The incidence of back pain has drastically increased. Approximately 90% of Americans experience back pain at different stages of their life. In America, the annual expenditure for the treatment of back pain is approximately $50 billion. Back pain is not a disease; rather it is a symptom due to an underlying pathology. Sometimes people with no underlying spine pathology can experience back pain, and people with severe spine pathology can have no back pain. In other words, in some cases we do not fully understand what causes some people to suffer from back pain.
Pain in the lumbosacral region (lower back) is the most common type of back pain. Back pain may have a variable presentation.
- Pain localized to the lower back or pain radiating down the front, side or back of the legs
- Worsening of the pain with physical activity
- Aggravation of the pain at night or by sustained sitting posture such as long drives
- Numbness or weakness in the legs, which may result in difficulty to stand or inability to perform upward and downward movements of the foot
The common causes of back pain are as follows:
- Strain or sprain of the back muscles
- Common degenerative spinal disorders such as degenerative disc disease or arthritis of the facet joints
- Herniated discs
- Abdominal disorders such as appendicitis, kidney diseases, aneurysms, bladder infection, kidney infection, pelvic infection, and ovarian disorders
- Conditions such as pregnancy, due to stretching of ligaments and irritation of the nerves
- Spinal deformities such as scoliosis or kyphosis
The diagnostic workup of back pain includes a detaild medical history, physical examination and use of imaging techniques such as X-rays. Occasionally an MRI scan, CT scan, electromyogram or EMG may be indicated. In some cases, blood tests such as sedimentation rate and complete blood count (CBC) may be also be ordered.
The mainstay of management of back pain consists of avoiding aggravating activities, physical therapy, improvement in sitting or standing posture and medications. Acupuncture, chiropractic care, and yoga under the guidance of a certified instructor all may be helpful. Different classes of medications such as NSAIDs or muscle relaxants may be prescribed. Injections may also be helpful in certain instances to help control back pain. Surgery is recommended for certain diagnoses which fail to respond to conservative modalities of treatment and in conditions such as herniated disc and other spinal disorders. Patients with degenerative disc disease with back pain alone without pressure on the nerves are rarely candidates for spine surgery as spinal fusion for back pain is unreliable at treating pain.