Back Pain
- WHAT’S THE CAUSE?
- SYMPTOM CHECKER
- WHAT TESTS TO EXPECT
- TREATMENT
WHAT’S THE CAUSE?
Back pain is a common complaint.
Most people in the United States will experience back pain at least once during their lives.
It’s one of the most common reasons people go to the doctor or miss work.
Back pain often develops without a specific cause that’s easy to identify with a test or imaging study.
Conditions commonly linked to back pain include:
Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms.
Bulging or ruptured disks.
Disks act as cushions between the individual bones (vertebrae) in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve (herniated disk).
Compressed nerve.
A herniated disk or a bone spur presses on a spinal nerve, causing pain in the lower back.
The compression may also cause numbness in the affected leg. Most commonly, the sciatic nerve is affected (sciatica).
Arthritis.
Osteoarthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
Osteoporosis.
Porous and brittle bones in your spine (vertebrae) can cause compression fractures, resulting in back pain.
SYMPTOM CHECKER
Symptoms may include:
• Muscle ache
• Shooting or stabbing pain
• Pain that radiates down your leg
• Pain accompanied by numbness or tingling in a leg
• Limited flexibility or range of motion of the back
• Inability to stand up straight
WHAT TESTS TO EXPECT Diagnostic tests aren’t always needed.
If there’s reason to suspect a specific condition may be at fault, a doctor may order one or more tests.
Tests used to diagnose back pain include:
• X-ray.
An X-ray shows the alignment of your bones and whether you have arthritis or broken bones.
• Magnetic resonance imaging (MRI) and computerized tomography (CT) scan.
They can reveal herniated disks or problems with bones, muscles, tissue, tendons and nerves.
• Bone scan.
In rare cases, a doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
• Nerve studies.
An electromyography (EMG) test measures the electrical impulses produced by nerves and the responses of your muscles.
It can confirm nerve injury caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
• Myelogram.
A dye is injected into the spinal fluid, and then X-rays are taken.
This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
TREATMENT
Most back pain gets better with a few weeks of care and attention at home.
If self-care therapies aren’t effective, you may need stronger medications or other treatments.
Medications
If mild to moderate back pain doesn’t get better with over-the-counter pain relievers, your doctor may prescribe a muscle relaxant.
Be aware that muscle relaxants can cause dizziness and may make you sleepy.
Narcotics may be used for a short period of time with close supervision by a doctor.
For nerve-related back pain, drugs such as gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica) and duloxetine (Cymbalta) are sometimes used.
Low doses of certain antidepressants — particularly tricyclic antidepressants — may be used for chronic pain.
Physical therapy
Treatments such as heat, ultrasound, electrical stimulation and muscle-release techniques applied to your back muscles and soft tissues may reduce pain.
A physical therapist also can provide instruction on specific exercises that may increase flexibility, strengthen back and abdominal muscles, and improve posture.
The exercises can help prevent pain from returning.
Injections
If other measures don’t relieve your pain and if the pain radiates down your leg, your doctor may inject an anti-inflammatory medication such as cortisone into the space around your spinal cord (epidural space).
A cortisone injection helps decrease inflammation around the nerve roots, reducing pain.
The relief may be temporary.
In some cases, numbing medication and cortisone are injected into or near structures believed to be causing pain, such as the facet joints of the vertebrae.
Located on the sides, top and bottom of each vertebra, these joints help stabilize the spine.
Surgery
If you have unrelenting pain or progressive muscle weakness from nerve compression, you may benefit from surgery.
Otherwise, surgery usually is reserved for pain related to a structural problem that doesn’t respond to other measures.
Lifestyle
A short period of bed rest is OK, but more than a couple of days may do more harm than good.
Continue your daily activities as much as you can tolerate.
Light activity, such as walking and daily activities of living, is usually OK. If an activity increases your pain, stop doing that activity.
It’s also important to maintain a healthy weight because extra weight strains your back muscles.
In addition, try and lift smartly, letting your legs do most of the work.
Back pain can occur for many reasons.
Often, it stems from a muscle or ligament strain.
Sometimes, back pain is related to one of the following conditions.
Herniated disk
A herniated disk describes a problem with one of the rubbery cushions (disks) between the bones (vertebrae) that form your spine.
A spinal disk is a bit like a jelly doughnut — a softer center encased within a tougher exterior.
Sometimes called a slipped or ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a crack in the tougher exterior and presses on a nearby nerve.
Sciatica
Sciatica is the name for pain that radiates along the path of the sciatic nerve — which branches from your lower back through your hips and buttocks and down each leg.
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or a bony overgrowth (bone spur) on your vertebrae.
Typically, sciatica affects only one side of your body.
Some people also experience numbness, tingling or muscle weakness in the affected leg or foot.
Spinal stenosis
Spinal stenosis describes a narrowing of the open spaces within your spine, causing pressure on the spinal cord and the nerves that travel through it. Spinal stenosis occurs most often in the neck and lower back, producing neck or back pain.
Compressed nerves in your lower (lumbar) spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.
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