What Is The Terrible Triad
When pain becomes such a problem that it interferes with your life’s work and normal activities, you may become the victim of a vicious circle. Pain may cause you to become preoccupied with the pain, depressed, and irritable. Depression and irritability often leads to insomnia and weariness, leading to more irritability, depression, and pain. This state is called the “terrible triad” of suffering, sleeplessness, and sadness. The urge to stop the pain can make some people drug-dependent, and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the one suffering with the pain.
How Is Low Back Pain Diagnosed
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
What Are The Different Types Of Pain
Two types of pain include the following:
Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery. It usually lasts less than a week or two. The pain usually ends after the underlying cause is treated or has been resolved.
Chronic pain. Pain that persists for months or even years.
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When Should I Call My Doctor
- You have severe pain.
- You have new numbness, tingling, or weakness, especially in your lower back, legs, arms, or genital area.
- You lose control of your bladder or bowel movements.
- You have a fever or sudden weight loss.
- You have new or worse pain.
- You have questions or concerns about your condition or care.
What Else Can I Do To Relieve Or Prevent Back Pain
- Manage stress. Stress can cause back pain or make it worse. Some ways to reduce stress are listening to music, meditating, or using aromatherapy. It may help to talk with a therapist about anything that is causing you stress. Your healthcare provider can give you more information.
- Stay active as much as you can without causing more pain. Ask your healthcare provider which exercises are right for you. Do not sit or lie down for long periods. This could make your back pain worse. Yoga or similar gentle movements may help relieve pain and tension in your back. Go slowly and do not strain your back as you do any movement.
- Be careful when you lift heavy objects. Do not lift anything heavy until your pain is gone. Never strain your back when you lift a heavy item. If possible, ask someone to help you.
- Go to physical therapy as directed. A physical therapist can teach you exercises to help improve movement and strength, and to decrease pain.
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What Causes Chronic Pain
Sometimes chronic pain has an obvious cause. You may have a long-lasting illness such as arthritis or cancer that can cause ongoing pain.
Injuries and diseases can also cause changes to your body that leave you more sensitive to pain. These changes can stay in place even after youve healed from the original injury or disease. Something like a sprain, a broken bone or a brief infection can leave you with chronic pain.
Some people also have chronic pain thats not tied to an injury or physical illness. Healthcare providers call this response psychogenic pain or psychosomatic pain. Its caused by psychological factors such as stress, anxiety and depression. Many scientists believe this connection comes from low levels of endorphins in the blood. Endorphins are natural chemicals that trigger positive feelings.
Its possible to have several causes of pain overlap. You could have two different diseases, for example. Or you could have something like migraines and psychogenic pain together.
When Is Surgery A Good Idea For Back Pain
These red flags can be indicators for surgery, if theyre found to berelated to your spine condition:
- New or progressing bowel/bladder issues
- Weakness in limbs
- Gait and balance problems
- Evidence of increased reflexes
Surgery can also be an option for chronic back pain if there is a knowncause confirmed by imaging and if other treatments didnt help. Getopinions from at least two surgeons, suggests Nava, as pain can stillcome back after the surgery.
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Availability Of Data And Materials
The data that support the findings of this study are available from The Welsh Government but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Welsh government.
What Are The Risk Factors For Chronic Pain
Since many conditions or injuries can cause chronic pain, there are several risk factors for experiencing it. Some risk factors include:
- Your genetics: Some chronic pain causes, like migraines, run in the family .
- Having obesity: Having obesity can worsen certain health conditions that cause pain, such as arthritis since theres extra pressure on your joints.
- Your age: Older people are more likely to experience chronic pain from arthritis and neuropathy.
- Having a previous injury: If youve had a traumatic injury, youre more likely to develop chronic pain in the future.
- Having a labor-intensive job: If you have a physically strenuous job, youre at greater risk for developing chronic pain.
- Experiencing stress: Studies have shown that chronic pain is connected to both frequent stress and post-traumatic stress disorder.
- Smoking: If you smoke, youre at greater risk for developing medical conditions that lead to a need for chronic pain treatment.
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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
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 TRIA Neck and Back Strengthening 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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Can Back Pain Lead To Complications
The good news is that most people recover from back pain within a few weeks.1 See your doctor if you experience additional symptoms, such as:
- loss of bowel and/or bladder control
- severe pain that gets worse instead of better over time
- problems with passing urine or bowel movements
- numbness or a pins-and-needles sensation in your legs, back or elsewhere
- unexplained weight loss
- back redness or swelling
For some people, back pain becomes an ongoing problem. Around 1 in every 2 people who experience back pain will experience it again, and for 1 in 5 people, back pain may last beyond 8 to 12 weeks. Possible complications that result from persistent, long-term back pain include:
- dependence on strong pain medicines, such as opioids
- reduced quality of life
- more difficulty finding work and keeping active
See your healthcare professional if your back pain is unresolved and limits your movement and activities. A health care professional can help you find ways to manage your pain and regain a better quality of life.
What Causes Chronic Pain Syndrome
Doctors don’t know exactly what causes CPS. It often starts with an injury or painful condition such as:
- Endometriosis, when tissue in the uterus grows outside of it
The roots of CPS are both physical and mental. Some experts think that people with the condition have a problem with the system of nerves and glands that the body uses to handle stress. That makes them feel pain differently.
Other experts say CPS is a learned response. When you’re in pain, you may start to repeat certain bad behaviors even after the pain is gone or has lessened.
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What Causes Back Pain
Your spine or backbone is a complex structure that is made up of 24 small bones called vertebrae that are stacked on top of each other. Discs sit between each vertebra to act as cushions or shock absorbers and give your spine flexibility. Vertebrae are joined together by small joints called facet joints. These joints allow you to move and bend your back. A mesh of ligaments and muscles hold the spine together and provide structural support, which allows you to move.
Back pain can originate from any of these structures, but in most cases, this pain doesnt result from any significant damage to your spine. This pain usually stems from surrounding muscles, ligaments or joints and occasionally spinal disc problems.
For at least 9 in 10 people, back pain is not caused by any particular condition and is referred to as non-specific back pain.
This type of back pain results from a range of different factors such as:
Less than 1 in 100 people have back pain that is related to a serious medical problem such as cancer, infection, a spinal fracture or specific conditions such as ankylosing spondylitis. Research has also shown that you actually dont need to know the cause of back pain to treat it successfully.
Classification And Diagnosis Of Back Pain
To facilitatediagnosis, back pain can be considered by anatomical location, with pain occurring in the neck, the upper back, or the lower back. The most-common site is the lower back, which encompasses the lumbar region. Back pain may be further characterized as acute, with pain being relatively severe but lasting only a few days or weeks chronic, with frequent pain over more than three months or subacute, with mild or bothersome pain of a duration somewhere between acute and chronic. Most back pain is benign in nature and responds to conservative treatment, such as temporary cessation of activities that aggravate the pain. However, in the presence of certain symptoms, an aggressive pathology may be suspected, necessitating urgent evaluation and intervention.
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Other Causes Of Back Pain
There are many other potential causes of back pain, but most are rare. Be sure to see a doctor if you experience regular back pain that does not go away.
After ruling out the more common causes of back pain, your doctor will perform tests to determine if you have a rarer cause. These can :
- one of the vertebrae moving out of place and onto a nearby vertebra, called degenerative spondylolisthesis
- loss of nerve function at the lower spinal cord, called cauda equina syndrome
- fungal or bacterial infection of the spine, such as Staphylococcus, E. coli, or tuberculosis
Back pain can have many symptoms, including:
- a dull, aching sensation in the lower back
- a stabbing or shooting pain that can radiate down the leg to the foot
- an inability to stand up straight without pain
- a decreased range of motion and reduced ability to flex the back
The symptoms of back pain, if due to strain or misuse, are usually short lived but can last for days or weeks.
Back pain is chronic when symptoms have been present for 3 months.
Urgent Advice: Ask For An Urgent Gp Appointment Or Get Help From 111 If:
You have back pain and:
- a high temperature
- you’ve lost weight without trying to
- there’s a lump or swelling in your back or your back has changed shape
- the pain does not improve after resting or is worse at night
- the pain is made worse when sneezing, coughing or pooing
- the pain is coming from the top of your back , rather than your lower back
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Low Back Pain Surgery
Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:
. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.
. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.
What Is Chronic Pain
Patients and healthcare providers commonly think of pain as a symptom of an underlying injury or illness. Say, for example, you hurt your low back while lifting. Perhaps, youve injured a muscle or ligament, or perhaps its an injury to the spine, like a disc bulge or herniation. Either way, you now have pain and the pain is the symptom of the injury. The same might be true for any health condition that causes pain, particularly when it first starts.
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Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
Cause Of Chronic Pain
What then is the cause of chronic pain? To answer this question, we need to understand some facts about the nervous system.
Whatever its initial cause, pain is a function of the nervous system. Say you injure your low back. Nerves around the site of the injury detect it and sends signals that travel on a highway of nerves from the injury to the spinal cord and up to the brain. Once they get to the brain, the brain processes the signals and they register as pain in the low back. The whole highway, from the nerves in the low back to the brain, is the nervous system.
At the same time as the signals travel from the injury to the brain, the whole nervous system becomes reactive. Like a fire detector in a building sounding the alarm in response to fire, the nervous system sets off the alarm bells when in pain. Our muscles become tense. We guard and grimace. We cry and are emotionally alarmed. The nervous system controls all these reactions. We can think of it as the whole nervous system going into red alert.
This reactivity of the nervous system is all well and good when it comes to acute pain. It helps us to know that something is wrong. Becoming alarmed, we protect against further injury and seek help. Once the original injury or illness heals, everything about the nervous system comes back to normal.
The upshot of it all is that chronic pain is pain causing pain by way of central sensitization.
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