Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. WebMD takes a look at living with and managing chronic back pain. Back pain symptoms can range in intensity from mild to severe. Back Strain One of the main causes of back pain, whether acute or chronic, is low back strain.
Pain? Back What Chronic is
These red flags include: There is moderate quality evidence that suggests the combination of education and exercise may reduce an individual's risk of developing an episode of low back pain.
Patients with uncomplicated back pain should be encouraged to remain active and return to normal activities. The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual's ability to function in everyday activities, to help the patient cope with residual pain, to assess for side-effects of therapy, and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery.
For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long-term pain relief.
Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better. Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them.
The present stage of the condition acute or chronic is also a determining factor in the choice of treatment. Back pain is generally treated with non-pharmacological therapy first, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended.
Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident. Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome.
When a herniated disc is compressing the nerve roots, hemi- or partial- laminectomy or discectomy may be performed, in which the material compressing on the nerve is removed. A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root.
Spinal fusion is a procedure in which bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots. If infection, such as a spinal epidural abscess , is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective. Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of the lower back, or lumbar lordosis , to support the added weight on the abdomen.
This softening and increased flexibility of the ligaments and joints in the lower back can result in pain. Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.
Local heat, acetaminophen paracetamol , and massage can be used to help relieve the pain. Avoiding standing for prolonged periods of time is also suggested. Although back pain does not typically cause permanent disability, it is a significant contributor to physician visits and missed work days in the United States, and is the single leading cause of disability worldwide.
From Wikipedia, the free encyclopedia. Back pain Different regions curvatures of the vertebral column Specialty Orthopedics Back pain is pain felt in the back. Retrieved 1 August Diagnosis and treatment of back pain. Accessed December 12, The Anatomy of Pain in Backache". From Occiput to Coccyx.
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Spinal disease M40—M54 , —, Simple musculoskeletal back pain accounts for the majority of cases. It is mechanical in nature and occurs in the age group of 20—55 yr.
Pain occurs mainly around the lumbosacral area and the buttocks; it is often associated with referred leg pain into the upper thighs that rarely extends below the knees. The pain is typically described as a dull ache that varies with physical activity. Patients are generally otherwise physically well.
The intervertebral discs form the main articulation between the vertebral bodies. The disc is formed by an outer layer annulus fibrosus that consists of concentric bands of fibrous lamellae. The disc receives its sensory innervation from the sinuvertebral nerve and grey rami communicantes. The nucleus pulposus occupies the central area of the disc and it consists of a network of collagen fibres enmeshed in a mucoprotein gel. The nucleus pulposus has no sensory innervation, so its degradation is not a direct cause of pain.
Discogenic pain probably occurs as a result of internal disc changes that lead to leakage of the contents of the nucleus pulposus into disruptions within the annulus fibrosus. The sacroiliac joint is the largest axial joint in the body and it is surrounded by a fibrous capsule.
Pregnancy may lead to pain in the sacroiliac joints. In sacroiliac pain, as with the majority of causes of mechanical back pain, there are no unique identifying features in the history and physical examination to pin point this diagnosis.
However, pain arising from this joint has been recorded rarely above the level of the transverse process of L5. Stressing the joint may reproduce the patient's pain. The facet joints zygapophysial joints consist of paired synovial joints formed from the superior articular process of one vertebra and the inferior articular process of the vertebra above Fig.
These joints function to stabilize the spine and limit rotation and shift. Certain features in the history may suggest facet joint involvement in the generation of pain e. Unfortunately, these signs are not specific to facet joint pain and a diagnosis cannot be made by history and examination alone.
Ligaments of the spinal column help to stabilize the spine and set limits to certain movements. Strains or tears in these ligaments can cause chronic back pain. The muscles of the lumbar spine may also be a source of pain myofascial pain. Such pain is characterized by the presence of trigger points in the muscles.
This is defined as a tender point in a taut band of muscle that can cause referred pain. Palpation or needling of these trigger points can reproduce the patient's pain. Spinal nerve root pain is often well localized, radiating down the leg in a dermatomal pattern.
The radicular element is characteristically much worse than the associated back pain because it is neuropathic. The pain typically radiates below the knee into the foot. It is described as a sharp, electric shock-like pain and is well localized. Nerve root pain should not be confused with referred back pain; the latter rarely extends below the knee and is poorly localized.
Paraesthesia may occur along the same dermatomal distribution as the pain. Coughing, straining and sneezing often reproduce or exacerbate radicular pain. Both the straight leg raise test and femoral stretch test can be used to elicit signs of nerve root irritation. Neurological examination may reveal sensory, motor and reflex abnormalities.
Nerve root pain can be caused by disc herniation, spinal stenosis and epidural adhesions. The nerve roots leave the spinal canal via the intervertebral foramina.
These are bounded anteriorly by the posterior longitudinal ligament, intervertebral discs and vertebral bodies. They are bounded posteriorly by the facet joints, pedicle and ligamentum flavum Fig. Posterior disc herniation can compress nerves directly by herniation into the central canal or into the intervertebral foramen.
The peak age for disc herniation is 30—55 yr. The disc can become increasingly prone to herniation secondary to tears and degeneration in the annulus fibrosus. Pain arises from compression of the nerve roots and also from inflammatory changes that occur in response to the herniated disc material. Spinal stenosis typically occurs after the age of 55 yr and is a result of bone and ligament hypertrophy leading to reduction in the diameter of the spinal canal and intervertebral foramina causing compression and chronic inflammatory changes of the nerve roots with the development of adhesions.
Its clinical features include neurogenic claudication pain that occurs after 10—20 min of walking. It is important to differentiate this from claudication pain secondary to vascular insufficiency.
Extension of the spine exacerbates pain and flexion often eases it. Patients often describe walking up hill easier than walking on the flat; they can often cycle even if they cannot walk.
Epidural adhesions can lead to nerve root pain. These can occur after spinal surgery, chronic inflammation as a response to leakage of nucleus pulposus from damaged discs or from cytokines released from facet joints. Pain associated with epidural adhesions is mostly continuous and independent of activity; the distribution of pain can be mono- or multi-segmental, and unilateral or bilateral.
History and examination of the patient by appropriate healthcare professionals allows triage that will guide management. It is not necessary for all patients with back pain to be triaged by medical staff and assessment by other professionals e. It is essential to assess any associated disability. Specific questions should be asked about restrictions to activities of daily living e.
Questionnaires can be used as more reproducible assessment tools; two commonly used questionnaires are the Oswestry Disability Index and the Roland Disability Questionnaire. It is also important to look for features of anxiety e. Depression may also present with anhedonia, hopelessness, loss of self-esteem, appearing withdrawn and crying; it may also be associated with some physical symptoms including early morning awakening, and loss of appetite and libido.
Patients with persistent pain often present with anger. These problems may indicate the need for more formal psychological assessment and management.
The history and examination are likely to dictate the most appropriate investigations and referral pathways for patients in this category.
When to Worry About Low Back Pain
Back pain is one of the most common reasons people go to the doctor. Back pain that lasts more than three months (chronic) is less common. I have worked with many truly miserable chronic low back pain patients, and of course the huge economic costs of back pain are cited. Surgery can also be an option for chronic back pain if there is a known cause confirmed by imaging and if other treatments didn't help. “Get opinions from at least.