Back Pain causes and treatment

Back pain is a symptom. Pain arising from other organs may be felt in the back. This is called referred pain. Many intra-abdominal disorders-such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others-can cause pain referred to the back. Your doctor will have this in mind when evaluating your pain.

* Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is touched), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, in one spot, and ***ociated with numbness in the area of the leg that the affected nerve supplies.

o Herniated discs are produced as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in a third of adults older than 20. Only 3% of these, however, produce symptoms of nerve impingement.

o Spinal stenosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc spaces. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce cl***ic sciatica without disc rupture.

o Spinal degeneration is caused by alterations in the disc that progress to degeneration. This, coupled with disease in joints of the low back, causes spinal canal narrowing. These changes in the disc and the joints produce symptoms and can be seen on an x-ray. A person with spinal degeneration may have morning stiffness or pain while standing for a long time or walking even short distances.

o Cauda equina syndrome is a medical emergency. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence, or the inability to begin urination.
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* Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.

o Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.

o Fibromyalgia results in pain and tenderness on 11 of 18 trigger points when touched, one of which is the low back area, as cl***ified by the American College of Rheumatology. Generalized stiffness, fatigue, and muscle ache are reported.

Medical Treatment

Initial treatment of low back pain is ****d on the ***umption that the pain in about 90% of people will go away on its own in about a month. Many different treatment options are available. Some of them have been proven to work. Others are of more questionable use.

Home care is recommended for the initial treatment of low back pain. Bed rest remains of unproven value, and most experts recommend no more than 2 days of bed rest or decreased activity. Some people with sciatica may benefit from 2-4 days of rest. Application of local ice and heat provide relief for some people and should be tried. Acetaminophen and ibuprofen are useful for controlling pain.

* Many studies have called into question the usefulness of our present treatment of back pain. For any given person, it is not known if a particular therapy will provide benefit until it is tried. Your doctor may try treatments known to be helpful in the past.