Back pain

Back pain is a common symptom that affects 60–80% of people at some time in their lives.

The prognosis (outcome) is generally good. After 2 days, 30% are better and 90% have recovered by 6 weeks. Recurrences  of  pain  may  occur  and  about  10–15%  of patients  go  on  to  develop  chronic  back  pain  that  may  be difficult  to  treat.  Psychological  elements,  such  as  job  dissatisfaction,  depression  and  anxiety,  are  important  risk factor.

Causes of Back pain

  • Mechanical back pain
  • Prolapsed intervertebral  disc
  • Osteoarthritis
  • Vertebral fracture
  • Spinal stenosis
  • Paget’s disease
  • Spondylolysis
  • Bone metastases etc.

Others causes

Renal colic, Pyelonephritis

Pelvic inflammatory disease

Pancreatitis

Peptic ulcer disease

 

What causes back pain in children?

These injuries are usually caused by activity and overuse. Scheuermann’s disease causes pain that is not severe enough to limit activity. It is the second most common cause of back pain in children and young adults. Your child may have a rounded spine.

Can Stomach pain be caused by back pain?

A back injury or injury to the spine can cause pain to radiate in the abdomen. Also, a pinched nerve can not only cause pain to the entire area served by that nerve, but it can also cause various stomach functioning problems as well. Inflammation of the colon, or colitis, is very often associated with lower back pain.

Why do girls have back pain?

Lower back pain during your period, or primary dysmenorrhea, is caused by contractions in the uterus.

What causes muscle spasms in the lower back?        

Back spasms can be the result of injuries to the muscles, tendons, and ligaments in the back or it can be related to more serious medical conditions. Heavy lifting is a common cause of back spasms. Any activity that puts excessive strain on the muscles and ligaments in the lower back can cause an injury.

 

Symptoms of mechanical low back pain

  • Pain  varies  with  physical  activity  (improved  with  rest)
  • Sudden  onset,  precipitated  by  lifting  or  bending
  • Recurrent  episodes
  • Pain  limited  to  back  or  upper  leg
  • No  clear-cut  nerve  root  distribution
  • No  systemic  features
  • Prognosis  good  (90%  recovery  at  6  wks)

 

Red flags for possible spinal pathology (Danger features)

  • Age:  presentation  <  20  yrs  or  >  55  yrs
  • Character:  constant,  progressive  pain  unrelieved  by rest
  • Location:  thoracic  pain
  • Past  medical  history:  carcinoma,  tuberculosis,  HIV,  systemic corticosteroid  use,  osteoporosis
  • Constitutional:  systemic  upset,  sweats,  weight  loss
  • Major  trauma

Investigations

Investigations are not required in patients with acute mechanical back pain.  Those  with  persistent  pain  (> 6  weeks)  or  red  flags  should  undergo further  investigations such as MRI, X-Ray, Bone scan and some blood tests.

What are the treatment of LBP?

General

  • Self-limiting nature of the condition.
  • Stay active, exercise is helpful rather than damaging
  • Medication if necessary (preferably at fixed time intervals).
    • Paracetamol
    • NSAID like ibuprofen, indomethacin, naproxen.

Regular use, improved mobility, and facilitate exercise

  • Doctor may consider opioids, muscle relaxant medicine
  • Bed rest is not helpful it increase the risk of chronic disability
  • For pain relief doctor may consider spinal manipulation
  • Lumbar supports, back-specific exercises, traction, acupuncture, epidural or facet injections not helpful for mechanical back pain
  • Physiotherapy may be required if not improved within 6 weeks
  • Low dose Tricyclic anti-depressant drugs will help pain, sleep and mood

Specific

Treatment of other causes should be done accordingly with involving other special departments as per doctor advice.

What should we do for back spasms?

Warm water compression helps to promote healing by drawing healthy blood cells to the area of the back spasm. Heat also relaxes the nerves and muscle fibers. Try an ice & heat alternate cycle after the first 72 hours. Some physical therapists suggest using heat applications before stretching and ice after stretching.

What is the cause of muscle spasms?

Spasms may affect many different types of muscles in the body, leading to many different symptoms. Spasms of skeletal muscles are most common and are often due to overuse, dehydration, and electrolyte abnormalities. The spasm occurs abruptly, is painful, and is usually short-lived.

How do you get rid of a muscle spasm?

Natural Treatments for Muscle Spasms.

  • Prevent Electrolyte Imbalances. A potassium and/or magnesium deficiency can contribute to muscle spasms.
  • Stretch and Massage Your Muscles.
  • Stay Hydrated.
  • Use Ice or Heat Packs on Sensitive Muscles
  • Fix Your Posture.
  • Take a Bath with Epsom Salt.

How long does it take to heal from a back spasm?

After the first three days, you can start using heat to loosen muscle tightness and increase blood flow. Waiting at least 72 hours after your spasms start allows the initial swelling and inflammation to go down, and moist heat is generally preferred to dry because it reduces the potential for dehydration.

Dr. Md Elias Bhuiyan

MBBS, FCPS (Medicine)

Registrar

Bangladesh Medical College & Hospital, Dhaka.

Low Back pain

What is lumbago?

Pain in the lower part of the back is commonly referred to as Lumbago. It can be defined as mild to severe pain or discomfort in the area of the lower back.

The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.

It can occur at any age but is a particular problem in younger people whose work involves physical effort and much later in life, in the elderly.

In most cases it settles in a few weeks but for some it is a persistent problem.

What causes lumbago?

In the majority of cases, it is impossible to identify the exact cause of low back pain.

There may, for example, have been tiny strains or tears of some of the small muscles and ligaments, which can be difficult to pinpoint within the complex structure that is the human back.

Often, these patients are suffering from conditions like arthritis of tiny joints called facet joints between the vertebral bones, a slipped disc (prolapse of an intervertebral disc), a collapse or fracture of one or more vertebrae (this is more likely in older patients especially when they have fallen or there is osteoporosis or brittle bones), deformation of natural spine curvature (scoliosis) or more rarely, skeletal damage due to tumours or infection.

What are the symptoms of lumbago?

  • Pain across the lower part of the back that sometimes radiates into the buttocks, the back of the thigh or to the groin. The pain is usually worse on movement.
  • Limitation in movement of the spine – especially bending forward and leaning back.
  • Tense spasm of the muscles surrounding the spine and causing a stiff back.
  • With severe pain and spasm, the back may tilt to one side causing a change in posture or a limp.
  • The pain is sometimes accompanied by a tingling sensation or numbness in the back or buttocks or leg, which may pass right down into the foot. This is called sciatica, and it indicates irritation of the sciatic nerve, which passes down from each side of the spine to the feet.

What are the danger signs?

If you suddenly find out that you are unable to control your bladder or bowel movements or if the area of the lower back or legs suddenly turns numb or weak, contact a doctor or accident and emergency (A&E) immediately.

If you suffer from backaches and notice reduced strength or muscle bulk in one or both legs, you should also get checked by a doctor.

These warning signs indicate that damage in the spine may be causing compression of the spinal cord and/or the nerves which branch out from it, and early treatment is essential if permanent damage is to be avoided.

What can be done at home to ease back pain?

Acute low back pain

  • Use simple painkillers regularly. Your GP may also sometimes prescribe special medicines which relax the muscles of the back. Research shows that NSAIDs (nonsteroidal anti-inflammatory drugs eg ibuprofen) and muscle relaxants relieve pain better than placebo. Some people prefer paracetamol. Painkillers should be taken regularly throughout the day, for a couple of days, not just when pain becomes intolerable.
  • Activity is beneficial. Stay active. Get on with your life within the limits of your pain. This helps to keep the muscles that support the spine strong and prevents scar tissue from forming and causing stiffness.
  • Warmth (such as hot packs or capsaicin heat creams) helps, as does swimming in a warm pool.
  • Rest and sleep lying on a firm, flat surface, if possible.
  • Avoid stooping, bending, lifting and sitting on low chairs.
  • Bear in mind that backaches are rarely caused by a serious illness and usually settle in a few days.

Chronic low back pain

If your backache persists for a long period, more than a few weeks, you should consult your GP who can advise on what to try next.

They are unlikely to suggest an X-ray or other type of scan as these are rarely of any help.

National recommendations advise that patients with persistent low back pain (which has lasted more than 6 weeks) should be offered their choice of one of several treatment options:

  • a structured exercise programme, which should be tailored to the person and comprise of up to a maximum of 8 sessions over a period of up to 12 weeks
  • a course of manual therapy (such as physiotherapy, or treatment from an osteopath or chiropractor)
  • or a course of acupuncture.

Low back pain benefits from regular activity, attention to posture and seating, back schools, behavioural therapy and multidisciplinary pain treatment programmes. Your GP can refer you if appropriate.

There is no evidence that use of antidepressants, traction, facet joint injections and EMG (electromyography) feedback are effective.

How does the doctor make a diagnosis?

In most cases, a back problem can be diagnosed by a doctor from the information given by the patient, although they may not be able to establish the cause.

Physiotherapists and chiropractors usually perform an especially thorough examination and will observe the movement of the joints in the spine, pelvis, and hips; perform orthopaedic and muscle tests and check to see if any nerves are trapped in the spine.

Generally speaking, it is seldom necessary to take X-rays, scans or blood tests in order to rule out more serious underlying causes of back pain.

However in some cases an X-ray or MRI of the spine can be very useful to assess the health of the intervertebral discs, check for fractures and look for compression of the nerves.

How is lumbago treated?

What does the research tell us about how effective treatments are?

Acute low back pain

Shown to be beneficial by research:

  • NSAIDs such as ibuprofen.
  • advice to stay active
  • colchicine, antidepressants

Likely to be beneficial:

  • other simple analgesics such as paracetamol
  • spinal manipulation

Trade off between benefits and harms: muscle relaxants.

Effectiveness unknown: colchicine, antidepressants, epidural steroid injections, facet joint injections, back schools, behavioural therapy, EMG feedback, back exercises, multidisciplinary treatment, lumbar supports, physical treatment, TENS (trans electrical nerve stimulation).

Likely to be ineffective or harmful: bed rest, traction.

Chronic low back pain

  • Beneficial: back exercises, multidisciplinary treatment.
  • Likely to be beneficial: analgesics, NSAIDs, triggerpoint and ligament injection, back schools, behavioural therapy, spinal manipulation.
  • Unknown effectiveness: colchicine, antidepressants, muscle relaxants, epidurals, steroid injections, acupuncture, TENS, physical treatments, lumbar supports, advice to stay active.
  • Unlikely to be beneficial: bed rest, EMG biofeedback.
  • Likely to be ineffective or harmful: facet joint injections, traction.