Understanding Back Pain Causes And Treatment

Back pain affects nearly 80% of Americans and the most common form is Low Back Pain. Because you rely on your back for almost every move you make, it is vulnerable to injury. Back pain can even be disabling. It is one of the most common problems prompting a visit to your doctor and for missing work. In fact, it is the second highest cause of disability in persons under the age of 45.

Although people complain of back pain, it is not a diagnosis but rather a symptom of an underlying disorder. There are two types of back pain, acute and chronic. Acute back pain is pain with a new onset. It comes on suddenly, usually due to injury. This is the most common type of back pain. It is usually resolved in less than one month but no more than 6 weeks duration. Chronic pain is pain that can have a quick or slow onset, but it lingers for long periods of time. Although it may last three months or longer, some people experience a lifetime of chronic back pain. Chronic pain is the least common type of pain.

What Causes Back Pain?

To begin to understand the causes of back pain, we need to understand the spine. The back is made up of 33 vertebrae or bones. It is divided into 5 groups: Cervical, Thoracic, Lumbar, Sacrum and Coccyx. The cervical spine (upper back or neck) consists of 7 vertebrae. The thoracic(middle back) has 12, and the lumbar spine(low back) has 5 vertebrae. The sacrum consists of 5 fused vertebrae, and the coccyx(tail bone) has 4 vertebrae fused together.

The vertebrae are held together by ligaments and muscles with discs between the vertebrae. The discs are filled with a jellylike center, allowing them to act like a shock absorber. The vertebrae link together to provide stability and support. They protect the spinal cord and spinal nerves that run through the spinal canal.

Because the neurological system is complex, it is difficult to pinpoint the exact cause of back pain. The causes of back pain are divided into categories: Mechanical, Injuries, Acquired disorders or diseases, Infections or tumors.

Mechanical causes: These are problems with how the spine works. For example, Spondylolistesis(deterioration of the disc one vertebrae to slip forward over another, causing the vertebrae to rub together, therefore causing pain). Other mechanical problems are fractures, herniated discs, spinal stenosis, spinal degeneration and sciatica.

Injuries- This category includes common forms of back pain due to injury to the spine or the ligaments and muscles involved with the spine. Sprains, for example, result if a ligament that supports the spine is pulled or torn due to improper lifting or body mechanics, even twisting the wrong way, Fractures can occur from osteoarthritis which causes the bones to become brittle and weak. Sever injuries can result from an accident or fall.

Acquired disorders- These are medical problems that you might have been born with such as scoliosis(an abnormal curvature of the spine) to other problems that you acquired, such as arthritis(osteoarthritis and rheumatoid arthritis) which can lead to fractures; musculoskeletal pain syndromes such as fibromyalgia, spinal stenosis (Narrowing of the spinal canal putting pressure on spine or nerves); and even pregnancy.

Infection/Tumors- Infection, although not common, can cause pain if it involves the vertebrae. Two examples of this are Osteomyelitis(infection and inflammation of the vertebrae) and Discitis(infection in the discs).Tumors, although rare, can also cause back pain. These can be benign or cancerous, but usually result from a tumor that has spread from another area of the body.

How is back pain diagnosed?

In order for your physician to discuss the proper treatment for your back pain, he will need to do a thorough medical history and physical exam. You will need to give a clear concise description of your pain. Your physician will need to know how the pain started, what you were doing when it started, how severe it is, does it come and go or is it constant, and what makes the pain better or worse. You will need to undergo some diagnostic tests. Common tests done to diagnose back pain are x-rays, bone scans, and MRI’s. These diagnose problems due to bone or soft tissue injuries. Your doctor may order blood and urine tests to look for infection. If your physician feels the pain might be caused by a nerve problem, then you will have an EMG(electromyography) or nerve study. An EMG is an assessment of the electrical impulses of nerves and the response of the muscles.

How is Back Pain Treated?

The common goals of treatment are to relieve back pain and to restore mobility. Treatment varies depending on the severity and type of injury. The most common and basic treatment used for strains or minor injury is Rest. Heat can be used to promote circulation to the area and relieve spasms. Cold packs can be used to decrease the swelling in the affected area of the back. Common OTC (over the counter) medications such as Aspirin, Motrin, Tylenol, and Aleve are prescribed to help the pain and inflammation.

Long term bed rest is not usually recommended because it can make recovery slower and can ultimately cause other problems. Usually the doctor will have you gradually resume normal activities after 24-72 hours of rest. He may start you on a physical therapy program which should include heat, massage, ultrasound and an individualized exercise regimen. If the pain does not subside and it is interfering with your normal daily activities, your doctor may order prescription pain medications such as Darvocet, Vicodin, or Percocet and anti-inflammatory agents to relieve muscle spasm.

If your pain becomes chronic and all other treatments have failed, your doctor may refer you to a Back or Pain specialist. Because the back is a complex entity, specialists are more up to date on new advances in the treatment of back pain. Some treatments you might encounter are epidural nerve block (injection of anesthetic, anti-inflammatory, or steroid into the epidural space of the back for long term pain relief)and trigger point injections(injection of steroids and anesthetic into the muscle that is triggering pain.)This should also provide long term pain relief. Other medications such as antidepressants and anticonvulsants have been found to help relieve pain caused by nerve injuries.

Other types of treatment include:

Use of TENS(transcutaneous electrical nerve stimulation) unit. Electrodes are placed on 2-3 painful areas of the back and attached to a unit that provides mild electrical stimulus to the area in order to relieve pain.

Chiropractic adjustments of the back.

Acupressure or acupuncture treatments.

Relaxation and breathing techniques and stress management instruction.

Massage and basic stretching exercises to promote mobility and relieve spasm.

Yoga-and Pilates- This can help relieve pain and stress. Some Yoga postures may help relieve low back pain and help improve strength, flexibility and balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.

Aquatic or water therapy- This can be very beneficial in relieving pain and improving mobility in those with chronic low back pain. There is no resistance to movement in the water, and water is soothing, comfortin

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Understanding Chronic Treatment-Resistant Pain – Psychosomatic Back Pain

Science has demonstrated that there is an incredibly powerful link between the mind and the body. In many instances, the underlying cause of neck pain, back pain and sciatica, also referred to as the back pain complex, may be psychological. Many times, when an individual is in pain and told that it may be psychological or psychosomatic, the patient immediately becomes defensive, often stating, “It is not in my mind, the pain is real!” The fact is, it is indeed very real, regardless of whether the pain is labeled as psychosomatic or not. When dealing with treatment-resistant, chronic pain the mind/body link must be explored, so it can be ruled out. In this article, we will discuss psychological pain, psychosomatic pain, and chronic psychological back pain. While discussed in a previous article, we will also address, once again but briefly, the link between chronic back pain and depression. Chronic pain, in any form, can be the most insidious, debilitating, and disabling of any medical complaint. In order to fully treat the condition, underlying causality must be explored and diagnosed thoroughly. It is true that most cases of neck pain, back pain, and sciatica are or have their basis in an actual pathology or other physiological condition. However, psychological back pain is quite common and in fact is one of the primary causes of treatment-resistant chronic pain.

Unfortunately, when an illness is labeled psychosomatic there is often an immediate stigma or negative perception associated with it. Very often, when an individual suffering from neck pain, back pain and/or sciatica hears the term psychosomatic, they immediately respond defensively. When a condition is labeled as psychosomatic the connotation attached is that the condition is “all in the mind” or somehow “imaginary.” There is even a mental illness stigma attached, with the patient protesting, “I am not crazy, this pain is real!” Even people close, at times members of the individual’s own family, will say unkind things like, “I knew he was faking it” or “I knew she was just trying to get attention, I felt sorry for her!” For these reasons and others, the resistance to a psychosomatic diagnosis is considerable, often socially and culturally based.

As discussed in a previous article, there is a powerful link between stress and psychosomatic illness, in this case neck pain, back pain, and/or sciatica; or treatment-resistant chronic back pain. Additionally, the link between depression and psychosomatic illness, particularly as we age, is often quite powerful. Individuals suffering from psychosomatic illness may experience incredible pain or other physical manifestations or symptoms, with no physical diagnosis. Paradoxically, there are a number of physical conditions, such as brain injuries and vitamin deficiencies just to name two, which may exhibit profound psychological symptoms. However, it is often the case that many individuals exhibiting treatment-resistant chronic pain, with no underlying medical diagnosis, may have a psychological or psychosomatic condition.

Contrary to commonly held beliefs, pain that is the result of a psychosomatic condition, of an emotional or psychological process, is actually quite real. Psychosomatic pain, in this case treatment-resistant chronic back pain, is not imaginary, it is not “in our heads,” it is not the result of a delusional or a sick mind, and it is not the consequence of mental illness. The fact is that anyone suffering from tension headaches, ulcers, colitis, tension backaches, and a myriad of other stress-related illnesses has a psychosomatic condition. Clearly, all of these individuals are not “crazy.” I suppose the best way for an individual to understand just how real psychosomatic pain can be is to have them think back to their last tension headache and ask a single, quite simple question: “Was the pain real?”

Psychological back pain is simply another name for psychosomatic back pain and is sometimes referred to as stress-induced back pain. Once again, pain associated with this condition is indeed very real. While the pain may ultimately be linked to the mind/body link, the physical expression of pain, whether the pain is neck pain, back pain or sciatica, may be debilitating and disabling. Consequently, dealing with psychosomatic, treatment-resistance chronic pain is often difficult, if not close to impossible, without effectively dealing with the underlying condition. As a noted evolutionary scientist once pointed out, psychosomatic pain may be considered an evolutionary anomaly but it is completely human and utterly normal. As our system, and that includes our mind, becomes overloaded, it seeks to alleviate or eliminate the problem as quickly and efficiently as possible. Unfortunately for the patient, it does this by shifting focus away from the actual cause, the real danger, expressing it in a very uncomfortable, often intense fashion; and, in this case through chronic treatment-resistant back pain.

Psychosomatic pain is the most frequently diagnosed and least understood form of both acute and chronic back pain. Significantly, most treatment-resistant chronic back pain sufferers, those with unresolved back pain, meaning that there is no clear diagnosis, by definition suffer from an underlying and misdiagnosed psychological ailment or condition. While medical schools are beginning to address this very significant medical issue, psychosomatic illness has long been relegated to the back burner of medical education. Consequently, medical practitioners are simply not prepared for or able to understand, much less treat, this condition. As a result, many individuals are misdiagnosed with this “scapegoat condition,” leaving individuals with very real physiological, structural, and medical conditions undiagnosed.

Unfortunately, while solutions are available, they are still relatively unknown. As the medical community begins to educate itself, so they can be better prepared to deal with this condition, we are beginning to see the first steps towards a holistic approach to this problem. Psychosomatic medicine has been talked about for centuries, even Sigmund Freud was fascinated by it in his time, yet it is only in the last few years that we see a real movement to deal with this ongoing epidemic. Treatment-resistance chronic pain sufferers, particularly those individuals with an extended history of unresolved and undiagnosed pain, are most likely to exhibit a myriad of medical complaints to include ulcers, colitis, and depression, just to name a few. The combination of unresolved neck pain, back pain and/or sciatica and depression leads to profound consequences for the individual, the family, the community, and even the state. The impact of this poorly understood and often misdiagnosed condition or set of conditions ripples throughout the system with consequences far beyond those of a medical nature.

Ultimately, and until such time as the underlying condition has been diagnosed, treated, and eliminated, symptoms must be recognized and alleviated. For this reason, it is advisable for the individual to begin a wide-ranging, individualized, and medically supervised program to deal with both symptoms expressed and causality yet undetermined. Exercise, in and of itself, will have a remarkable and immediate impact on most individuals. Not only will an exercise program, properly administered and supervised, do wonders to alleviate stress, it will also serve to improve self-esteem and self-confidence. With exercise, particularly until the musculature adapts and adjusts to the new routine, certain other measures will need to be taken. The additional treatment strategies to be initiated, along with the exercise program, should include a stretching program, 2 to 3 times a day (see: “Simple and Easy Program of Exercise for Sciatica Relief… Part I & Part II”). Self-education, both individually and in a group setting, will also enhance understanding, self-knowledge, and self-esteem. Most importantly, either individual or group therapy should be initiated in order to comes to grips with the underlying issues contributing to the unresolved and/or misdiagnosed psychosomatic pain condition. The concert of bad back strategies will do wonders to alleviate symptoms, ultimately leading to a resolution when used along side of a solid therapy program to understand underlying stressors which resulted in the back pain complex of neck pain, back pain, and sciatica.

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