Back pain

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Back pain pain in the back of the body. It is divided into neck pain (cervix), middle back pain (thorax), lower back pain (lumbar) or coccydynia (tail bone or sacral pain) based on the affected segment. The lumbar area is the most common area for pain, as it supports most of the weight in the upper body. Episodes of back pain may be acute, sub-acute, or chronic depending on their duration. Pain can be characterized as a blunt, shooting or piercing pain, or burning sensation. Discomfort can spread to the arms and hands and feet or feet, and may include numbness, or weakness in the legs and hands.

Back pain can come from muscles, nerves, bones, joints or other structures in the spine. Internal structures such as gall bladder, pancreas, aorta, and kidney can also cause referred pain in the back.

Back pain is common, with about nine out of ten adults experiencing it at some point in their lives, and five out of ten working adults have it every year. Some estimate up to 95% of Americans will experience back pain at some point in their lives. This is the most common cause of chronic pain, and is a major contributor to missed work and disability. However, infrequent back pain becomes permanently deformed. In most cases disc and herniated stenosis, rest, injection or surgery have the same general pain resolution results on average after one year. In the United States, acute lower back pain is the fifth most common reason for a doctor's visit and causes 40% of the day to work. In addition, this is a major cause of disability worldwide.

Video Back pain

Classification

Back pain can be classified with a variety of methods to aid diagnosis and management. Duration of back pain is considered in three categories, following the expected pattern of healing connective tissue. Acute pain lasts up to 12 weeks, subacute pain refers to the second half of the acute period (6 to 12 weeks), and chronic pain is pain that persists outside 12 weeks.

Maps Back pain

Cause

In as many as 85% of cases, no physiological cause can be found.

There are many causes of back pain, including blood vessels, internal organs, infections, mechanics, and autoimmune causes. Spinal cord, nerve root, vertebral column, and muscles around the spine can all be a source of back pain. The anterior ligaments of the intervertebral disk are very sensitive, and even the slightest injury can cause significant pain. In osteoporosis, bones become weaker and may develop small cracks, or fractures, in bone, resulting in pain. Arthritis in the back joint can also cause discomfort. The synovial joints of the spine (eg the zigoskofil joint/facet joint) have been identified as the main source of pain in about a third of people with chronic back pain, and in most people with neck pain after whiplash.

About 98 percent of people with back pain are diagnosed with nonspecific acute back pain where no underlying pathology is serious. Less than 2 percent is associated with secondary factors, with metastatic cancer and serious infections, such as spinal osteomyelitis and epidural abscess, accounting for about 1 percent.

Back pain can be divided into non-radicular pain and radiculopathy. Radiculopathy occurs when there is irritation in the nerve roots, causing neurological symptoms, such as numbness and tingling. Disk disc herniation and foraminal stenosis are the most common causes of radiculopathy. Non-radicular back pain is most often caused by injuries to the spinal or ligament muscles, degenerative spinal diseases, or disc herniation. Spondylosis, or spinal degeneration, occurs when the intervertebral disk undergoes degenerative changes, causing the disk to fail on the vertebral pads. The space between the vertebra becomes narrower, resulting in compression and irritation of the nerves.

Back pain can also be due to pain referred from other sources. The pain generated occurs when pain is felt in a different location from the source of the pain. Abdominal aortic aneurysms and ureteric colic can cause back pain.

Another possible cause of chronic back pain in people with normal scans is central sensitization, where initial injury or infection leads to an increasingly agitated state of sensitivity to pain. This persistent condition retains the pain even after the initial injury has healed. Treatment of sensitization usually involves low-dose anti-depressant.

Risk factors

Obesity, lifestyle, and lack of exercise can increase a person's risk of back pain. People who smoke are more likely to experience back pain than others. Poor posture and weight gain in pregnancy are also risk factors for back pain. In general, fatigue can aggravate pain.

Several studies have shown that psychosocial factors such as workplace stress and dysfunctional family relationships may be more closely correlated with back pain than structural abnormalities revealed in X rays and other medical imaging scans.

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Diagnosis

In most cases of low back pain, the medical consensus suggests not looking for the right diagnosis but beginning to treat the pain. This assumes that there is no reason to expect that the person has a fundamental problem. In most cases, the pain disappears naturally after a few weeks. Usually, people looking for diagnosis through imaging may not have better results than those who wait for the conditions to complete.

Laboratory testing may include white blood cell count (WBC), blood sedimentation rate (LED), and C-reactive protein (CRP).

Increased ESR may indicate infection, malignancy, chronic disease, inflammation, trauma, or tissue ischemia.
Increased CRP levels are associated with infection.

Red flag

Imaging is usually unnecessary in early diagnosis or treatment of back pain. However, if there are certain "red flag" symptoms, plain radiographs (x-rays), CT scans, or magnetic resonance imaging (MRI) can be recommended. These red flags include:

Cancer history
Unexplained weight loss
Immunosuppression
Urinary tract infection
Intravenous drug use
Long-term use of corticosteroids
Back pain does not improve with conservative management
Significant trauma history
Small fall or heavy burden on potentially osteoporotic or elderly individuals
Acute onset of urinary retention, overflow incontinence, loss of anal sphincter tone, or faecal incontinence
Soldering anesthesia
Global or progressive motor weakness in lower limbs

Back Pain Management Guide | Everyday Health

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Prevention

There is evidence of moderate quality that suggests a combination of education and exercise can reduce the risk of an individual developing an episode of low back pain. Lower quality evidence indicates exercise alone as a possible barrier to the risk of this condition occurring.

How Did Your Low Back Pain Really Start? â€

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Management

The goal of management when treating back pain is to achieve maximum reduction in pain intensity as quickly as possible, to restore the ability of individuals to function in daily activities, to help patients deal with residual pain, to assess the side effects of therapy, and to facilitate patient travel through obstacles legal and socioeconomic for recovery. For many, the goal is to keep the pain to a manageable level for progress with rehabilitation, which can then lead to long-term pain relief. Also, for some people the goal is to use non-surgical therapy to manage pain and avoid major surgery, while for other surgery it may be the quickest way to feel better.

Not all treatments work for all conditions or for all individuals with similar conditions, and many find that they need to try out some treatment options to determine what is best for them. The current stage of the condition (acute or chronic) is also a decisive factor in care selection. Only a small percentage of people with back pain (mostly 1% - 10% forecast) require surgery.

Non medical

Back pain is generally treated with the first non-pharmacologic therapy, as it usually heals without taking any medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended.

Hot therapy is useful for back spasms or other conditions. A review concluded that heat therapy can reduce the symptoms of acute and sub-acute lower back pain.
Regular activity and gentle stretching exercises are recommended in uncomplicated back pain, and are associated with better long-term outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine can also be recommended. This exercise is associated with better patient satisfaction, although it has not been proven to provide functional improvement. However, one study found that exercise is effective for chronic back pain, but not for acute pain. If used, they should be done under the supervision of a licensed health professional.
Massage therapy can provide short-term pain relief, but not functional improvement, for those with acute lower back pain. It may also provide short-term pain relief and functional improvement for those who have long-term (chronic) and sub-acute lower pack pain, but these benefits do not appear to be sustainable after 6 months of treatment. There are no serious side effects associated with massage.
Acupuncture can relieve back pain. However, further research with strong evidence needs to be done.
Spinal manipulation is a widely used method for treating back pain, although there is no evidence of long-term benefits.
"Back to school" is an intervention consisting of educational and physical training. The 2016 Cochrane Review found evidence of returning schools of inferior quality and inability to generalize whether schools were effective again or not.

Drugs

If non-pharmacological measures are not effective, drugs may be tried.

Non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first. NSAIDs have been shown to be more effective than placebo, and are usually more effective than paracetamol (acetaminophen).
In severe back pain not lost by NSAIDs or acetaminophen, opioids may be used. However, the long-term use of opioids has not proven effective in treating back pain. Opioids do not always prove to be better than placebo for chronic back pain when risks and benefits are considered.
Skeletal muscle relaxants can also be used. Their short-term use has proven effective in relieving acute back pain. However, evidence of this effect has been disputed, and these drugs do have negative side effects.
In people with nerve root pain and acute radiculopathy, there is evidence that a single dose of steroids, such as dexamethasone, may provide pain relief.
Epidural corticosteroid injection (ESI) is a procedure in which a steroid drug is injected into the epidural space. Steroid drugs reduce inflammation and thereby reduce pain and improve function. ESI has long been used to diagnose and treat back pain, although recent research has shown a lack of efficacy in treating low back pain.

Surgery

Surgery for back pain is usually used as a last resort, when serious neurological deficits are proven. A systematic review of surgical studies again found that, for certain diagnoses, surgery is better than other general treatments, but the benefits of surgery often decrease over the long term.

Surgery is sometimes appropriate for people with severe myelopathy syndrome or cauda equina. Causes of neurological deficits may include spinal herniation, spinal stenosis, degenerative disc disease, tumors, infection, and spinal hematoma, all of which can affect the nerve roots around the spinal cord. There are several surgical options to treat back pain, and this choice varies depending on the cause of the pain.

When a disc is herniated compressing nerve roots, hemi- or partial-laminectomy or discectomy can be performed, in which the material compressing on the nerve is removed. Mutli laminectomy may be performed to widen the spinal canal in cases of spinal stenosis. Foraminotomy or foraminectomy may also be necessary, if the spine causes significant nerve root compression. The discectomy is performed when the intervertebral disk undergoes herniation or tearing. This involves removing discs that are bulging, partially or completely, which put pressure on the nerve roots. Total disk replacement can also be performed, where the source of the pain (damaged disc) is removed and replaced, while maintaining spinal mobility. When all discs are removed (as in discectomy), or when the vertebra is unstable, spinal fusion surgery can be performed. Spinal fusion is a procedure in which bone graft and metal hardware are used to repair together two or more vertebrae, thus preventing the spine bone from compression in the spinal cord or nerve roots.

If an infection, such as a spinal epidural abscess, is the source of back pain, surgery may be indicated when an antibiotic test is ineffective. Spinal hematoma evacuation surgery can also be tried, if the blood product fails to damage itself.

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Pregnancy

Approximately 50% of women experience low back pain during pregnancy. Some studies show women who experience back pain before pregnancy have a higher risk of back pain during pregnancy. It may be severe enough to cause significant pain and disability in up to one third of pregnant women. Back pain usually begins at about 18 weeks of pregnancy, and peaks between 24 and 36 weeks of gestation. About 16% of women who experience back pain during pregnancy report back pain that continues many years after pregnancy, suggesting them with significant back pain has a greater risk of back pain after pregnancy.

Biomechanical factors of pregnancy that have been shown to be associated with back pain include increased lower back curvature, or lumbar lordosis, to support additional weight in the abdomen. Also, a hormone called relaxin is released during pregnancy that softens the structural tissues in the pelvis and lower back to prepare for vaginal delivery. The softening and increased flexibility of the ligaments and joints in the lower back can cause pain. Back pain in pregnancy is often accompanied by radicular symptoms, suggested to be caused by fetal pressure on the sacral plexus and lumbar plexus in the pelvis.

Common factors that aggravate the back pain of pregnancy include standing, sitting, bending forward, lifting, and walking. Back pain in pregnancy can also be characterized by pain radiating to the thighs and buttocks, nighttime pain severe enough to wake the patient, increased pain during the night, or increased pain during the day.

Local heat, acetaminophen (paracetamol), and massage can be used to help relieve pain. Avoiding standing for long periods is also recommended.

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Economy

Although back pain usually does not cause permanent disability, it is a significant contributor to doctor visits and skipping weekdays in the United States, and is a major cause of disability worldwide. The American Orthopedic Surgeons Academy reports about 12 million visits to the doctor's office each year due to back pain. Work loss and disability associated with lower back pain cost more than $ 50 billion annually in the United States. In Britain in 1998, approximately Ãƒ, Ã‚ Â£ 1.6 billion per year was spent on expenses related to disability from back pain.

Chronic Back Pain - Ocala Orthopaedic Care, LLC

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References