What is Back Pain?

Back pain is one of the most commonly reported medical problems in society as well as the leading cause of job related disability. It is estimated to affect 8 out of 10 people at some point in their lives. Back pain can occur slowly over time due to changes as we age, or can occur suddenly from injury. Back pain can be acute (short term) lasting a few days to a few weeks, or chronic (long term) persisting for more than 3 months. It is important to understand that most back pain will resolve itself within a few weeks.

Anyone can develop back pain at any point in their lives; however there are certain risk factors that may predispose you to developing back pain. These include the following:

• Age: Increasing age raises your risk of developing back pain due to decreased bone strength and muscle tone. Discs can lose their flexibility and deteriorate with age causing less cushioning between the vertebrae.
• Physical Fitness: Inactive lifestyle and lack of exercise can lead to weight problems and obesity causing stress on the spine. When back and abdominal muscles are not strong enough to support the spine, back pain can occur.
• Smoking: Although smoking is not a direct cause of back pain, smoking affects circulation which can affect the delivery of nutrients to the discs. Chronic coughing from smoking can cause back pain. Also, smokers don’t heal as well as non-smokers which can prolong pain after back injury or surgery.
• Occupational Risks: If you are working in a job that involves heavy lifting, pushing, pulling, or frequent twisting of the body, you are at higher risk for developing back pain. If you work at a desk job and have poor posture or sit in an uncomfortable chair all day, back pain can develop.
• Genetics: Some painful back conditions may be hereditary such as disc disease and congenital scoliosis.
• Diet: An unhealthy diet high in fat and calories can lead to overweight or obesity increasing your risk of developing back pain.
• Medical Factors: Certain medical conditions such as osteoarthritis, rheumatoid arthritis, or cancer that has metastasized to the spine can cause back pain. It is important to know back pain is a symptom not a medical diagnosis. Some medical conditions that can cause back pain include:
• Sprain, strain, or spasm to the back muscles or ligaments caused by heavy or improper lifting. This is the most common cause of low back pain and will usually resolve completely in a few weeks.
• Injury or trauma to the back such as in car accidents, sports injuries or falls.
• Degenerative Disc Disease: A condition caused by wear and tear on the discs between the vertebrae causing them to lose their cushioning ability.
• Osteoporosis: Weak, porous bones caused by osteoporosis can lead to fractures of the spine.
• Arthritis: Degenerative changes from osteoarthritis and ankylosing Spondylitis are associated with back pain.
• Herniated Discs: A condition caused by a tear in a disc causing the disc contents to bulge outside of the disc. Symptoms related to herniated discs in the lumbar region include sharp, continuous back pain, weakness in the legs, and some loss of sensation to the leg and foot.
• Sciatica: Irritation of the sciatic nerve, one of the large nerves to the legs and thighs, is usually caused by a ruptured or herniated disc compressing the nerve. Sciatica causes pain to the leg and buttock often accompanied by tingling and numbness.
• Spondylitis: Infection or inflammation of the spinal joints causing chronic back pain.
• Spinal Stenosis: Narrowing of the spinal canal as we age, most commonly due to degenerative arthritis.
• Skeletal Conditions: Spine curvatures such as in Scoliosis and Kyphosis
• Cauda Equine Syndrome: A very serious compression disorder of the spine. The Cauda Equine is an area at the base of the spinal cord where the nerve roots of all spinal nerves are located. Compression in this area can cause pain and loss of all nerve function below the site of compression and loss of bowel and bladder control. This condition is a surgical emergency requiring immediate decompression of the spinal nerves.
• Fibromyalgia: A common condition characterized by chronic body wide pain with localized tender points in muscles, joints, and soft tissues.
• Referred Pain: Pain that occurs somewhere else in the body but is experienced in another location, such as in the back. Examples include kidney and bladder infections, ovarian cancer, ovarian cysts, endometriosis, etc.
• Psychological Factors: Stress and depression have been associated with increased complaints of back pain.
• Tumors: Although spinal tumors are rare, cancer can spread from other parts of the body to the spine causing pain.

Diagnosis

Evaluating the source of back pain is critical in determining your treatment options for relief of the pain.

Dr Hsu or your GP will perform the following:

• Medical History
• Physical Examination

Depending on what the history and exam show, Dr Hsu or your GP may order medical tests to determine the cause of your back pain. Diagnostic Studies may include:

• MRI: magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.
• CT scan: This test creates 3D images from multiple x-rays and shows your physician spinal structures not seen on regular x-ray.
• CT scan with myelogram: a type of medical imaging which is done by injecting contrast medium into the affected area of the spine followed by CT scan of the area that creates 3D images from multiple x-rays.
• X-rays: a form of electromagnetic radiation that is used to take pictures of bones.
• Electromyogram: a test involving the placement of small needles into the muscles to monitor electrical activity. This test is used to detect the level of nerve root damage related to chronic pain.

Conservative Treatment Options

Treatment for back pain will depend on the cause of the pain and whether the pain is acute or chronic.

Acute back pain, the most common type of back pain, usually gets better on its own. Treatment guidelines for acute back pain include:

• Continue your normal daily activities as much as possible: bed rest is not recommended and in fact can make your pain worse
• NSAIDS (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, acetaminophen, can help ease the pain until it resolves
• Ice or heat packs, or both, applied to the back can help relieve stiffness and pain.
• Sleeping with a pillow between the knees while lying on your side or placing a pillow under your knees while sleeping on your back may help alleviate back pain.
• Exercise or surgery is not recommended for acute back pain

Dr Hsu may refer you to a Physiotherapist or Sport Physician to instruct you on exercises to strengthen your trunk and back muscles.

• Medications: Dr hsu or your GP may prescribe over the counter anti-inflammatory medications such as ibuprofen, Tylenol, etc. For severe pain, you may be prescribed narcotic pain medications, muscle relaxants, anti-depressants, or injections into the back to decrease pain and inflammation. Prescription sleep aids are sometimes prescribed as most chronic pain patients also suffer with sleep disorders.
• Therapeutic Massage: Massage by a trained therapist can decrease muscle spasms
• Electrical Stimulation: Safe and painless, Transcutaneous electrical nerve stimulation, or TENS, sends a weak electrical current from the skin to the nerve pathways to interrupt pain signals being sent to the brain.
• Spine Care Education: Dr Hsu may recommend that you speak with one of our Practice Nurses to learn about posture, exercises, proper body mechanics, and back pain prevention.
• Behavioral Modification: Dr Hus or your GP may discuss ways for you to change current behaviors which may be affecting your back health. These include quitting smoking, eating healthier, losing weight, and getting regular sleep.

Surgical Treatment

Surgical treatment is rarely the first choice for back pain unless Cauda equine syndrome, a medical emergency, has been diagnosed. Dr Hsu will likely order conservative treatment methods as previously described.

If your back pain persists, interferes with your sleep and daily activities, and does not respond to conservative treatment, your doctor may suggest surgery. Some of the medical diagnoses that may need surgical intervention include:

• Herniated discs
• Spinal Stenosis
• Spondylolisthesis
• Degenerative Disc Disease
• Vertebral Fractures

Dr Hsu will decide which options are best for you depending on your specific circumstances.

Postoperative Care

After surgery, you will be instructed on how to use proper body mechanics to turn in bed, reposition, stand up, sit, and walk while the incision is healing.

• You will be given oral and/or intravenous pain medications for the discomfort.
• You will be encouraged to walk as much as tolerated and avoid prolonged sitting.
• Avoid pulling, pushing, or lifting.
• A postoperative Rehabilitation program will be prescribed by Dr Hsu.
• Keep the incision area clean and dry and report any signs or symptoms of infection to your surgeon such as redness, swelling, increased pain, excess drainage, odorous drainage, fever, or chills.

Risks and complications

• As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
• It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to spinal surgery.

Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include

• Allergic reactions to medications
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attacks, strokes, kidney failure, pneumonia, bladder infections
• Complications from nerve blocks such as infection or nerve damage
• Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.

Specific complications of Back Surgery include:

• Skin infection at the incision line
• Spinal fluid leak
• Spinal instability
• Nerve root injury/damage
• Failure to improve
• Discitis, a rare occurrence involving infection of the disc.