None — Back Pain
Back pain is a common ailment, affecting up to 85 percent of Americans at some point in their lives. The pain can be short-lived or long-lasting. In acute back pain, the symptoms last up to 6 weeks. About 80 to 90 percent of patients recover within this time period. In chronic back pain, symptoms last 12 or more weeks. Roughly 10 to 15 percent of patients with back pain have chronic symptoms. These patients account for most of the $90 + million dollars spent on back pain treatments in the U.S. each year.
There are many different causes of back pain. Over-activity, degenerative changes associated with aging and injury may all play a role in risk for back problems. Here are some of the more serious causes of back pain:
Herniated disk. The intervertebral disks separate the vertebrae in the spine and act as shock-absorbing cushions. Although the disks are covered with a tough membrane, this outer layer can become worn or torn. In a disk herniation, some of the jelly-like inner contents of the disk push through a break in the outer wall, putting pressure on the nearby spinal nerves. A herniated disk in the lower back may push on the roots of the sciatic nerve, causing pain in the buttocks and leg, weakness, numbness and tingling (sciatica).
Degenerative spondylolisthesis. With time and aging, wear and tear on the spine can cause the vertebrae to move out of alignment. If one vertebrae slips forward, the bone can put pressure on the spinal nerves.
Spinal stenosis. The spinal cord is encased inside the spinal column in a central tunnel, called the spinal canal. Disk herniation or collapse, degeneration of the facet joints and other changes in the spinal column can cause this space to narrow. This, in effect, squeezes the spinal cord, putting pressure on the spinal nerves.
Treating Back Pain
Richard Deyo, M.D., Internist with Oregon Health and Science University in Portland, OR says patients (and some doctors) often consider surgery to be the answer to many cases of back pain. Patients may also push for surgery in an effort to gain quick relief from their symptoms. However, surgery isn't always the right answer. It can have risks (like infection and an increased risk for complications) and doesn't always resolve the problem.
Deyo acknowledges there are cases where surgery is necessary. But experts say doctors should try non-surgical options first. Oral medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, steroids and narcotics may be useful to help patients get over the initial phase of severe pain and inflammation. Injected medications relieve pain by targeting the affected areas of the spine.
Another important part of many back pain treatment programs is physical therapy. It may include specific exercises to strengthen the back and increase range of motion, ultrasound therapy, electrical stimulation, or, in some cases, braces or traction. Some patients also gain relief through alternative therapies, like acupuncture or massage.
Health experts recommend back pain patients try nonsurgical options for at least 6 to 12 months before considering surgery. Deyo adds surgery isn't a guarantee that back pain will be eliminated. In fact, in some cases, surgical treatment for back pain can lead to problems that eventually require more surgery at some point in the future. In addition, some types of back pain can't be treated with surgery.
Research compiled and edited by Barbara J. Fister
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If you have any specific concerns or questions about your back pain treatment, speak with your health care provider and/or seek a second opinion. For general information about back pain or treatment options:
American Academy of Orthopaedic Surgeons, http://orthoinfo.aaos.org
North American Spine Society, http://www.knowyourback.org