Back Pain

Approximately 80% of Americans will experience back pain. Roughly 10% of people in the world struggle with chronic lower back pain. Over 30% of Americans have had back pain that affected their ability to complete day-to-day activities. Across the United States, more than $50 billion is spent annually to treat problems associated with back pain.

Symptoms  

The following are the most common symptoms of back pain.

  • Pain, tingling or numbness that radiates down the legs
  • Pain when bending, squatting, lifting or pain with movement or activity
  • Achy muscles in the back
  • Stabbing, sharp or shooting pain
  • Stiffness in the back
  • Pain when standing

Common Causes

Strains of Ligaments or Muscles    

Often, those who regularly lift heavy objects experience ligament or muscle strains. This may be common among those who repeatedly put pressure on their back at their job. A strain can also occur from a sudden impact or awkward body movement. Those who are experiencing muscle spasms likely have a strained muscle. 

Ruptured or Bulging Disks 

Disks exist between the bones along the spine and they act as cushions. These disks may bulge and can rupture, creating significant nerve pain. Many individuals suffer from degenerative conditions that cause problems with spinal disks which can lead to significant pain. 

Arthritis

Arthritis involves inflammation within the joints of the body. Arthritis in the spine can result in spinal stenosis. This is a condition where the normal spacing between the bones erodes. Osteoarthritis is a condition associated with joint damage that is common in the lower back region as well. 

Scoliosis  

Scoliosis is a condition where the spine is irregularly curved. It is often diagnosed during childhood. In severe cases, individuals may need to wear a brace or support that will prevent the curvature from getting worse. Some patients require surgery. 

Osteoporosis  

Those suffering from osteoporosis have bones that have become weak and may be porous or brittle. This condition can impact any bones in the body. A bone fracture, such as in the back or hip, may trigger significant pain and possible long-term consequences. 

Cauda Equina Syndrome  

Cauda equina syndrome is a rare condition involving compression within the spinal nerves. It occurs at the base of the spine. This is a critical point that allows signals to be transmitted that control leg movement. This condition may result from trauma or be the result of a birth defect. Emergency surgery may be required to avoid paralysis in the lower body. 

Cancer       

Although it is uncommon, back pain may be caused by cancer. A spinal tumor may develop or a malignant growth that results from metastasis. This metastasis may be caused by the spread of cancerous cells from other parts of the body. Several types of cancers that are most likely to spread and develop in the spinal region include breast, lung, prostate, and kidney cancers.

Lung cancer is most likely to spread to the spinal region. A lung tumor can also cause pressure that affects spinal nerves. Breast cancer can also metastasize to the spine.

Pregnancy 

The American College of Obstetricians and Gynecologists explains that back pain may develop during pregnancy. Some of the common causes are strained muscles in the back, weak abdominal muscles, and hormonal changes. During pregnancy, the uterus increases in weight. This may cause the mother to hunch over and alter her posture which can cause back pain

The abdominal muscles are stretched during pregnancy as well. This can weaken the abdominal muscles which are important for back support. Hormones in the body cause the ligaments near the pelvis to loosen, which can lead to back pain. Some of the best ways to avoid back pain during pregnancy are: 

  • Find shoes that support the arches of your feet and avoid high heels
  • Sleep on a firmer mattress for better back support when pregnant
  • Always bend from the knees and straighten your back when lifting things
  • Consider using a lumbar support when seated
  • Apply a heating pad or cold pack

Risk Factors  

There are various risk factors that increase the likelihood of experiencing back pain. The tissues and bones in the back region do tend to worsen with age. Some experts suggest that conditions such as degenerative disc disease are hereditary. Those who work in certain occupations are susceptible to back pain. This may include construction workers, landscapers, and those who perform very repetitive tasks. 

When to See a Doctor

Those experiencing minor back pain or discomfort may try over-the-counter pain relief products before visiting a doctor. When back pain is moderate to severe or has persisted for several days, it may be best to see your doctor. Those who have experienced trauma, such as a car accident, should seek medical attention immediately. If you experience a fever that accompanies back pain, you should see your doctor as well.

Those with a family history of bone or cancerous conditions are encouraged to be increasingly cautious when experiencing back pain. If back pain occurs accompanied by impaired functioning of the bowels or bladder, visit your doctor. 

Assessments For Diagnosis

Physical Examination    

Before a physical examination, you will be asked for your medical history. This can be critical when identifying serious back conditions because it will help your doctor identify the source of your pain.

A medical professional may perform a variety of assessments when evaluating back problems. Gait and posture may be observed while standing and while walking. A patient’s range of motion will tend to be limited in the upper torso when back problems exist. If pain results when extending the back, it may suggest spinal stenosis. 

Your doctor may apply some pressure with their hands to the region of the spinal canal. Tenderness may indicate a possible fracture or infection in the region. Tenderness in the pelvic region with "radiating" pain in the legs may suggest problems with the sciatic nerve. 

How a patient reacts when raising a single leg while lying down may indicate where the pain is originating. For example, if pain occurs when raising a leg to a 30 to 60-degree angle it may suggest nerve inflammation. The doctor may also test the reflexes of the knees and ankles to determine the origin of the problem.

Imaging 

X-Rays are commonly the first imaging test completed when diagnosing back conditions. They are used to check for fractures and broken bones. MRIs may be used to look at muscles, ligaments and tendons in the back. They can also detect inflammation, herniated disks, tumors and more. A CT scan can detect spinal stenosis and ruptured disks as well.

Labwork

In some cases, blood tests are ordered. Blood can be tested to detect the presence of infection and arthritis. Certain genetic markers can be identified through blood tests as well.

Treatment

Prescription Medications      

Narcotic pain medications known as opioids may be used to treat severe back pain. These medications decrease pain by reducing the sensitivity of nerve cells as they interact with the brain. These are typically short-term options due to the potential for addiction. Common examples include oxycodone (Oxycontin) and a combination of acetaminophen and hydrocodone (Vicodin). 

Prescription muscle relaxers work by interacting with the central nervous system to reduce symptoms such as acute low back pain. Although effective for the treatment of back pain, caution should be used because of potential drowsiness. Common examples include cyclobenzaprine (Flexeril) or carisoprodol (Soma).

Your doctor may consider prescribing antidepressants as an “off-label” form of treatment. Many people experience worsening of pain symptoms when they experience stress or anxiety. A product such as duloxetine (Cymbalta) is among the most commonly used.

Those who are struggling with chronic low back pain and similar conditions may benefit from injections. Your doctor may inject an anti-inflammatory such as cortisone to reduce painful inflammation. This treatment may provide relief that lasts from weeks to months. 

Surgical Options   

A surgical procedure is only considered when several other treatment options have not proven to be effective. Surgery may be needed when there are bone fractures or feelings of numbness or pain extending to the arms or legs. 

A laminectomy is a procedure that extracts bone known as the lamina. Advancements in surgery have been made that allow for a minimally invasive procedure. These less invasive methods allow for much smaller incisions to be made for the surgeon to access the back. 

Discectomy is a surgical procedure used to treat those with a ruptured or herniated disk in the spine. When a disk becomes herniated, it may cause pressure and significant pain. The procedure may be completed using the traditional open discectomy method. Here, the surgeon removes the disc material and ligament and bone as needed. 

“Micro” discectomy is when a customized microscope is used to create an enlarged image of the region. This method has become increasingly common over the last 30 years. Using this option allows the patient to potentially recover more quickly since the incision required may be smaller. Following the surgery, the patients may need medication for pain and may need physical therapy as well. 

Spinal Fusion 

When conservative options to stabilize the spine are unsuccessful, a spinal fusion procedure may be necessary. Those suffering from conditions including degenerative disc disease, spinal stenosis, or a fracture may be candidates for this process. The surgeon will use imaging tests to “pinpoint the source of the pain.” It can be compared to “welding” or “fusing” spinal vertebrae. 

Artificial discs may be implanted as an option for some individuals. A spinal fusion may also involve the removal of bone and tissue through a laminectomy. The goal of the procedure is to stabilize a segment of the spine and reduce the pain created by motion. Bone material is usually added to strengthen the fusion and stimulate healing. 

Spinal Manipulation       

The term spinal manipulation may refer to moving, massaging, applying pressure or otherwise manipulating the spinal region. This is considered to be a manual means of reducing inflammation, relieving pressure, and enhancing the function of the nerves. The spine is a critical component of the body. It is a key to the structure of the body and the central nervous system. 

Manually manipulating the spine in the U.S. is often conducted by various types of physicians, chiropractors, physical therapists, and more. The practitioner may use their hands to apply force to a specific joint along the spine. Spinal mobilization is a method that involves both applying pressure and stretching. 

Physical Therapy  

A physical therapist may develop a customized plan for back pain relief and rehabilitation. This type of therapy commonly involves various exercises that will build strength and increase flexibility. Some of the goals that may be accomplished include the following:

  • Improving your posture
  • Strengthening your core for improved back support. For example, building up the abdominal muscles can be beneficial.
  • Identifying exercises that are effective that can be done on your own at home
  • Maintain steady progress in pain reduction
  • Becoming educated on how to safely complete tasks such as lifting heavy objects 

Medical Specialists Treating Back Pain      

Those who are struggling with back pain may initially visit their primary care physician. These are doctors that may specialize in internal medicine, family practice, or pediatric medicine. Your doctor may examine you to identify the problem. The doctor may order tests or refer you to a specialist. 

There are also non-surgical specialists that treat back problems. Some of these physicians include physiatrists, neurologists, and pain management specialists. Surgical specialists include orthopedic surgeons, neurosurgeons, and others. Physical therapists and occupational therapists can be helpful treating back conditions as well.   

There are some instances where back pain is associated with cancer. Oncologists would be heavily involved in the treatment process. Within the field of oncology, there are also subspecialists. These include medical, radiation, and surgical oncologists. 

Arizona Medical Provider for the Successful Treatment of Back Pain   

The medical professionals at the Arizona Pain and Spine Institute have been effectively treating painful conditions for many years. We use the latest advancements in medical treatment and state-of-the-art technology. We have offices located in Mesa and Queen Creek for your convenience. Contact our staff to schedule an appointment today at (480) 986-7246.