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Posts Tagged ‘Spinal Nerves’

Back pain affects nearly 80% of Americans and the most common form is Low Back Pain. Because you rely on your back for almost every move you make, it is vulnerable to injury. Back pain can even be disabling. It is one of the most common problems prompting a visit to your doctor and for missing work. In fact, it is the second highest cause of disability in persons under the age of 45.

Although people complain of back pain, it is not a diagnosis but rather a symptom of an underlying disorder. There are two types of back pain, acute and chronic. Acute back pain is pain with a new onset. It comes on suddenly, usually due to injury. This is the most common type of back pain. It is usually resolved in less than one month but no more than 6 weeks duration. Chronic pain is pain that can have a quick or slow onset, but it lingers for long periods of time. Although it may last three months or longer, some people experience a lifetime of chronic back pain. Chronic pain is the least common type of pain.


What Causes Back Pain?


To begin to understand the causes of back pain, we need to understand the spine. The back is made up of 33 vertebrae or bones. It is divided into 5 groups: Cervical, Thoracic, Lumbar, Sacrum and Coccyx. The cervical spine (upper back or neck) consists of 7 vertebrae. The thoracic(middle back) has 12, and the lumbar spine(low back) has 5 vertebrae. The sacrum consists of 5 fused vertebrae, and the coccyx(tail bone) has 4 vertebrae fused together.

The vertebrae are held together by ligaments and muscles with discs between the vertebrae. The discs are filled with a jellylike center, allowing them to act like a shock absorber. The vertebrae link together to provide stability and support. They protect the spinal cord and spinal nerves that run through the spinal canal.

Because the neurological system is complex, it is difficult to pinpoint the exact cause of back pain. The causes of back pain are divided into categories: Mechanical, Injuries, Acquired disorders or diseases, Infections or tumors.

Mechanical causes: These are problems with how the spine works. For example, Spondylolistesis(deterioration of the disc one vertebrae to slip forward over another, causing the vertebrae to rub together, therefore causing pain). Other mechanical problems are fractures, herniated discs, spinal stenosis, spinal degeneration and sciatica.

Injuries- This category includes common forms of back pain due to injury to the spine or the ligaments and muscles involved with the spine. Sprains, for example, result if a ligament that supports the spine is pulled or torn due to improper lifting or body mechanics, even twisting the wrong way, Fractures can occur from osteoarthritis which causes the bones to become brittle and weak. Sever injuries can result from an accident or fall.

Acquired disorders- These are medical problems that you might have been born with such as scoliosis(an abnormal curvature of the spine) to other problems that you acquired, such as arthritis(osteoarthritis and rheumatoid arthritis) which can lead to fractures; musculoskeletal pain syndromes such as fibromyalgia, spinal stenosis (Narrowing of the spinal canal putting pressure on spine or nerves); and even pregnancy.

Infection/Tumors- Infection, although not common, can cause pain if it involves the vertebrae. Two examples of this are Osteomyelitis(infection and inflammation of the vertebrae) and Discitis(infection in the discs).Tumors, although rare, can also cause back pain. These can be benign or cancerous, but usually result from a tumor that has spread from another area of the body.


How is back pain diagnosed?


In order for your physician to discuss the proper treatment for your back pain, he will need to do a thorough medical history and physical exam. You will need to give a clear concise description of your pain. Your physician will need to know how the pain started, what you were doing when it started, how severe it is, does it come and go or is it constant, and what makes the pain better or worse. You will need to undergo some diagnostic tests. Common tests done to diagnose back pain are x-rays, bone scans, and MRI’s. These diagnose problems due to bone or soft tissue injuries. Your doctor may order blood and urine tests to look for infection. If your physician feels the pain might be caused by a nerve problem, then you will have an EMG(electromyography) or nerve study. An EMG is an assessment of the electrical impulses of nerves and the response of the muscles.


How is Back Pain Treated?


The common goals of treatment are to relieve back pain and to restore mobility. Treatment varies depending on the severity and type of injury. The most common and basic treatment used for strains or minor injury is Rest. Heat can be used to promote circulation to the area and relieve spasms. Cold packs can be used to decrease the swelling in the affected area of the back. Common OTC (over the counter) medications such as Aspirin, Motrin, Tylenol, and Aleve are prescribed to help the pain and inflammation.

Long term bed rest is not usually recommended because it can make recovery slower and can ultimately cause other problems. Usually the doctor will have you gradually resume normal activities after 24-72 hours of rest. He may start you on a physical therapy program which should include heat, massage, ultrasound and an individualized exercise regimen. If the pain does not subside and it is interfering with your normal daily activities, your doctor may order prescription pain medications such as Darvocet, Vicodin, or Percocet and anti-inflammatory agents to relieve muscle spasm.

If your pain becomes chronic and all other treatments have failed, your doctor may refer you to a Back or Pain specialist. Because the back is a complex entity, specialists are more up to date on new advances in the treatment of back pain. Some treatments you might encounter are epidural nerve block (injection of anesthetic, anti-inflammatory, or steroid into the epidural space of the back for long term pain relief)and trigger point injections(injection of steroids and anesthetic into the muscle that is triggering pain.)This should also provide long term pain relief. Other medications such as antidepressants and anticonvulsants have been found to help relieve pain caused by nerve injuries.

Other types of treatment include:

Use of TENS(transcutaneous electrical nerve stimulation) unit. Electrodes are placed on 2-3 painful areas of the back and attached to a unit that provides mild electrical stimulus to the area in order to relieve pain.

Chiropractic adjustments of the back.

Acupressure or acupuncture treatments.

Relaxation and breathing techniques and stress management instruction.

Massage and basic stretching exercises to promote mobility and relieve spasm.

Yoga-and Pilates- This can help relieve pain and stress. Some Yoga postures may help relieve low back pain and help improve strength, flexibility and balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.

Aquatic or water therapy- This can be very beneficial in relieving pain and improving mobility in those with chronic low back pain. There is no resistance to movement in the water, and water is soothing, comforting, and relaxing for the body.


How can Back Pain be Prevented?


Although some people say that you can’t avoid injuring your back, most doctors are in agreement that the common causes of back pain can be prevented by following a few lifestyle changes:

Exercise: You will need to consult your physician prior to starting an exercise program because there are some exercises, such as high impact aerobics and weight lifting that can make back pain worse. Other exercise, such as swimming, walking and biking can help overall health and strengthen the back. Nonetheless, exercise should not be avoided as it helps to improve overall health.
Lumbar support belts: Some people that work jobs that do heavy lifting on a daily basis are required to wear lumbar support and undergo back training on the job to learn how to prevent lifting injuries.
Do not wear high heels.
Keep head up and stomach in when standing. If standing for prolonged periods of time, place one foot up on a stool and alternate your weight frequently.
Sit in a chair with good lumbar support. Maintain good posture, sit up straight and keep both feet flat on the floor. Make a lumbar roll out of a rolled towel to place behind the low back when you drive or sit for prolonged periods of time.
Use proper body posture when lifting. Keep objects close to your body. Keep your back straight and your head up with stomach tucked in. Don’t lift objects that are too heavy. Get help when lifting awkward or heavy objects. Don’t bend forward to pick something up, rather bend at the knees and lift straight up from the knees.

In conclusion, back pain can be difficult to treat but there are many options out there for you. Specialists are finding new research every day. You can take care of your back by making good lifestyle changes and eliminating or reducing the amount of stress in your life. By maintaining good posture, using proper lifting techniques, and educating yourself on how to avoid back pain, you can prevent more back injury.

CAUSES OF BACK PAIN

Considering the fact that the majority or between 70 and 90 percent of the population will experience some sort of back pain at one time or another, knowledge about back pain relief is certainly welcome, appreciated and a popular topic. One of the best ways to begin learning about back pain relief is by understanding the basics of back pain: what causes it, how it’s diagnosed, what treatments are available, how to manage the pain, etc.

Most references to back pain focus on lower back pain in the lumbar spinal region. However, back pain causes in no particular order are:

A. Accidents or injuries leaving muscle pain

B. Osteoarthritis with deteriorating cartilage

C. Osteoporosis with bone loss / fracture

D. Fibromyalgia

E. Major conditions like cancer

Muscle, ligament and tendon problems are generally at the root of the pain problems along with some weakness in the lower back. Other body parts in the region can also be associated like bones and small joints.

When no specific cause is apparent, the term NSLBP (nonspecific low back pain) is used. Any number of reasons for this pain can include degenerative disk disease, psychological issues, systemic disease, facet syndrome (similar to pinched nerves symptoms), herniated disk, spondylolisthesis or the forward displacement of one of the lower lumbar vertebrae over the vertebra below it or on the sacrum. Other factors could be spinal stenosis or constriction or spondyloarthropathy (disease affecting spinal joints).

Let’s take a look at each of these and what pain relief solutions are available.

DEGENERATIVE DISK DISEASE – The degeneration of vertebral disks is a natural part of the aging process. What often happens though, is that when the narrowing of the disk space combines with the nociceptors, sensory receptors that respond to pain, in the outer annulus (in the disk space outside the nucleus) or dorsal root ganglion (spinal nerves) that become heightened, the result can be pain, although not always. Sometimes pain can be felt by some people, and other times not. For example a minor accident like missing a step and landing a little harder than usual on your feet might cause back pain. And certain activities can aggravate degenerative disks, like yard work or house cleaning movements. But overall, pain associated with degenerative disk disease generally heals within a few days at most. Preventative measures like strengthening muscle groups to lessen future traumas are usually recommended along with an analgesic or medication that helps relieve pain. Only in some cases are epidurals or injections, blocks or surgery needed.

PSYCHOLOGICAL ISSUES – If acute back pain turns into chronic stages, factors of depression, fear and anxiety could increase discomfort and pain. And the longer the chronic pain persists, the more these factors tend to play a role, an increased role over time. So treatment strategies may need to include learning coping skills and alternative lifestyle enhancements to deal with the psychological factors present.

SYSTEMIC DISEASE – This disease is the cause for up to 10% of back pain and largely among the elderly. Causes could be cancer-related or related to reduced bone mass or simply the aging process. Increasing or decreasing activities as well as switching positions all may have no affect on pain relief. Alternative therapies may be in need.

FACET SYNDROME – Similar to pinched nerves symptoms, this is believed to be associated with pain in the back’s side joints and the main cause of up to 20 percent of back pain cases, with buttocks and upper leg pain increasing with long-term standing, and when switching sitting / standing / lying positions. An injection of local anesthetic into the facet joint helps determine the diagnosis. However, since the anesthetic relieves the pain at the same time and is used as a short-term solution, an x-ray doesn’t help with imaging the pain results. Recommended treatment includes rigorous lumbar activities and body mechanics exercises to learn proper or more beneficial posture and movement techniques.

HERNIATED DISK – Also known as a ruptured or protruding disk, a herniated disk extends beyond its own area into a surrounding region. Compression of the nerve root can cause pain. And pressure on the fibers in surrounding ligaments can cause pain. Although an accident involving lifting could be the cause of a herniated disk, it’s not necessarily so. For many, the cause is unknown; pain can occur suddenly or gradually over time. Relief for the pain can come from walking instead of sitting or standing, and surgery is rarely required right away, if at all in the event relief from pain happens within a limited amount of time. During this time (up to several weeks) any of the following might be effective to use, depending upon your healthcare provider: medication, physical therapy or non-frequently, steroid spinal injections.

SPONDYLOLISTHESIS or the forward displacement or slippage of one of the lower lumbar vertebrae (generally the fourth or fifth) over the vertebra below it or on the sacrum. This state of health is diagnosed by x-ray. Pain is believed to occur where the displacement is, at or below the displacement, or from spinal stenosis, discussed next. Depending upon the patient, strengthening exercises or a back support may be all that’s required. In others, surgery may be an option.

SPINAL STENOSIS – is the constriction or narrowing of the vertebral canal. Mainly due to aging, as the gradual lessening of disk space and changes in ligaments advance upon the nerve roots below the lumbar vertebra or L2, pain can result. It’s often accompanied by numbness in the legs and is not aided any by walking. Different vertebra and varied physical activities can affect the pain’s location, intensity, recurring and duration. To help diagnose this condition, healthcare providers can use myelography, or an x-ray of the spinal cord after injection of air or a radiopaque substance into the subarachnoid space, with a post-CAT scan. And depending upon the patient, treatments can vary and be minor with medication if the pain gradually disappears, to epidural corticosteroid injections in the epidural, to blocks or surgery.

SPONDYLOARTHROPATHY – This term refers to a variety of diseases affecting spinal joints; arthritis variations- psoriatic arthritis and ankylosing spondylitis, the more common of the two and in males more often than women; and sacroiliitis, accompanies inflammatory bowels. Diagnosis consists of a physical exam, history and testing including x-rays, CAT or MRI, as the disease progresses slowly long-term fusing sacroiliac joints together and joints between vertebrae together. To relieve pain, there is treatment with exercises and physical therapy to promote better enhanced posture and mobility and some arthritic medications.