Understand causes and treatment of back pain

The complaint of low back pain is among the most common medical problems. To begin on the positive side, patients must understand that most episodes of back pain resolve, and usually within a few weeks. Unfortunately, back pain can be among the most difficult and frustrating problems for patients and their doctors. 

Understanding the cause of your back pain is the key to proper treatment. Because back pain is sometimes difficult to treat, a better understanding of the causes of this problem will assist patients in their recovery from back pain.

Causes of Back Pain

Lumbar Muscle Strain--Muscle strains are the most common cause of low back pain. Patients may or may not remember the initial event that triggered their muscle spasm, but the good news is that most episodes of back pain from muscle strains resolve completely within a few weeks. 

Ruptured Disc--A ruptured intervertebral disc, also called a herniated disc, is another common cause of back pain. 

Discogenic Back Pain--Discogenic back pain is thought to be a common cause of low back pain. Discogenic back pain is the result of damage to the intervertebral disc, but without disc herniation. Diagnosis of discogenic back pain may require the use of a discogram. 

Spinal Stenosis--Spinal stenosis causes back pain in the aging population. As we age, the spinal canal can become constricted, due in part to arthritis and other conditions. If the spinal canal becomes too tight, back pain can be the result. 

Arthritis--Arthritis most commonly affects joints such as the knees and fingers. However, arthritis can affect any joint in the body, including the small joints of the spine. Arthritis of the spine can cause back pain with movement. 

Spondylolisthesis--Spondylolisthesis causes back pain because adjacent vertebras become unstable and begins to "slip." The most common cause of spondylolisthesis is due to degenerative changes causing loss of the normal stabilizing structures of the spinal column. If the spine becomes unstable enough, back pain can become a problem. 

Osteoporosis--Osteoporosis can cause a number of orthopedic problems and generalized discomfort. Back pain from osteoporosis is most commonly related to compression fractures of the vertebra. Osteoporosis causes weak bones and can lead to these fractures.

Back Pain Treatment

The most frustrating aspect in treatment of back pain is that there is no "magic bullet." Most individuals recover completely by simply avoiding strain to their spine. Patients often find help from ice, heat, and medications. If the basic steps do not alleviate back pain, the next step is to seek a good medical evaluation. Depending on the symptoms and the length of the problem, our doctors can properly organize a treatment schedule for you. 

When do I need to go to my doctor for back pain?

As stated previously, most episodes of back pain last a few days, and have completely resolved within a few weeks. If you have new back pain, you should contact your doctor to see if you need further evaluation. There are also a few warning signs that may indicate a problem that needs immediate evaluation:

• Your back pain persists beyond a few days
• Your back pain awakens you at night
• Your have difficulty controlling your bowels or bladder
• You have a fever, chills, sweats, or other signs of infection
• Any other unusual symptoms

Beginning treatment for back pain

Treatment of low back pain usually begins with a few basic steps. Before beginning any back pain treatment program, be sure you know your diagnosis, and discuss the treatment plan with our doctors. There are some conditions that cause back pain and require immediate treatment. For most cases of back pain, the first treatments are as follows: 

Chiropractic Manipulations--Manipulations are safe, and have been shown to be more effective than most conventional treatments for certain types of back pain. That said, there are situations when spinal manipulations can be dangerous and should be avoided. Patients should generally have an x-ray of their spine to assess for lesions or instability prior to beginning treatment of spinal manipulations.

Anti-Inflammatory Medications--Anti-inflammatory medications, or NSAIDs, are helpful in treatment of both back and hip pain. There are both over-the-counter and prescription NSAIDs, and both work well in the treatment of back pain. Side-effects of NSAIDs include problems of GI bleeding, and these medications should be avoided in patients with stomach ulcers. 

Exercises--Strengthening of back muscles is probably the most important step in treatment of most causes of back pain. By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine. 

Narcotic Pain Medications--Narcotic pain medications are excellent at relieving pain, but these can be dangerous, addictive medications. These medications include Percocet, Vicoden, Oxycontin, and others. Using narcotic medications must be under close supervision, and only for a limited period of time. Prolonged use of narcotic medication can be dangerous. 

Muscle Relaxers--Muscle relaxing medications can be very helpful in the treatment of some types of back pain. Muscle relaxers are sold under the trade names of Flexeril, Soma, Valium, and others. These medications help to relieve muscle spasm, but may also make patients quite drowsy. 

Physical Therapy / Rehabliltation --Back exercises, as listed above, are the focus.  However, there are other modalities that can be used in the treatment of back pain if the exercises alone do not help. Modalities include aqua therapy, ultrasound, electrical stimulation, and others. 

Epidural Steroid Injections--Epidural steroid injections are an option for back pain treatment and inflammation around the spinal nerves. An epidural steroid injection is performed using an x-ray to guide the medication to the area adjacent to the inflamed spinal nerve. 

Facet Injections—Facet injections are injections into the zygapophysial joints to help with pain in the low back region.  It is done using an anesthetic and anti-inflammatory.  This is also done using the x-ray or c-arm to guide the medication to the area.

Spine Surgery--Usually a step when extensive efforts at conservative back pain treatment fails to relieve symptoms.