BACK PAIN

Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the back. While any part of the back can be affected, the lower back is the most common site of arthritis back pain, most likely because it bears more of the body's weight.

The main two types of back pain are mechanical and inflammatory. The largest group is mechanical back pain, which includes strains and sprains, injuries, disc lesions, degenerative disc disease, spinal stenosis, osteoarthritis and fractures of bone secondary to osteoporosis. The second largest group is inflammatory back pain. It can be caused by diseases such as ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, polymyalgia rheumatica and other forms of arthritis.

Some people also may have back pain that arises from inflammation in the soft tissues in the back and not the spine itself. Others may experience back pain because the sciatic nerve – which runs through the buttocks – is inflamed causing hip and back pain. Having scoliosis may also cause back pain. In this condition, the spine twists to one side instead of running straight up the center of the back. A small number of people can develop infections or tumors in the spine.

Who’s Affected?

Back pain is one of the most common health problems. It can occur at any age in both men and women.

Back Pain Symptoms

If you have a severe fall or injury or your back pain is accompanied by any of the following, make an appointment to see a doctor immediately:

• Pain that doesn’t improve when you lie on your back
• Weakness, pain or numbness in one or both legs
• Fever or unintentional weight loss
• Pain or difficulty when urinating

Diagnosing Back Pain

A primary doctor can evaluate and treat most cases of back pain. Health history, a physical exam and possibly diagnostic tests will be used to make a proper diagnosis.

Health History and Physical Exam

The doctor will collect information about your health history and symptoms and perform a physical exam. The answers to the questions below will help the diagnosis process:

• When did the pain first begin?
• What were you doing at the time?
• Where is the pain?
• What makes it better or worse?
• How does it feel when you lie on your back with your knees bent?
• What treatments, including over-the counter drugs and nutritional supplements, have you used?
• Do you have any other health problems?

During the physical exam, the doctor will check your posture and look for problems such as curvature of the spine. He may ask you to stand and walk to determine if back pain is affecting your gait (the manner in which you walk) or if an awkward gait (perhaps due to leg-length discrepancy or arthritis in the knee or hip) may be contributing to your back pain.  She may ask you to move, bend and change position to see if a particular activity or position makes your pain worse. Your doctor may also press on different parts of your body – even parts where you may not be aware of pain – to check for tender points (tender painful areas that are characteristic of fibromyalgia) and trigger points (areas of the body that, when pressed, cause pain elsewhere) to locate the source of your pain.

Diagnostic Tests

If the doctor needs more information, you may undergo one or more of the tests listed below. However, these tests are rarely needed for most routine cases of back pain.

Blood Tests

For people with arthritis of the spine, a finding of a specific genetic marker called HLA-B27 in the blood can help the doctor identify a possible diagnosis of a spondylarthropathy, such as ankylosing spondylitis or reactive arthritis. Although the genetic marker is more common in people with these diseases, perfectly healthy people can have it. For that reason, a positive HLA-B27 test does not mean you have one of these diseases.

Tests of fluid drawn from the joint with a needle may reveal crystals of uric acid, confirming a diagnosis of gout, or a bacterium, suggesting that joint inflammation is caused by an infection.

Lower Body Nerve Evaluation

The doctor runs a device called a pinwheel along the skin, from hips to feet, to check for any areas that are either abnormally sensitive or insensitive to stimulus, which would suggest possible nerve involvement in the lower spine.

Muscle-strength Evaluation

The doctor checks the strength of the different muscle groups in the lower body to detect possible nerve problems. Because different nerves supply different muscle groups, a weakened muscle group may suggest damage to the nerve that supplies that group of muscles.

Sciatic Nerve Stretch Test

The doctor determines whether stretching the sciatic nerve causes pain, suggesting possible nerve-root involvement.

X-rays

For most cases of back pain of short duration, X-rays are not necessary. They are most helpful if your doctor suspects that your back pain is caused by arthritis, infection, inflammation or a tumor, or if symptoms are severe.

CT, MRI and Bone Scans

Computerized tomography (CT), magnetic resonance imaging (MRI) and bone scans are usually not necessary to diagnose acute low back pain, but are often very helpful in determining the cause of chronic back pain. The CT scan helps the doctor see if there is a ruptured or degenerated disc, spinal stenosis, tumors or infections of the spine. MRI can provide clear pictures of bone structures and soft tissues such as muscles, cartilage, ligaments, tendons and blood vessels. It is the best test for detecting whether there is pressure on a nerve or on the spinal cord. A bone scan is often used to detect infections or bone inflammation.

Myelogram

In a myelogram, a special dye is injected into the spinal canal and X-rays are then taken of the area. This test may give much more information about the cause of the back pain than a CT scan or MRI.

Electromyography

This is a nerve test used to determine whether the electrical activity of the nerves has been disrupted as a result of problems in the back.

Back Pain Treatments

For most instances of back pain, self-care and over-the-counter (OTC) medications are all that are needed. If your back pain is caused by arthritis, your treatment plan will follow that for the specific type of arthritis.

Analgesics

Analgesics are drugs that relieve pain, but not inflammation. The most common over-the-counter analgesic is acetaminophen. These drugs are available as pills or topicals (creams, gels, patches, rubs or sprays). Topical analgesics may contain other ingredients as well as acetaminophen, and include one of the following:

• salicylates, such as aspirin, that inhibit pain and inflammation by stimulating blood flow
• counterirritants, such as menthol, oil of wintergreen, eucalyptus oil and/or camphor that cause feelings of cold or warmth that distract attention from the actual pain.
• capsaicin, that works by reducing the amount of substance P, a chemical that sends pain signals to the brain.

Topical analgesics should not be used with heat therapy as this can cause burns. If necessary, the doctor may prescribe a stronger analgesic.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen, help reduce inflammation and relieve pain. If necessary, the doctor may prescribe a stronger NSAID. The selective COX-2 inhibitor celecoxib may be safer for the stomach and less likely to cause ulcers than other NSAIDs. There are concerns about an increased risk of cardiovascular problems when taking NSAIDs. Let your doctor know if you have heart disease or high blood pressure before starting these medications, and talk with your doctor about all risks.

It’s a good idea to talk to your doctor or pharmacist before using any OTC medicine for back pain.

Surgery

People with sciatica, spinal stenosis or tumors within the spinal canal may require surgery to relieve pressure on the spinal cord or nerves. Otherwise, surgery is not usually recommended to relieve pain. A spine specialist can help you decide if a back operation is necessary.

Back Pain Self-care

Maintaining good posture, using natural and alternative therapies, getting exercise, losing weight and relieving stress are different ways to reduce back pain.

Posture

Maintaining good posture can help reduce stress and ease discomfort in your back. Here are some techniques to try.

When Sitting

• Keep stomach muscles pulled in, and maintain the proper curve in your lower back. You can do this by tightening your stomach and buttocks.
• Place a small cushion behind your lower back to help maintain the natural curve of the back.
• Keep your knees slightly higher than your hips. Use a footstool or book under your feet if necessary.
• Don’t sit for long periods of time. Stand up and move around periodically to stretch tight muscles and give them a chance to relax.

When Standing

• Stand with your weight equally distributed on both feet.
• Place one foot on a footstool to ease tension in your back.
• Wear flat or low-heeled shoes if you stand for long periods of time.
• Keep your back straight by tightening your stomach muscles and buttocks and doing a pelvic tilt.

When Lifting and Carrying Objects

• Bend and lift using your knees and legs instead of your back.
• Hold the object close to you.
• Straighten your legs to lift the object.
• Get help to lift objects that are too heavy.

When Sleeping

• Sleep on a firm mattress.
• Place a pillow between your knees while sleeping on your side.
• Do not sleep on your stomach.           
• If you do not have knee problems, you may try placing a pillow under your knees when lying on your back.

Heat and Cold Therapy

Heat can help relieve back pain by relaxing muscles and soothing painful areas 48 hours after the pain begins. Some safe, effective options include hot showers or baths, warm compresses, hot water bottles, heat wraps, heating pads, warm-water therapy and hydromassage. If you have arthritis, warming your muscles first may make it easier for you to do back exercises. Sometimes, a healthcare professional may recommend applying cold to your back when pain is acute or severe, or after you exercise.

Exercise

There are stretching and flexibility exercises that may help to alleviate pressure on the back and loosen tight muscles. These include yoga and tai chi.  Make sure to talk to your doctor before beginning an exercise program.

Weight Loss

The doctor may recommend weight loss as one way to reduce your back pain and improve your general health. The best way to lose weight is by eating a balanced diet and exercising regularly. Be sure to avoid fad diets or quick weight-loss programs.

Natural and Alternative Therapies

Acupuncture may provide back pain relief. The practice involves inserting very fine metal needles into your skin at specific points, but not necessarily the area that’s bothering you. For example, back pain may be treated by stimulating points in your feet. Make sure you are treated by a certified acupuncturist.

Massage is also a great way to reduce pain. It can be done by massage therapists or some physical therapists.

A licensed chiropractor can provide spinal manipulation that can help with back pain.  But be aware that this procedure should not be done in individuals with inflammatory back pain such as ankylosing spondylitis. Spinal manipulation of the neck is also potentially dangerous in older individuals who have an increased risk of stroke.

Stress Relief

Here are some ways to reduce daily stress that may cause you to tighten shoulder and back muscles and worsen pain.

• Soak in a warm bath, hot tub or spa.
• Get involved in a hobby.
• Do therapeutic exercise such as yoga or tai chi after getting clearance from your doctor.
• Plan fun and relaxing activities with your family or friends.
• Learn to accept what you cannot change instead of feeling constantly frustrated.
• Consider getting professional help for problems that you are unable to handle on your own.

See also: Health care in Islam; healthy Eating;Arthritis; Obesity

References

http://www.arthritis.org/about-arthritis/types/back-pain/