Back Pain (Back Pain)

What is Back Pain (Back Pain)?

Back pain is a common reason why people seek medical care, whether it’s from their primary doctor or at an emergency room. In fact, it’s estimated that each year, about $200 billion is spent managing back pain. This not only impacts the health system financially but also affects work productivity and employee benefits.

Back pain can stem from several sources in both adults and children. The majority of cases are linked to mechanical problems or don’t have a specific cause. It’s worth noting that approximately 90% of back pain cases are mechanical, which means healthcare professionals might overlook rare causes as they focus on common ones.

Recognizing serious warning signs and determining the right treatment is key in managing back pain. Luckily, most cases can be treated conservatively. However, signs of nerve issues or other alarming symptoms may call for a more detailed examination and a team approach to care.

Medications used for treating back pain often include painkillers that act on peripheral and central nerve paths, as well as muscle relaxants. If people prefer to avoid medicines or are recovering from injuries, there are several types of physical therapy available. Acupuncture is an alternative therapy that has demonstrated moderate success in improving back pain. Surgical options are only considered if the pain is tied to severe nerve issues or serious conditions like cancer. If back pain persists for over six weeks after an initial injury, it may be necessary to use X-rays, CT scans, or MRIs to aid in diagnosis.

A thorough assessment of back pain is crucial in order to identify its cause and develop a personalized treatment plan. Effectively addressing the root cause of the pain greatly improves patient’s functioning and overall quality of life.

What Causes Back Pain (Back Pain)?

Back pain can come from a variety of conditions, which can be grouped into these categories:

* Traumatic: This type of back pain often comes from direct or indirect impact. Examples include whiplash from a car accident, muscle strains, and fractures caused by trauma.
* Degenerative: This refers to issues that happen because parts of the body weaken over time due to aging, overuse, or a pre-existing physical problem. Conditions like slipped discs and degenerative disc disease fall into this category.
* Cancer-related: This category includes times when parts of the back develop cancerous growths, or when bone cancer causes fractures.
* Infectious: Infections of muscles, bones, or other structures in the back can happen directly or spread from another part of the body.

Inflammatory: This includes conditions that cause inflammation not due to infection or cancer. Examples are ankylosing spondylitis, which affects the spine, and sacroiliitis, which affects the sacroiliac joints. Over time, this inflammation can cause spinal arthritis. Metabolic: This type of pain happens because of issues with the metabolism of calcium and bone. Two examples are osteoporosis and osteosclerosis. Referred pain: Sometimes, problems with internal organs can cause what’s known as referred pain in the back. Conditions like gallstone pain, lung disease, and problems with the aorta or vertebral artery are examples.

Postural: Staying upright for long hours can cause back pain. Pregnancy and certain jobs can make people more prone to this type of back pain. Congenital: These are conditions people are born with that affect the spine and can cause back pain. Examples are kyphoscoliosis, which is an abnormal curvature of the spine, and tethered spinal cord.

Psychiatric: Sometimes, chronic pain syndromes or mental health conditions can manifest as back pain. There are also cases when individuals pretend to have back pain for various reasons.

Sometimes, the course of the back pain also offers clues to the source. Acute back pain and chronic back pain often come from different causes. Proper medical evaluation combined with diagnostic testing usually reveals the exact cause of the pain. The findings may then point to consultation with specialists like orthopedic surgeons, neurologists, rheumatologists, or pain management specialists for further evaluation and treatment planning.

Risk Factors and Frequency for Back Pain (Back Pain)

Back pain is a common issue among adults. In fact, research shows that nearly a fourth of all adults worldwide experience chronic lower back pain. This pain often reoccurs within a year, with rates ranging from 24% to 80%. Over a lifetime, up to 84% of adults may experience back pain.

However, back pain is less common in children and teenagers than in adults. A research study from Scandinavia showed that only about 1% of 12-year-olds and 5% of 15-year-olds have back pain. But, by 18 for girls and 20 for boys, about half would have already experienced at least one bout of back pain. Just like adults, the likelihood of teenagers experiencing back pain gets higher as they get older, reaching levels similar to adults by age 18.

Signs and Symptoms of Back Pain (Back Pain)

Getting to the bottom of back pain involves a detailed history recording and physical examination by a healthcare professional. They will want to know when the pain started. Short-term back pain, lasting less than 6 weeks, is often brought on by an injury or a sudden worsening of an ongoing condition such as cancer. Long-term back pain, which persists beyond 12 weeks, can be due to mechanical issues or chronic conditions.

It’s crucial to understand what makes the pain worse or better. This information not only offers additional indicators of the cause but can also guide the healthcare professional in managing the patient’s pain. The type and location of the pain can help to distinguish between different kinds of pain, and any other symptoms can give further hints about the origin of the back pain.

Additional useful information can be obtained from the patient’s medical, family and employment history, as well as lifestyle factors. For instance, past cancer treatment could suggest the possibility of cancer spreading or a new tumor. Some forms of arthritis can run in families. Travel to areas where tuberculosis is prevalent could lead to spinal tuberculosis. Long hours sat down at work can trigger both acute and chronic back pain.

Physical examination usually includes looking at, listening to, and feeling the back, and carrying out certain tests. Visual inspection of the back may detect irregularities, inflammation or skin changes. Listening to the back can be worthwhile in cases where back pain may be connected to lung conditions. Touching specific parts of the back can identify areas of tenderness.

Certain physical tests can provide valuable leads about the possible cause of back pain. The straight-leg-raising test, for example, can help diagnose a slipped disc in the lower back. This involves lifting the patient’s leg to an angle of 30° to 70°. If pain is felt in the same side leg when lifted to less than 60°, the result is positive.

The Stork test is used to check for spondylolysis. The patient is supported while standing on one leg and leaning back; the test is then repeated on the other side. If this movement causes back pain, the result is positive.

The Adam test is used to assess for scoliosis (curvature of the spine). With the patient bending over, the examiner can identify a lump in the back in patients with scoliosis.

Further tests of movement range, limb strength, reflexes and feeling can evaluate the health of the musculoskeletal and nervous systems.

However, certain “red flags” in the medical history or physical examination call for further diagnostic tests. Signs to be alert for include:

Adults:

• Cancer symptoms: History of cancer spread, unexplained weight loss or highly localized tenderness during the physical examination.
• Signs of infection: Past spinal procedures, intravenous drug use, a compromised immune system, previous back surgery or signs of fever, wound in the back area and localized pain during the physical examination.
• Fracture symptoms: Significant trauma, long-term steroid use, osteoporosis, aged over 70 years or evidence of bruising, skin breaks or tenderness during the physical examination.
• Neurologic symptoms: Progressive loss of motor or sensory function, new urinary or fecal incontinence or loss of feeling in the “saddle” area, anal sphincter laxity or significant multiple muscle group weakness during the physical examination.

Pediatric patients:

• Cancer symptoms: Aged under 4 years, nighttime pain or highly localized tenderness during the physical examination.
• Signs of infection: Aged under 4 years, nighttime pain, history of tuberculosis exposure or signs of fever, wound in the back area and localized pain during the physical examination.
• Inflammation symptoms: Aged under 4 years, morning stiffness lasting more than 30 minutes which improves with activity or hot showers or limited range of motion and localized tenderness during the physical examination.
• Fracture symptoms: Activities involving repetitive lumbar hyperextension (such as cheerleading, gymnastics, wrestling, and football) or tenderness in the spinal process area and a positive Stork test result during the physical examination.

Testing for Back Pain (Back Pain)

In general, a doctor can identify the cause of back pain via a physical examination and your health history. However, in some cases, further testing may be needed. Early imaging like X-rays or scans can sometimes lead to more harsh treatments that may not necessarily benefit the patient. But if back pain last for more than 6 weeks in adults, or more than 4 weeks in children, despite other treatments, then imaging tests are recommended.

Standard X-rays can spot issues with the bones, while a Magnetic Resonance Imaging (MRI) scan is used to look at softer areas, like the nerves, spinal disks, and tendons. Both methods can see signs of cancer or inflammation. However, if the softer tissues are involved, an MRI is the better option. Bone scans can display conditions like bone infection, spinal disk inflammation, and stress reactions, but MRIs are better for examining these conditions.

If a teenager has a herniated disk, a type of scan called a computed tomogram (CT) can be done to confirm whether there is a separation in their spinal bones. This condition is seen in about 5.7% of teenagers with disk herniation.

Patients who have had spinal surgery before and may have nerve-related complications could benefit from Electromyography (EMG) or nerve conduction tests. These tests can confirm whether there is an injury to a joint in the lower back called the sacroiliac joint.

In some cases, medical tests may be needed to identify the cause of the back pain. Common tests like HLA-B27, antinuclear antibody (ANA), rheumatoid factor (RF), and Lyme antibodies tend not to be very helpful for back pain. However, tests that look for inflammation in the body, like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), can be useful. A full blood count and blood cultures might be needed in some cases to identify whether the back pain is caused by an infection, inflammation or cancer. High levels of lactate dehydrogenase (LDH) and uric acid are usually seen in conditions that involve rapid turnover of bone marrow cells like leukemia.

Treatment Options for Back Pain (Back Pain)

Back pain in adults and children tends to come from different causes and must be managed differently as well. While in adults it’s often due to age-related conditions or injuries, in kids it mostly arises from overuse and muscle strain. Other rare factors such as cancer and metabolic conditions also show up differently in different age groups. Hence, the treatment should suit both the cause and the age of the patient.

If an adult has acute back pain, critical conditions must be dismissed first. Once the doctor is sure these serious conditions can be ruled out, the patient should get reassurance about the condition and help managing their symptoms. Initial treatments mainly involve changes to daily routines, such as:

* Returning to normal routines early, but avoiding heavy labor
* Steering clear of activities that trigger the pain
* Providing patient education

If these don’t work, doctors may suggest other options. These include painkiller drugs like NSAIDs and muscle relaxants, alternative treatments like acupuncture and massage, or physical therapy. It’s important to educate the patient about back pain according to their specific situation. Continued education increases the chances of preventing the worsening or return of back pain.

If an adult has sharp, radiating back pain, they may be advised to take NSAIDs, exercise, or try treatments like traction, and spinal manipulation. Certain other treatments like diazepam or systemic steroids might not provide additional benefits. If a serious condition can’t be ruled out, tests are needed, and the patient should be referred to a specialist.

The treatment approach for chronic back pain is quite similar. First, rule out serious conditions. If there’s no specific cause, the patient should be advised to stay active and avoid what’s triggering their pain. Exercise and cognitive-behavioral therapy — a type of psychotherapy treatment — are generally the first options. If these don’t work, other treatments can be tried, including spinal manipulation, massage, acupuncture, yoga, stress reduction, NSAIDs, and certain antidepressants.

The use of certain drugs, like gabapentin and topiramate, in treating back pain is yet to be confirmed. Additionally, devices that send electrical impulses to nerves through the skin (transcutaneous electrical nerve stimulation—TENS) are not thought to be much more effective than a placebo in managing chronic back pain.

Surgery is generally considered only when the patient has been in disabling pain for longer than a year and other methods haven’t worked. Yet, the evidence supporting the effectiveness of many common surgical procedures is ambivalent.

Back pain treatment for children and teenagers isn’t studied as much, but the general consensus is to try modifying their physical activities, physical therapy, and NSAIDs first. If a serious illness is at play, the treatment plan follows the standard care for that illness. If the back pain is a result of repetitive stress on the spine, the treatment is quite the same as for adults. Still, there might be cases, particularly with active young sportsmen, where a referral for surgery might be necessary.

In cases of Scheuermann’s kyphosis, a condition where the front of the vertebrae grow slower than the back to give a roundback look, conservative treatment with physical therapy and guided exercises might work if the spinal curve is less than 60 degrees. If the curve is between 60 and 70 degrees, bracing might need to be added to the treatment. A curve greater than 75 degrees, especially if conservative treatments have failed and the patient is done growing, might need surgical correction. Indications for surgical consultation also include a spinal curve of 20 degrees or more during peak growth, substantial scoliosis, progressive curvature, and atypical scoliosis.

What else can Back Pain (Back Pain) be?

Here’s a simplified rundown of some conditions in adults and children that commonly cause back pain. Of course, there are many possible causes of back pain, so diagnosis involves careful evaluation of your symptoms and a physical examination to identify the source of the pain.

In adults, common causes can include:

• Strains and sprains of lower back muscles: These are often due to injuries or repeated overuse. They cause pain, especially when moving, and tenderness in the muscles.
• Age-related wear and tear of the spine (lumbar spondylosis): Usually noticed by people above the age of 40 and may cause hip pain
• Herniated disk: Can cause tingling, numbness, weakness or other unusual sensations in different areas of the body, depending on severity
• Vertebral causes: Like fractures and tumours which might cause localized pain that becomes more intense when bending.
• Spinal stenosis: This involves narrowing of the space in the spine, causing muscle weakness in the legs that gets better with rest.
• Infections or previous surgeries in the spine: Symptoms include fever, localized pain and sensitivity

In children and adolescents, back pain might be caused by:

• Tumours: symptoms may include fever, fatigue, unexplained weight loss, and aches at night.
• Infections in the spine: Similar to adults, these can present with fever, fatigue, and weight loss.
• Herniated disks and slipped bones in the spine: acute back pain along with other symptoms like tingling sensations.
• Scheuermann’s kyphosis: A condition causing upper spine to curve forward.
• Inflammatory conditions of the spine: Involves chronic discomfort and sensitivity in joints.
• Muscle strain: Tenderness without any radiating pain
• Psychological conditions: Ongoing pain with no physical cause.

Each condition can present differently and with varying levels of severity, making accurate diagnosis crucial in order to treat effectively. That’s why it’s best to consult a medical professional if you’re experiencing back pain and it won’t go away, or comes with other worrying symptoms.

What to expect with Back Pain (Back Pain)

In adults, how well a person recovers from back pain depends on what caused it. Most of the time, back pain that doesn’t have a clear cause gets better without causing any serious problems. It has been discovered that proper treatment and teaching patients about their condition can help relieve back pain. Stress often contributes to the pain. For some people, having had back pain before, intense symptoms, depression, fear of carrying out certain activities, or having symptoms in the leg or throughout the body, can lead to chronic, disabling back pain.

Social factors, such as level of education, physically demanding jobs, poor job compensation and job dissatisfaction can make the condition worse. Lifestyle factors also have a role in back pain. Having a weight higher than what’s typically considered healthy (Body Mass Index over 25) and smoking are associated with continuous back pain.

Less is known about the prognosis of back pain in children compared to adults, as fewer studies have been conducted. Also in the pediatric panels, the cause of the back pain affects recovery. For instance, back pain due to cancer is more likely to cause disability than back pain due to muscle strains. Some studies suggest that non-specific back pain in young people worsens with certain behavioral factors. These include conduct problems, attention deficit hyperactivity disorder (ADHD), passive coping mechanisms and fear of carrying out certain activities.

Possible Complications When Diagnosed with Back Pain (Back Pain)

The reasons behind back pain can also influence the likelihood of experiencing complications. The impact of this condition stretches across both the physical and social aspects of life. Physically, back pain can become a long-term issue and can lead to physical changes in the body or problems with the nervous system. Socially, the complications can include a reduced ability to function, a drop in national earnings, and greater instances of work absence. In 2015, a study shared that back pain had resulted in 60.1 million years of disability across the world. This makes back pain the leading cause of disability anywhere in the world. In the United States, lower back pain specifically is the top cause of disability.

Preventing complications is possible by tending to back pain before it becomes a recurring issue. Early movement can boost the chances of a successful outcome, while staying inactive and becoming overweight can make the prediction worse.

Common Consequences of Back Pain:

• Chronic pain
• Physical changes or nervous system problems
• Decreased day-to-day functionality
• Drop in national earnings
• Increased work absence
• Leading cause of disability

Tips to Prevent Complications:

• Address the pain early
• Maintain an active lifestyle
• Avoid inactivity and obesity

Recovery from Back Pain (Back Pain)

The treatment for back pain depends on what’s causing the pain, the person’s existing health conditions, and their overall health goals. The McKenzie method, which is a specific type of physical therapy, is often recommended for chronic, nonspecific low-back pain.

Physical Therapy Clinical Practice Guidelines suggest techniques such as manual therapy, which involves hands-on treatment, and exercises focusing on strengthening the trunk, adjusting to the pain, practicing a preferred direction of movement, and gradually increasing endurance.

Occupational therapy can also assist patients by helping them handle day-to-day activities and if necessary, use adaptive equipment. For female healthcare workers, using assistive devices while moving patients can help decrease the occurrence of low-back pain.

Preventing Back Pain (Back Pain)

Teaching patients how to prevent back pain from reoccurring or getting worse should be personalized. For example, people who have jobs that don’t require much physical effort need to be reminded to stay physically active to maintain a healthy weight. If a person’s Body Mass Index (BMI) is over 25, their back pain may get worse. People with physically demanding jobs should also be reminded about this, but they also need to avoid stuff that could cause back pain, like lifting heavy stuff and twisting their back a lot. These folks should try to carry less weight at a time or use tools that can help them lift heavy objects.

Everyone should be told to stay away from smoking, as it raises the risk of back pain for people at all ages. Sessions that last for 2.5 hours to teach patients about things like changing their activities, staying active, and returning to their usual activities soon after treatment have shown to be effective in motivating adult patients to return to work.

When it comes to kids, it’s not clear whether the weight of a backpack affects back pain. However, the American Academy of Pediatrics advises that a child’s backpack shouldn’t weigh more than 10% to 20% of the child’s body weight.

In most cases, back pain gets better on its own. But if a discharged patient has been told to follow up, they need to know to seek medical help right away if they notice worrying signs such as sudden weakness in their senses or movement.