Everyone gets an episode of low back pain once
in awhile. The lower spinal cord is subject to strains,
dislocations, injuries and diseases. Low back pain
is difficult to treat and it is even more difficult
to know when expensive imaging such as CAT (computerized
axial tomography) scans or MRI (magnetic resonance
imaging) is necessary.
The spine is composed of 24 mobile vertebrae that
each have 3 joint articulations which allow bending
forward or backward, bending to the side, and rotation
allowing the head and shoulders to rotate almost 90
degrees left or right of the hip plane. Ligaments
of the spine and back muscles along the spine help
protect from bending or rotating too far as well as
allowing lifting of weight. In between each vertebrae
is a shock absorbing disk filled with fluid sort of
like a shoe insert or cushioned sole that makes running
less "bone-jarring". You could also look
at it as a "mini-waterbed" in between each
vertebrae; but what happens if the fluid leaks out
of the waterbed?
In the normal aging process, routine wear and tear
of the spinal cord structures start as early as age
30 and by age 50, 97% of autopsies of people who died
from non-spinal problems show detectable degeneration
of the spine. Intervertebral disks begin to wear or
grind down, tear or even leak and put pressure on
spinal nerves which pass from the spinal cord.
A recent article, Borenstein, DG et al.: A low-tech
approach to low-back pain. Contemporary Ob/Gyn. 1998;40:80-
96, emphasizes that in most cases, the cause of low
back pain is unknown with certainty, but it doesn't
really matter because the treatment is the same regardless
of the cause.
Since the start of x-rays in the 1930's, doctors
have always assumed that x-ray or imaging changes
explained a patient's back pain problem. Most experts
now believe that imaging changes are mostly coincidental
and do not explain the actual cause. So when is back
pain a sign of something serious that needs to be
accurately diagnosed?
When does back pain mean a severe or dangerous problem?
associated fever can mean bone infection (osteomyelitis)
or central nervous system infection
recent weight loss can mean either benign or malignant
tumors
pain worse in the morning (other than transient pain
upon waking) that persists, rather than back pain
that worsens late in the day may suggest diseases
such as ankylosing spondylitis or Reiter's syndrome.
pain that radiates down below the posterior thigh
may indicate nerve involvement (sciatica)
no improvement after 4-6 weeks
The above list also serves to tell when it is time
to get an x-ray or MRI imaging study. You have to
remember that there is controversy about MRIs. Up
to 90% of all spinal MRIs can be read as abnormal.
Some experts think this high frequency of abnormalities
just represents normal aging changes over time, while
others think, although common, these changes represent
pathological disease processes.
Well what can you do to ease the pain for the 4-6
weeks that many back pain problems last for?
Heat application helps a muscle stiffness problem
and should be tried to see if it benefits the pain.
Non steroidal anti-inflammatory drugs (NSAIDs) such
as ibuprofen or naproxen on a regular daily basis;
not so much for the pain relief as for the anti-inflammation
effect to heal up the injury.
Some herbal preparations for muscle pain relief and
arthritis pain may be helpful.
Light to moderate activity (NOT bed rest) such as
walking, swimming, back exercises and physical therapy.
The important thing to know is that most back pain
will improve in 4-6 weeks and that trying to keep
up with most normal activities is the best approach
to take.
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