Doctor Stephen Ferguson- Back Pain

Research on Back pain

References

  1. http://www.webmd.com/back-pain/guide/back-pain-symptoms-types
  2. http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx
  3. http://en.wikipedia.org/wiki/Back_pain
  4. http://www.webmd.boots.com/pain-management/guide/back-pain-osteoporosis-bone-fractures
  5. http://www.netdoctor.co.uk/diseases/facts/lumbago.htm
  6. http://www.nationalpainaudit.org/media/files/NationalPainAudit-2012.pdf

 

Introduction – What is back pain?

Back pain is experienced by most people at some stage in their live.  It affects both young and old and the pain usually stems from the bones, joints, muscles and nerves in the spine.  Back pain may be caused by bad posture while standing or sitting for long periods of time, bending in an uncomfortable position or even lifting incorrectly.  Apart from causative injury to the back, internal health conditions that affect the gallbladder, pancreas and certain types of cancer and infections can cause a person to experience back pain.  Non medical conditions such as menstrual bleeding and pregnancy may also cause women to experience varying degrees of back pain.  Most people suffer pain in the lower back or lumbago.  Almost 80% adults suffer from lower back pain.

Back pain is a common problem but not always a permanent life crippling condition.  Severe and chronic back pain has adverse effects on employment status, relationships, mood, sleep, daily activities, mobility, general health and lifestyle.  Back pain usually improves in a matter of weeks or months but some people experience long-term back pain, one that keeps coming back.

 

 

What are the symptoms and types of back pain?

Back pain can be felt at any part of the segments on the spine ranging from the neck right down to the hips.  The pain can be felt in the upper, lower and middle region of the back and in different intensity.  It can be a sharp stab, piercing or burning sensation or a dull ache.   It can radiate to other parts of the body such as the legs, feet, arms, hands and shoulders. Generally, the pain may be acute or chronic, short term or long term.   It can be intermittent, constant or stay in one place in the back.  Apart from pain, other nerve like sensation may be felt; a weakness or numbness in the arms and legs may indicate injury to the nerves or tingling pins and needles like sensations in the legs, feet, arms and hands.

The symptoms of back pain are usually felt from mild to severe.  Acute pain takes up to 12 weeks to subside.  Sub-acute pain is the second half of the acute pain phase which is the duration between 6 and 12 weeks.  Chronic pain is when a person’s back pain goes beyond the 12 weeks and may potentially recur more than once at a later stage.

What causes back pain?

Some of the causes and symptoms of back pain are listed below.

Sciatica

It causes pain that radiates from the lower back to the thighs and leg.  The pain is caused by the sciatic nerve that is a large nerve extending from the lower back down to the back of each leg.  Pain is usually felt on one side of the leg.  Common symptoms include:

  • Burning or tingling feeling experienced down the leg
  • A shooting pain that is difficult to ignore when standing up
  • Constant pain on side of the buttock/rear or leg that worsens when sitting down
  • Weakness, numbness and difficulty moving the leg or foot

Slipped disc

A slipped disc is a condition that describes damage incurred in the disc of the spine.  It damages and presses or constricts the nerves in the spine causing the back to be uncomfortable, weak, numb and painful.  A slipped disc is sometimes termed as a prolapsed or herniated disc.  It is said, 95% of disc herniations are experienced in the lowest two lumbar of the spine.

A slipped disc is experienced when the outer case of the disc splits and the gel within the disc.  The damaged disc may apply pressure on the entire spinal column or a single nerve root that leaves the spinal column.  The pain may be experienced in the swelling area of the disc and other parts of the body that is controlled by the nerve that the disc is pressing or constricting.  It is unclear what causes the disc to degenerate, but is usually common as we increase in age.  Part of the aging process in the body causes the disc to lose fluid content causing it to be rigid and split.  Smoking is another indication for the disc to be inflexible and causes it to degenerate.  Some people may go through life not recognising they have a slipped disc problem even though they have one!

Osteoporosis

Back pain maybe a sign that a fracture has occurred in the spine.  Brittle, weak bones caused by osteoporosis are usually the culprit of this type of condition.  Osteoporosis itself does not present a symptom. It is a condition that makes the bones more susceptible to bone fracture.  It is a progressive bone disease that reduces bone mineral density and structure.  In the long term it proteins that make up the bones are altered causing fracture.  The World Health Organisation defines osteoporosis as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass measured by two x-ray beams with different energy levels.  These beams measure the energy levels of the bones when soft tissue absorption is subtracted out, as a result the bone mineral density can determined.

Osteoporosis is a degenerative disease categorised as primary type 1, primary type 2 or secondary.  Fractures caused by osteoporosis are one of the main reasons for back pain and sometimes disability for women post menopausal, also known as primary type 1.  The cause is the depletion in oestrogen production after menopause.  Primary type 2 conditions are usually referred to both men and women after the age of 75.  Secondary osteoporosis affects both men and women due to side effects of steroid induced medication on a continued basis for other health related medical conditions.

Lumbago

Lumbago is a type of back pain that affects the lower region of the back.  It is difficult to identify the precise cause of this condition. The pain is usually mild to severe or a general ache experienced in the lower back.  The onset of pain can be acute or chronic.  The pain is there in a matter of weeks in acute conditions and under chronic conditions it persists for three or more months.  There is the possibility of small tears and strains of the muscles and ligaments.  There are many complex muscles and ligaments that make up the anatomy of the back.  It is a struggle to determine the cause in the complexity of the back structure.

The symptoms of lumbago are:

  • Muscle spasms surrounding the spine causing it to be stiff in the back region
  • Inflexible spine to cause the body to bend forward and lean back
  • Severe spasm and pain experienced in the back may cause it to lean to one side casuing a poor posture or limp
  • Cause sciatic symptoms such as tingling, numbness and pain in the lower back shooting through the thigh and one side of the leg.

Most people will experience lumbago at some point.  If strenuous physical activities are required for work, younger people are susceptible to this condition and persist later in life as senior citizens.

Spinal stenosis

This is a condition that narrows the spine and causes pressure on the spinal column and nerves.  Most cases of spinal stenosis occur in the lower back in the lumbar region and may pain on the back of the leg.

There are several factors that induce spinal stenosis to occur such as the aging process, arthritic conditions mainly osteoporosis and rheumatoid arthritis.   Other related possibilities are heredity and tumours in the spine.

Stenosis symptoms may also press the nerve that control the muscle power and the feelings and sensations in the legs.  Other symptoms include:

  • Pain when mobilising and walking
  • Clumsiness and frequent falls
  • Tingling, numbness and different hot and cold temperatures felt in the legs.

The causes and symptoms of back pain are exhaustive, some of the common causes are mentioned above.  To add to the list in no particular order: frozen shoulder, ankylosing spondylitis, whiplash, arthritis and cancer.

Who are susceptible or likely to have back pain?

  • Smoking – causes tissue damage in the back
  • Overweight and or Obesity – access weight exerts pressure on the spine and causes stiffness, general discomfort and pain to different areas of the back
  • Pregnancy – the extra weight of carrying a baby places additional strain on the back
  • Prolonged use of certain types of drugs such as steroids and corticosteroids induces to bone brittleness and fractures
  • Stress and depression causes unexplained back pain usually accompanied with headaches.

 

In summary, back pain has been reported to affect over five million people in the United Kingdom.  Most of them go on to develop chronic back pain and only two thirds recover from back pain.  An estimated 11% of adults, 5% of children suffer with acute back pain, which rounds-up 7.8 million people who live in the UK.  Senior citizens, women, poor housing and types of employments were indicators for people suffering back pain in the community.

 

 

 

 

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