
– Loss of bowel or bladder control
Your spine specialist might order some tests to help diagnose your condition. The common tests include an x-ray, a Computerized Axial Tomography scan (a CT or CAT scan), or a Magnetic Resonance Imaging test (an MRI).
Important facts about back pain
– At some point in their lives, 80% of people will experience back pain.
– You can injure your back by coughing or sneezing.
– If you have a sprained back without a serious injury, use ice first. After 48 hours, switch to heat to warm and relax sore tissues.
– Good posture is one of the best ways to avoid straining your spine.
– Exercising on a regular basis helps you maintain a healthy spine.
How is back pain treated?
Treatment for back pain generally depends on what kind of pain you experience: acute or chronic.
Acute Back Pain: Acute back pain usually gets better on its own, although you may want to try painkillers to help ease the pain. Perhaps the best advice is to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness, relieve pain, and have you doing your regular activities sooner. Exercises are not usually advisable for acute back pain
Chronic back pain: Treatment for chronic back pain falls into two categories: the kind that requires an operation and the kind that does not. In the vast majority of cases, back pain does not require surgery. Doctors will almost always try non-surgical treatments before recommending surgery. In a very small percentage of cases – when back pain is caused by a tumour, an infection, or a nerve root problem called cauda equina syndrome, for example – prompt surgery is necessary to ease the pain and prevent further problems.
Some of the more commonly used treatments for chronic back pain follow
Non-operative treatments
1. Hot or cold packs
2. Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning.
3. Analgesics: Analgesic medications are those designed specifically to relieve pain. They include over-the-counter acetaminophen (Tylenol) and aspirin, as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet). Aspirin and Panadol are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery.
4. Other medications: Muscle relaxants and certain anti-depressants have also been prescribed for chronic back pain, but their efficacy is doubtful.
5. Traction
6. Corsets and braces
7. Behavioural modification
8. Injections: When medications and other non-surgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief. Following are some of the most commonly used injections, although some are of questionable value:
a. Epidural injections
b. Nerve root blocks
c. Facet joint injections
d. Trigger point injections
9. Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. They include:
a. Manipulation
b. Transcutaneous Electrical Nerve Stimulation (TENS)
c. Acupuncture
d. Acupressure
e. Rolfing
Operative treatments
Depending on the diagnosis, surgery may either be the first treatment of choice or it may be reserved for chronic back pain for which other treatments have failed. If you are in constant pain or if pain recurs frequently and interferes with your ability to sleep, to function at your job, or to perform daily activities, you may be a candidate for surgery.
Some of the diagnoses that may need surgery include:
Spinal stenosis: the narrowing of the spinal canal, through which the spinal cord and spinal nerves run.
Spondylolisthesis: a condition in which a vertebra of the lumbar spine slips out of place.
Vertebral fractures: fractures caused by trauma to the vertebrae of the spine or by the crumbling of the vertebrae resulting from osteoporosis. This causes mostly mechanical back pain, but it may also put pressure on the nerves, creating leg pain.
Next week:
Low backache: Will I be pain-free without surgery?
