Back pain is an ache or pain that occurs anywhere along the spine or back. It can range from mild physical discomfort to a more serious disabling condition.
The spinal column or backbone is a very strong and equally flexible part of the body. It has 24 bones called vertebrae, with discs between each of them. The discs act as cushions between the vertebrae. Facet joints on the back of the spine allow for flexibility and movement.
The vertebrae protect the spinal cord, which is a bundle of nerves that start from the base of the brain and end at the tailbone. The backbone also supports the weight of the body and provides structure to the body.
In most cases, back pain occurs due to a minor strain in a ligament or muscle. It is best to continue with daily activities and increase movement in such cases. Using painkillers will help to overcome the initial discomfort during this phase.
With increasing age, the structures of the spinal column also tend to undergo wear and tear and become stiffer than normal.
Symptoms
It starts as an ache or pain in the back and may radiate down to the leg on either side.
If the pain does not subside and is accompanied by loss of weight, fever, swelling on the back, or if it spreads below the knees, it should be diagnosed by a specialist.
Back pain along with numbness in the legs, weakness and sudden weight loss or tingling sensations indicates a more serious underlying cause and requires a visit to hospital.
Causes
Often, back pain is caused due to a combination of factors:
Bad posture: Sitting in a hunched position for long periods. A lack of exercise causes stiffness of the spinal column and pain.
Sprain or spasm in the muscles, making sudden and awkward movements or lifting very heavy objects.
Interestingly, an increase in back pain does not mean a graver condition.
A few specific structural problems can also cause back pain:
Spondylosis: As part of the ageing process, the discs between the vertebrae undergo degeneration and become thinner than before. The spaces between the bones become narrow. This increases friction and results in the formation of small bony spurs. This condition is called spondylosis and is the equivalent of osteoarthritis seen in the knees and other joints.
Sciatica: Sometimes a disc may bulge out beyond its normal and start pressing on a nerve within the spine. This causes a pain in the back that usually travels along down to the leg on one side.
Spinal stenosis: In this case too, the pain is a result of a bone pressing on the small space around the spinal cord. The pain arises during walking and is relieved by rest.
Scoliosis: An abnormal curvature of the spine to one side called scoliosis. This condition is seen mostly in adolescents and can worsen with age, causing chronic back pain.
Osteoporosis: The vertebrae become brittle and porous, making them prone to compression fractures.
Kidney stones and kidney infections can also manifest as back pain.
Diagnosis
A description of symptoms and a physical examination are usually enough to make a diagnosis.
If the back pain is due to an injury or there is an underlying disease, then further tests may be required.
- X-ray examination helps to identify any injury to the bones and arthritis if present.
- CT scans and MRIs may be advised and are useful to observe problems with discs, tendons, ligaments and muscles.
- Bone scans: Small amounts of radioactive tracers are injected into a vein. A special tracer-sensitive camera is then used to scan and collect images. These scans can provide information about bone metabolism and help to diagnose infections and to detect any cancer that may have spread to the bone.
- An Electromyography (EMG) is done to study the health of muscles and the nerves that act on these muscles. Using tiny electrodes, the EMG translates electrical impulses from nerve cells to muscles. The results can be visualised as graphs or sounds and used to diagnose any dysfunction of nerves and muscles.
Treatment
It is important to continue with routine activities even in the presence of back pain.
Medication
Simple painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) for a short course will help to control the pain during everyday activities.
Alternatively, anti-inflammatory gels and creams also help when they are rubbed on the affected area.
Heat and ice packs may be applied for short durations.
If the pain is not controlled by NSAIDs, then antidepressants and muscle relaxants help to control the symptoms. These tablets have to be started in small doses and gradually increased. This approach lowers the risk of potential side-effects.
Sometimes anti-epileptic medicines are prescribed for their ability to relieve nerve pain.
Other therapies
Physiotherapy helps to strengthen the back and improve flexibility. Specific exercises are recommended for specific kinds of pain and they should not be tried without professional guidance.
In the case of a slipped disc, traction using pulleys and weights will help to move it back into position.
Epidural injections
For severe pain associated with sciatica, injections of steroids are given into the space around the spinal cord.
Surgical intervention is not usually needed for back pain except in rare circumstances.
