Everything you need to know about back-pain

Back pain are classified into three types Neuropathic, Nociceptive and Mixed and different treatments works better for each type of pain.

• Neuropathic pain is caused by damage to nerve tissue. It is often felt as a burning or stabbing pain. One example of neuropathic pain is a “pinched nerve.”
• Nociceptive pain is caused by an injury or disease outside the nervous system. It is often an ongoing dull ache or pressure, rather than the sharper, trauma-like pain that is characteristic of neuropathic pain. One example of nociceptive pain is arthritis pain.
• Some people experience mixed pain, which is a combination of neuropathic and nociceptive pain.

The  deep, aching, dull or burning pain in one area of the back or travelling down the legs for more than 3 months is described as Chronic back pain. Patients may experience  numbness , tingling, burning, or a pins-and-needles type sensation in the legs. Regular daily activities may prove difficult or impossible for the chronic back pain patient. They may find it difficult or unbearable to work, for example, even when the job does not require manual labor. Chronic back pain tends to last a long time, and is not relieved by standard types of medical management. It may result from a previous injury long since healed, or it may have an ongoing cause, such as nerve damage or arthritis.

Acute back pain is commonly described as a very sharp pain or a dull ache of less than 3 weeks duration, usually felt deep in the lower part of the back, and can be more severe in one area, such as the right side, left side, center, or the lower part of the back. Acute pain can be intermittent, but is usually constant, only ranging in severity.

Acute back pain can be caused by injury or by trauma  to the back, but just as often has no known cause. Patients with acute back pain, even when it’s severe, will typically improve or completely recover within six to eight weeks.

Approximately half of all back pain patients have acute pain caused by trauma. A contusion, torn muscle, or strained joint resulting from a back injury can cause acute pain. Patients with any of these conditions typically exhibit pain, muscle spasms, and decreased functional activities.

Acute back pain treatment  is short-term and usually successful. With Physiotherapy or physical therapy  follow-up treatment, and prevention practices, these patients typically return to full functionality in a few weeks. Occasionally, these patients will re-injure themselves and have to return for a short course of treatment. Patients with acute pain occurring more than three times in one year or who experience longer-lasting episodes of back pain that significantly interfere with functional activities (e.g., sleeping, sitting, standing, walking, bending, riding in or driving a car) tend to develop a chronic condition.

Mechanical back pain—a form of acute pain—is aggravated by movement and worsened by coughing. This type of pain is usually alleviated with rest. Mechanical back pain is typical of a herniated disc, stress fracture or as a result of instability. For patients with this condition, particular movements of the spine usually cause pain. In addition, posture, coughing, sneezing, and movement can all influence pain coming from the spine.

In Lumbar disc disease , acute back pain is severe and travels down both legs,—the most common cause of true sciatica, another form of acute pain.

X-rays – Painless, non-invasive imaging process, also known as radiographs or roentgenograms, are used to diagnose and monitor the treatment of various disorders.

CAT Scan (computed axial tomography scan)[also called a CT scan] – Detailed three-dimensional images of a body from a collation of cross-sectional X-rays taken along an axis. Best investigation to diagnose bony disorders.

MRI (magnetic resonance imaging) – Non-invasive technique for imaging the spine that involves rotating a magnet around the body and exciting its hydrogen atoms. Best test to diagnose soft tissues, spinal cord and disc related pathologies.

Myelogram – A test procedure that involves injecting a radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves, and then taking X-rays of the spine. This allows the radiologist to specifically X-ray the nerve roots. In this way, any abnormalities within the spinal canal can potentially be identified to aid in the diagnosis of certain spinal problems, such as nerve compression or a disc rupture.

Bone Scan – A test procedure that involves intravenously injecting a small quantity of a radiographic marker into the patient, and then running a scanner over the area of concern. The scanner detects the marker, which concentrates in any region exhibiting high bone turnover. A bone scan is utilized when there is suspicion of tumor, infection, or small fractures, i.e., conditions that all result in high bone turnover. A Bone Scan does not replace the above tests, but may provide additional information by eliminating other serious problems.

Acute Back Pain

If you handle acute back pain with care and it won’t keep you down for long.

Almost everyone experiences acute back pain at some point in their life. A trip to the doctor is often an unfortunate result of a spirited soccer match or ambitious afternoon of garage cleaning!

Most sudden attacks of acute back pain are the result of overstretched muscles (strains) or ligaments (sprains). The pain may be most severe immediately after injury, or it may worsen gradually over a few hours. In most instances, back pain as a result of strain or sprain can be resolved following a conservative course of treatment—usually within two to six weeks—provided there are no serious underlying medical conditions. Identifying the cause of the pain, alleviating the pain— either at home or with your physician’s help—and avoiding re-injury are key to the healing process.

Common causes of strains and sprains that can trigger acute back pain include:

• Improper lifting
• Sudden, strenuous physical effort
• Accident, sports injury or fall
• Sleeping position and/or pillow positioning
• Poor sitting or standing posture
• Bending forward too long
• “Hiking” your shoulder to hold the phone receiver to your ear
• Carrying a heavy purse, briefcase or backpack
• Stress and muscle tension
• Physical conditions that can possibly contribute to the onset of acute back pain include:
• Lack of muscle tone
• Excess weight
• Pregnancy

Home Or Hospital?

Depending upon  the severity and cause of your acute back pain to determine whether you need to see a physician. Consult a physician immediately if you:

• Are experiencing numbness in, or having difficulty moving, your extremities
• Experience bladder control loss or impairment
• Develop a fever or severe headache
• Are over 60 and have been taking steroids for a long period of time
• Experience chest pain or pain in the left arm
• Are pregnant
• Do not experience any improvement after 72 hours of self-treatment at home

If you’re not experiencing any of the above symptoms, there are several things you can do at home to help soothe your sore back:

Bed Rest Isn’t Best. Going about your normal, everyday activities—but perhaps at a slower pace, and definitely avoiding what may have caused your pain in the first place—is a good way to start the healing process. A little “couch time” won’t hurt, but light activity speeds recovery, so avoiding lying down for long periods of time.

Hot And Cold – Heat and cold, in the form of a hot bath or hot and cold compresses, can help relieve sore and inflamed muscles and tissue. Remember-cold comes first! Wrap an ice pack (or a bag of frozen vegetables) in a thin cloth to avoid frostbite, and apply to the affected area for up to 20 minutes several times a day. Ice slows inflammation and swelling, numbs tissue and slows nerve impulses to the injured area.

Once the acute pain and muscle spasms subside (about 48 hours after the first onset of pain is recommended), you can apply heat—to loosen muscle tightness – by taking a warm bath or using a heating pad, heat pack or heat lamp.

Pain Relief In A Pill – Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, acetaminophen or naproxen sodium, can ease pain, swelling and stiffness. There are a number of over-the-counter and prescription options. Your pharmacist can help you determine which is best for you.

Support Yourself – If you must sit or stand for long periods of time, consider using a brace or corset. Worn properly, they can relieve pain and provide warmth, comfort and support. But, don’t rely on this type of external support too long—allowing it to perform your muscles’ job will eventually weaken them, making re-injury easier.

If your back pain hasn’t improved noticeably after 72 hours of self-care, contact your health care provider.

To prevent re-injury of your back and hopefully avoid any recurrence of acute back pain – it’s important to build and maintain the strength and flexibility of those muscles, tendons and ligaments that support your back and spine. You can do this through:

Exercise

Regular, low impact cardiovascular exercises that don’t jar your back and are easy on the joints, such as bicycling, walking or swimming. If exercising outdoors is not option, consider using a treadmill, elliptical trainer or stationary bicycle. These can be found at almost any exercise studio, or you can buy a home version at your local sporting goods store.

Core strengthening exercises. By conditioning your abdominal and back muscles, you can develop a “natural corset” to support your spine.

Gentle stretching to improve and maintain flexibility.

For back-strengthening programs at the beginner, intermediate and advanced levels, check out these exercises for the back and spine at back.com

A Healthy Lifestyle

Eat a nutrient-rich, balanced diet, with sufficient intake of calcium, Vitamin D and phosphorus. (Phosphate makes up more than half the mass of bone mineral; Vitamin D helps maintain appropriate calcium/phosphorus levels. When phosphorus is too high, the body takes calcium out of the bones to bind with the phosphorus and remove it from the blood. Bones become brittle as a result.)

Avoid smoking and excessive alcohol use.

Maintain a healthy weight – additional pounds place excess strain on spinal vertebrae and discs.

Stay well-hydrated. The body is 70% water, and sufficient hydration contributes to intervertebral disc health and that of other back related structures and functions.

Get your vision checked. Poor vision can affect the way you carry yourself, which can contribute to back problems.

Proper Body Mechanics

When Standing

• Place feet shoulder width apart, don’t lock your knees;
• Avoid arching your lower back or slumping your upper back and shoulders;
• Keep your breastbone up, shoulder blades down;
• Keep your chin level, relax jaw and neck muscles.

When Sitting

• Rest your feet on floor with knees and hips bent 90 degrees;
• Maintain a neutral arch in your lower back;
• Keep your breastbone up, shoulder blades down;
• Keep your chin level, relax jaw and neck muscles.

When Driving

• Adjust your seat so that the back is vertical. Your back should be supported by the seat back and your head should rest against headrest with your chin level;
• Knees should be bent, and at least at the same height as your hips;
• Elbows should be slightly bent and relaxed, with your shoulders down.

When Sleeping

• Use a firm mattress. Placing a board between the mattress and box spring can provide a temporary fix for one that is sagging.
• Lie on your back or side. When lying on the side, a pillow between the knees helps maintain a neutral spine.
• Use a cervical roll (a foam roll approximately 3 inches in diameter and 18 inches long) to support the natural curves in your neck or low back.