How Is Chronic Back Pain Diagnosed
Your healthcare provider will ask if you have any medical conditions. He or she may ask if you have a history of back pain and how it started. He or she may watch you stand and walk, and check your range of motion. Show him or her where you feel pain and what makes it better or worse. Describe the pain, how bad it is, and how long it lasts. Tell your provider if your pain worsens at night or when you lie on your back.
When To See A Doctor
There is not always an obvious cause of lower back pain, and it often gets better on its own. Resting, trying hot or cold therapy, taking OTC pain relievers, and gently stretching may help speed up recovery.
However, a person should see a doctor for lower back pain that is severe, does not seem to be getting better, or occurs alongside other concerning symptoms, such as tingling or numbness down the legs.
People with lower back pain should seek immediate medical attention if they also have any of the following symptoms:
- difficulty walking or moving the legs
- loss of bowel or bladder function
- loss of sensation in the legs
- very severe pain
A doctor can help a person identify potential causes of lower back pain and recommend appropriate treatment.
Complementary And Alternative Techniques Include:
- Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them , which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
- Behavioral approaches include:
- Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature people regulate their response to pain by using relaxation techniques
- Cognitive therapy involves using relaxation and coping techniques to ease back pain
Spinal injections include:Trigger point injections can relax knotted muscles that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point can lessen or relieve pain.
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Unexplained Acute Low Back Pain
Unexplained low back pain means chronic pain that comes on gradually, over time, with no specific injury, event, or illness causing it.
- Prolonged sitting and lack of fitness can weaken back muscles and cause pain from lack of support.
- Ankylosing spondylitis, a form of arthritis.
- Spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord.
- Certain types of cancer, in rare cases.
Those most susceptible are over 30, overweight and/or pregnant, and not physically fit. Smoking interferes with healing after any sort of stress to the back.
If there are additional symptoms, medical care should be sought: fever, unexplained weight loss, leg weakness or numbness, or trouble urinating.
An exact diagnosis is made through blood tests and through imaging such as x-rays, CT scan, or MRI.
Once more serious causes are ruled out, treatment may include medications to ease pain, swelling, and inflammation. Steroid injections are useful in some cases.
Overall, exercise and maintaining a healthy weight can be very helpful with easing chronic low back pain.
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Symptoms that always occur with unexplained acute low back pain:lower back pain
Symptoms that never occur with unexplained acute low back pain:buttocks numbness, thigh numbness, involuntary defecation, fever
What Causes Or Increases My Risk For Chronic Back Pain
- A condition that affects your spine, joints, or muscles, such as arthritis, muscle tension, or breakdown of spinal discs
- Lack of regular physical activity
- Repeated bending, lifting, or twisting, or lifting heavy items
- Obesity or pregnancy
- Injury from a fall or accident
- Driving, sitting, or standing for long periods
- Bad posture while sitting or standing
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Anatomy Of The Lower Back
The lower back is called the lumbar spine and is made up of five vertebrae and the sacrum .
The lumbar spine is made up of a number of spinal segments. Each spinal segment includes:
- An intervertebral disc between the two vertebrae
- One nerve root leaving the spinal canal on each side
- One nerve root passing over the disc and down to the next segment on each side
- Two facet joints at the back, which link the two vertebrae
- Muscular attachments and ligaments
Lower back pain may be categorised as either mechanical or compressive.
Mechanical lower back pain results from inflammation. It is usually a consequence of irritation or injury to the:
- Intervertebral disc
- Ligaments or the muscles of the back
- Or as a result of spondylolisthesis .
Less common, but extremely important, causes of mechanical lower back pain include:
- Traumatic fractures and/or dislocations
- Tumours which have spread to the spine
Mechanical pain usually starts in or near the midline, and may spread to the buttocks and thighs. It is unusual for this type of pain to extend below the knee. Sometimes hip problems may mimic mechanical lower back pain.
Compressive lower back pain occurs when one or more nerve roots are either irritated or pinched. A prolapsed intervertebral disc is a common cause of compressive pain.
Compressive back pain is often associated with pain extending down the leg and sometimes into the foot. This leg pain may be associated with numbness or weakness.
When To Contact A Medical Professional
- Back pain after a severe blow or fall
- Burning with urination or blood in your urine
- History of cancer
- Loss of control over urine or stool
- Pain traveling down your legs below the knee
- Pain that is worse when you lie down or pain that wakes you up at night
- Redness or swelling on the back or spine
- Severe pain that does not allow you to get comfortable
- Unexplained fever with back pain
- Weakness or numbness in your buttocks, thigh, leg, or pelvis
Also call if:
- You have been losing weight unintentionally
- You use steroids or intravenous drugs
- You have had back pain before, but this episode is different and feels worse
- This episode of back pain has lasted longer than 4 weeks
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What Can I Do For Low Back Pain At Home
If your lower back pain has just started, the best thing you can do is start a log. Record your symptoms, times, dates and which activities trigger the pain or make it worse or better. Take this information to your family physician if the pain doesnt resolve on its own. It will make diagnosing the cause much easier.
Once you know which motion or position causes your lower back pain, try to avoid it and see if you get better. Icing the painful spot can also help. And so can over-the-counter pain relievers that help reduce inflammation. Just remember that pain killers treat only the symptom pain and not its cause.
When Should You See A Doctor For Your Lower Back Pain
Most back pain caused by sprains or overuse tends to get better without treatment within a few weeks. Over-the-counter pain relievers and/or heat or cold application to the painful area can help decrease your back pain. Bed rest is not suggested.
However, there may be other causes that require attention and treatment.
When to see your doctor
Call your doctor if your back pain doesn’t get better after treating it at home for a week. It can mean there’s a bigger problem that the doctor needs to evaluate. You’ll also want to call your doctor if your back pain:
Spreads down one or both of your legs, particularly if you have pain extending below your knee
Is intense or constant, particularly when you lie down or at night
Occurs with redness or swelling on your back
Causes numbness, tingling, or weakness in one or both of your legs
When is lower back pain an emergency?
While rushing to the emergency department is probably not something you want to do, you need to take back pain seriously left side, right side, or both.
When suffering from severe back pain, a visit to the ER is recommended. It could indicate a medical emergency. Some red-flag symptoms of back issues that may indicate an emergency are a combination of any of the following:
If you experience any of the above symptoms, visit the emergency room immediately or call 911 if you’re unable to get to the emergency room on your own.
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You’re Having Problems With Your Bowels Or Urination
If your back pain is paired with a loss of control over your bowels or urination, then it’s time to seek help immediately at a local emergency room. These symptoms point to cauda equina syndrome, where the nerves in the lower spine have become paralyzed. While rare, this syndrome can be permanently damaging to the nerves if left untreated. If you experience these symptoms, especially accompanied by numbness in the legs, then you may need surgery to decompress the nerves and preserve their overall function.
If I Need Spine Surgery Am I A Candidate For Minimally Invasive Surgery
Not every patient is a candidate for a minimally invasive approach. There are specific indications for minimally invasive surgery when it works well and when it shouldnt be done from a safety stand point. Each surgery must be customized for the patient and the technique. However, before surgery is even considered, your spine care team may decide, during your evaluation, that there are other treatment options that should be tried first before surgery is considered.
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Symptoms Of Lower Back Pain
Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement. Sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain.
Although nonspecific back pain is sometimes called simple back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back but sometimes it spreads to one or both buttocks or thighs. The pain is usually eased by lying down flat. It is often made worse if you move your back, cough, or sneeze. So, nonspecific low back pain is mechanical in the sense that it varies with posture or activity.
Most people with a bout of nonspecific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain .
What Is Adult Scoliosis
Scoliosis is an abnormal curvature of the spine . There is a natural, forward-and-backward curve to the spine. With scoliosis, the spine rotates and develops a side-to-side curve. Curves may be as mild as 10 degrees, or as severe as 100 degrees or more.
Most cases of scoliosis are mild and dont need treatment. In adults, the degree of the spinal curve may or may not determine treatment. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. The goal is always to decrease pain and improve function.
Though scoliosis itself is painless, the normal age-related degeneration of the spine may lead to symptoms. These symptoms are treated the same whether there is scoliosis or not. Scoliosis only becomes a factor when surgery is being considered. Changes in the appearance of the body are also possible depending on the degree of the spinal curve.
In general, most scoliosis in adolescents occurs in the thoracic or rib cage portion of the spine. In adults the main concern is typically in the lumbar or lower spine. This portion of the spine is most susceptible to the changes seen with aging or degeneration.
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How Can I Manage My Symptoms
- Apply ice for 15 to 20 minutes every hour, or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your skin. Ice decreases pain and helps prevent tissue damage.
- Apply heat for 20 to 30 minutes every 2 hours, or as directed. Heat helps decrease pain and muscle spasms.
- Use massage to loosen tense muscles. Massage may relieve back pain caused by tight muscles. Regular massages may help prevent this kind of back pain.
- Ask about acupuncture for pain relief. Back pain is sometimes relieved with acupuncture. Talk to your healthcare provider before you get this treatment to make sure it is safe for you.
Arthritis Of The Spine
Arthritis of the spine the slow degeneration of the spinal joints is the most frequent cause of lower back pain. All of us experience wear and tear as we age, and it is normal for your lower back to start acting up as you get older. As the cartilage breaks down between the spinal joints, surrounding tissues may become inflamed. The inflammation and the thinning of cartilage increase friction in the joints, which may cause pain in the lower back.
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How Is Chronic Back Pain Treated
- NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
- Prescription pain medicine called narcotics or opioids may be given for certain types of chronic pain. Ask your healthcare provider how to take this medicine safely.
- Muscle relaxers help decrease pain and muscle spasms.
- Steroids decrease inflammation that causes pain.
- Anesthetic medicines may be injected in or around a nerve to block pain signals from the nerves.
- Antidepressants may be used to help decrease or prevent the symptoms of depression or anxiety. They are also used to treat nerve pain.
Common Causes Of Chronic Lower Back Pain
“Chronic lower back pain is less likely to be caused by injury to your muscles and ligaments and more likely to be due to issues with the lumbar disks, nerves, joints or vertebrae,” says Dr. Palmer. “There are several potential causes of chronic pain in the lower back.”
In general, osteoarthritis and degenerative disk disease are the underlying cause of many types of chronic lower back pain. However, lower back pain can also be caused by accident-related trauma and acute stress.
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How To Relieve Lower Back Pain
If youre looking to relieve back pain , here are some tips to help reduce its severity so that you can get back to your everyday activities faster and with as little inconvenience as possible:
- Change your workout: There is such a thing as going too far when it comes to your workout and you need to make sure that you are careful in which workouts that youre doing, the severity of them, and how often youre doing them. As you get used to the workout, your back will get stronger and you can step it up a notch once you gain more muscle. Or, you can consider changing your workout all together, to one that is more back-friendly.
- Rest your back more often: If you are experiencing pain form work or other activities that involve lifting and strain on your back, try to rest more often. Lie on the floor or on a bed on your back and allow the muscles to relax and everything to return to its native position. If you have a desk job, take more breaks and stretch your back out to make sure that youre not over-doing it.
- Heat/Cold Therapy: Youll be able to do a lot with heat and cold therapy for your back. Using hot packs for 20 minutes intervals or cold therapy for the same amount of time can help with pain and to reduce inflammation . This is the preferred treatment for that reason.
Age And Gender Issues
Age and gender are important factors to consider when diagnosing low back pain. In a young patient, a benign tumor of the spine called an osteoid osteoma may be the culprit. Inflammatory bowel disease in young people can be connected with spondylitis and sacroiliitis . Low back pain from disc disease or spinal degeneration is more likely to occur as people get older. Conditions such as abdominal aneurysm or multiple myeloma are also considered in older individuals.
Osteoporosis and fibromyalgia are much more common triggers of back pain in women than in men. Osteoporosis is a progressive decrease in bone density that leaves the bones brittle, porous and prone to fracture. Fibromyalgia is a chronic disorder that causes widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips.
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