Ix Referred Pain To The Lumbar Spine
Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back.Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve. For example, a pinched nerve in the neck may cause pain that is felt in the arm or hand. Sources of referred pain may include abdominal aneurysm , tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine.
Previous Consultations Or Treatment
- What previous treatment have you had?
- Have you seen a chiropractor?
- Have you seen a therapist?
- How successful or non-successful has that treatment been?
- Have you seen a surgeon and if so, what did they say?
- Did you have previous spine surgery and if so, what procedure?
- What happened to your symptoms with the prior surgery?
Disclaimer: This symptom description list may seem obtrusive, long and picky but believe it or not, this symptom list is not fully thorough. Many other factors can cause symptoms. For example, there are disorders that can mimic the pain that you describe but not be spine related at all. However, for the majority of patients, this list will be a reasonable start regarding how spine pain should be described to your provider.
Additional Types Of Back Pain
Inflammatory back pain and back pain associated with cancer or infections are rare causes of back pain, but when they do occur, proper treatment and condition management can make a world of difference. Talk with your doctor if you feel that a separate medical problem is causing your back pain. Youll also want to let your doctor know if your back pain is keeping you awake at night or if it isnt at all relieved by rest.
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What Type Of Back Problemdo I Have
The reality is 80% of us will suffer from back pain at some point in our lives. And yet, getting the correct treatment to alleviate back pain can be a frustrating and challenging task, for both patients and healthcare providers.
Anytime such a large percentage of the population suffers from an ailment, you can be certain an entire economy will pop up purporting to be able to solve the problem. For this reason, theres a lot of nonsense out there about new and unique methods to cure back pain. As a general rule, the word cure is misleading and deceptive, and will leave patients frustrated and disenchanted with their progress. However, with the right treatment approach you can effectively manage back pain and reduce the negative impact it has on your life.
Many of the solutions marketed to patients treat back pain as a single diagnosis. In fact, the term back pain is not really a diagnosis at all, rather a description of a symptom. Treating all patients that present with back pain the same is like prescribing antibiotics to every patient with abdominal pain. Just as there are many diagnoses that cause abdominal pain, there are several distinct types of back pain.
How To Effectively Communicate Back And Neck Pain To Your Physician
What you consider excruciating lower back pain may be described by someone else with the same issue as a mild discomfort. Since back and neck pain can be highly subjective in terms of how someone describes their level of pain, its important to clearly articulate what youre experiencing to your doctor so that they can come up with a treatment plan thats more likely to produce positive results.
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Back Pain Can Come From Many Places
Every day, your back is subjected to a wide range of forces and movements twisting, lifting, sudden jolts, slouching over a desk, etc. All of these things are made possible by your backs complex anatomy, which includes:
- Large muscles that lift and support the spine
- Bones of the spine
- Ligaments that hold your vertebrae together
- Tendons that attach muscles to the spine
- Spinal nerves that transmit brain signals to the rest of the body
- Facet joints that connect vertebrae together
- Intervertebral discs that provide shock absorption for the spines bones
When any one of these anatomical structures is injured, or is not working in balance with the rest of the back, you may experience back pain. Because there are so many possible underlying causes, it can be difficult to identify the source of the pain and provide effective back pain treatment.
How Long Should I Try Self
Every person with sciatic pain is different. The type of pain can be different, the intensity of pain is different and the cause of the pain can be different. In some patients, a more aggressive treatment may be tried first. However, generally speaking, if a six-week trial of conservative, self-care treatments like ice, heat, stretching, over-the-counter medicines has not provided relief, its time to return to a healthcare professional and try other treatment options.
Other treatment options include:
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Establishing A Basis For Your Pain
Most board-certified physicians in Los Angeles tend to use a rating of 1-10 to determine the severity of a patients back or neck pain. The problem is the lack of a clear frame reference. Instead, consider using a specific scale you and your doctor agree on to describe your pain in a way that you both can understand. Example: On a scale of 1-10, 1-3 is mild and anything from 7 and up is severe.
What Structures Make Up The Back
The lower backwhere most back pain occursincludes the five vertebrae in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.
Other regions of vertebrate are cervical , thoracic , and sacral and coccygeal segments.
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Transparency Of Medical History
The most important part of your consultation is the discussion of your medical history. You should be completely transparent with your doctor, answering all of their questions accurately. Let them know of all past diseases and issues, even if they seem unrelated to you. Mention all of the medications youre currently on. This will help the pain doctor determine which pain treatments would be ideal for you.
Dont Wait To Get Relief: Learn More About Your Chronic Back Pain Treatment Options
If you have chronic back pain, chances are youre experiencing more than aching discomfort.
Youre not able to pick up your kids or grandkids. Youre missing out on your favorite activities. Youre not living your best life. And an active physical therapy program can help you get you back to it.
To learn more about the PNBC program, schedule an in-person or video visit consultation.
Ready to heal your chronic back pain? Get started by scheduling a consultation appointment.
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When Should I Call My Health Care Provider
See your health care provider if you have:
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Loss of bladder or bowel control, with weakness in both legs. These symptoms require immediate attention
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Severe back or neck pain that does not decrease with medication and rest
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Pain after an injury or a fall
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Weakness, numbness, or tingling in your legs or arms
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Fever
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Back and neck problems range from minor aches to severe, disabling pain
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Often, the reasons for your pain cannot be identified.
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See a health care provider if you have numbness or tingling, severe pain that does not improve with medication and rest, difficulty urinating, weakness, pain, or numbness in your legs, fever, unintentional weight loss, or pain after a fall.
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Often, back and neck pain will improve over time. Consult with your health care provider if your pain is not decreasing.
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Use prevention strategies to keep yourself healthy and injury-free.
For severe, disabling, or chronic back pain, consider an individualized rehabilitation program.
Viii Lower Back Pain And Cancer
Cancer involving the lumbar spine is rare. However, in people who have a prior history of cancer, for example, in the breast or prostate, or who have weight loss or loss of appetite along with back pain cancer needs to be considered.
Night pain can be a clue to cancer in the spine. A benign tumor called osteoid osteoma, which most often affects young people, causes pain that tends to respond well to aspirin. Multiple myeloma is a malignancy that occurs when the plasma cells in the bone marrow begin spreading uncontrollably. It is most common in older people, and can cause pain in many parts of the spine. When tumor or infection are suspected, blood tests may be ordered, including a CBC , sedimentation rate , and protein electrophoresis .
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The Phenomenon Of Back Pain/discomfort In Pregnancy
The review of the literature suggested that several physiological changes occur in pregnancy that potentially may cause back pain/discomfort . These potential causes of back pain/discomfort in pregnancy can best be described by examining three aspects: functional back changes, dysfunctional back changes, and additional factors that contribute to back pain/discomfort in pregnancy.
When Is Surgery Considered
Spinal surgery is usually not recommended unless you have not improved with other treatment methods such as stretching and medication, your pain is worsening, you have severe weakness in the muscles in your lower extremities or you have lost bladder or bowel control.
How soon surgery would be considered depends on the cause of your sciatica. Surgery is typically considered within a year of ongoing symptoms. Pain that is severe and unrelenting and is preventing you from standing or working and youve been admitted to a hospital would require more aggressive treatment and a shorter timeline to surgery. Loss of bladder or bowel control could require emergency surgery if determined to be cauda equine syndrome.
The goal of spinal surgery for sciatic pain is to remove the pressure on the nerves that are being pinched and to make sure the spine is stable.
Surgical options to relieve sciatica include:
Microdiscectomy: This is a minimally invasive procedure used to remove fragments of a herniated disk that are pressing on a nerve.
- Laminectomy: In this procedure, the lamina that is causing pressure on the sciatic nerve is removed.
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Incorporate The Locates Pain Scale
The LOCATES scale helps patients accurately describe pain, along with other varying symptoms and sensations associated with the pain. This system is an acronym for the following:
- Location Where is the pain felt? How does it travel? Is it isolated, or does it spread to other parts of the body?
- Other Symptoms Do you experience other symptoms alongside pain, such as weakness, fatigue, nerve pain in the knuckles, etc.?
- Characteristics of Pain This aspect of the scale is most commonly misunderstood because the character of the pain is the most accurate description of pain. Use adjectives such as throbbing, sharp, dull, aching, and hot to describe the pain to the best of your ability.
- Aggravating/Alleviating Factors Determine what makes your pain worse, and what makes it feel better. Inform your spine surgeon of what medication youve been taking to give your surgeon a better idea of your pain.
- Timing How long does the pain last? Is it constant, or infrequent?
- Environment What activities do you normally do that causes the pain to occur?
- Severity of the Pain Rate the pain on the 1-10 scale youve established with your doctor, and use adjectives to describe what those numbers mean.
If youre experiencing back pain, and are seeking a better source for treatment, then contact Dr. Diana Wilson at the Neurosurgical and Spine Consultants, located in Fort Worth, TX, to schedule a back pain appointment today.
Other Sources Of Stress And/or Trauma
Its also possible that there may be no apparent cause for your back pain. In cases like these, your doctor will ask if any significant event in your life has caused you stress, or if youve started or stopped doing a repeated activity. Your back is very sensitive to changes in routine, which can cause mild to severe back pain.
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How To Explain Your Back Pain To Your Doctor
Being in pain is . . . well, painful. But it can also be frustrating and annoying. When your pain is affecting your mood, your activities and your overall quality of life its time to talk to your doctor about your treatment options. But how do you explain something thats so overwhelming? Follow these guidelines for ways to effectively explain your back pain to your doctor and get the treatment that you need to get back to normal.
Use Words That Describe The Pain
The quality of your pain may mean something about what’s causing it. For example, if you experience burning, stabbing or electrical sensations down one leg or arm, it may indicate a compressed or irritated spinal nerve root .
If you can expand the pain vocabulary you use in your journal, you may find communicating with your healthcare provider is easier and more fruitful for you.
The McGill Pain Questionnaire from McGill University in Canada provides a series of descriptive words that some healthcare providers will use to try to get an insight into your pain, whether during the initial diagnostic process or at the follow-up and monitoring experiences. The words are categorized according to 3 questions that may help you describe the pain. They are:
- What does your pain feel like? Expanding your existing vocabulary with more descriptive words may come in handy here.
- How does your pain change with time? Example words include constant, intermittent, at night only, etc.
- How strong is your pain? With this category of questions, we’re back to the intensity piece discuss above.
Examples of descriptive words that describe pain, taken from the McGill Pain Questionnaire, include flickering, nauseating, rhythmic, squeezing, blinding, boring. These are just a few, but hopefully, you get the idea. The more expansive you can be with your language while keeping it accurate, the better your communication with your healthcare provider will likely be.
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Clarify The Timing Of Your Pain
The “when” of back pain, if it comes on suddenly or gradually, if it is present constantly or only sometimes, or if there is a particular time of day when it always shows up, is key information to your healthcare provider as she or he goes through the process of determining a diagnosis. Healthcare providers evaluate changes in pain patterns to monitor your progress and to be on the lookout for new problems.
Understanding your individual patterns of pain may also help your healthcare provider determine the best time for you to take medication.
More specifically, pain may come and go, which is called intermittent pain, or it can always be there, but with fluctuating severity. This second version is called variable pain.
People with variable pain may also experience breakthrough pain and background pain. Breakthrough pain is a temporary condition where pain is extremely severe and may benefit from medication or a specific pain management strategy. Background pain is of lower severity but is fairly constant.
There’s also stable pain, where the pain, which also includes its intensity, is always constant.
Explore All Your Options
In many cases, goes away with time. Other treatment options include surgery, , and alternative interventions like yoga, massage, and relaxation. Tell your doctor about back pain treatments youve already tried, whether they worked or not, and if you plan to continue using them.
Then, ask your doctor to list all the potential treatments for your pain, along with the benefits and risks of each. In most cases, youll want to consider invasive treatments like surgery only if medication, exercise, and other conservative therapies are not working for you.
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V Inflammatory Lower Back Pain
Although comparatively few patients have low back pain due to inflammation, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.
Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications.
People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. Its important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.
Reactive arthritis syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:
