A common condition among adults, back pain affects the quality of life and work performance, being one of the leading causes of disability in the world. It is found in all countries in similar proportions and is a common reason why people go to the doctor. For many people, back pain is benign and self-limiting, but if it does not improve after a period of about six weeks and persists for more than 12 weeks, it can turn into chronic back pain. Rarely associated with a serious illness, back pain is often accompanied by other symptoms, depending on the condition that causes it.
The pain can affect any region of the back, from the cervical area, at the base of the skull, to the lower back (lumbar) and the sacral area, near the coccyx. Back pain is one of the most common reasons why people go to the doctor or take days off. Statistically, all people face, sooner or later, back pain. These pains are not a condition, but a symptom that can occur singly or with other manifestations of a disease.
Types of Back Pain:
In general, back pain is classified according to the duration and the area it manifests. Thus, depending on the duration, we have three categories of back pain:
A. Acute pain: it is recently installed and can last up to twelve weeks. The most common form of back pain is acute pain. It can last up to six weeks and can be caused by an incorrect position in the chair or during sleep, or it can have other temporary causes, which, once adjusted, leading to pain reduction.
B. Subacute pain: is the second part of acute pain, six to twelve weeks after the onset of symptoms.
C. Chronic pain: By comparison, chronic pain lasts more than 3-6 months. It can occur as a result of an undetermined cause, an intervention in the back area, or other conditions, such as fibromyalgia.
Depending on the location, the pain can be in the cervical area (at the level of the neck), thoracic (middle area of the back), the lumbar area (lower part of the spine), or in the coccyx (the last segment of the spine).
Cervical pain is mainly caused by muscle problems, some sprains of the tendons or ligaments. It can be calmed by non-invasive treatments, such as medication or physical therapy. If the sore throat persists, it may require medical attention through complex treatment. Cervical back pain may be the first indication for conditions such as cervical degenerative disk, cervical herniated disk, cervical stenosis, or cervical arthritis.
People who have neck pain are less numerous than those who suffer from pain in the chest or lower spine.
Cervical pain can be of three types:
Axial neck pain – has a musculoskeletal character and can affect the neck or soft tissues;
Radiculopathy cervical pain – this consists of neck and arm pain due to compression of the nerve root. It is manifested by arm pain, physical weakness, and numbness;
Myelopathic cervical pain – indicates the existence of pressure on the spinal cord and also occurs due to nerve compression. Symptoms may include sore throat, weakness in the arms or legs, gait problems, and numbness.
Depending on how the pain spreads – The way the pain evolves and its area of propagation is important for establishing the correct diagnosis. Depending on the mode of spread, back pain can be axial, referred, or radicular.
A. Axial pain, also called mechanical pain, axial back pain, is restricted to only one point or region. It can be deaf or sharp, transient, constant, or pulsating. Muscle spasms, joint problems, or intervertebral disks are the main causes of axial back pain.
B. The referred pain, this form of pain occurs as a result of suffering in a certain area, but which manifests itself at a distance. It is an excruciating pain, with variable intensity. An example is lumbar pain, in which degenerative disk disease is the cause of pain in the hips and back of the thighs.
C. Root pain. occurs along a nerve and can cause compression or inflammation of its roots. In the case of the lower half of the back, radicular pain can be felt in the lower leg (sciatica). It can be caused by a herniated disk, spinal stenosis, or arthritis.
Causes of Back Pain
Back pain can have a variety of causes, from incorrect body postures and muscle strains to internal organs. A very small percentage of back pain is attributed to the side effects of serious conditions or infections (cancer, vertebral osteomyelitis). Some back pain spreads to other areas of the body, and others are spread from other parts of the body.
A. Back pain in the cervical area:
- Dislocations and sprains due to overload
- Incorrect posture when sitting on a chair or at night
- Strong blows to the neck
- Rheumatoid arthritis
- Disk herniation
- Rheumatoid arthritis
- Spinal stenosis
Neck pain can also have very serious, life-threatening causes, such as meningitis, heart attack, multiple myeloma (a cancer of the bone marrow plasma cells), or spinal tumors.
B. Back pain in the chest area:
- Muscle stretches
- Lung disorders
- Compression fracture of the spine
- Kidney disease
- Incorrect posture while sitting or exercising
Usually, pain in the middle of the back does not have serious causes, but in some rare cases, it can be a symptom of cancer.
C. Back pain in the lower back:
- Muscle stretches
- Lumbar disk herniation
- Kidney stones
- Degenerative disease of the intervertebral disk (changes in the intervertebral disks with age)
- Lumbar spondylosis
- Lumbar osteoarthritis
- Lumbar stenosis
D. Back pain in the coccyx area:
- Degenerative changes that occur with age
Treatment of Back Pain
The treatment of back pain depends on the cause of this symptom. Forms of treatment range from rest and the application of ice, for mild cases, to the administration of drugs, physical therapy, manual therapy, or even surgery.
A. Treatment for mild pain
Applying ice packs or heat can help reduce pain and inflammation and improve mobility in cases of acute back pain. Then, light and moderate activity and limitation of time spent in bed are indicated.
People with back pain should start a stretching exercise program and return to normal activities. However, avoid those movements that aggravate the pain.
B. Pharmaceutical treatment
Depending on the type of pain, your doctor may recommend:
Over-the-counter painkillers – such as paracetamol, ibuprofen or naproxen. These should only be taken on the advice of a doctor;
Muscle relaxants – help reduce mild to moderate pain. These have side effects such as dizziness and drowsiness;
Pain reduction creams
Opioids – these are indicated only under the strict supervision of a doctor and are especially recommended in severe pain. Generally, prescriptions are offered for a maximum of one week. This type of medication can have side effects, such as constipation, drowsiness, and decreased reaction time.
C. Physical Therapy
A well-developed physical therapy program will pay attention to the spine, and as the pain improves, the physiotherapist will also introduce flexibility and strength exercises for the abdominal, pelvic and back muscles.
The goal of physical therapy sessions is to facilitate pain-free movement. Recovery varies from person to person and depends on the severity of the symptoms, the degree of mobility, and the age of the person. Physical therapy is recommended for all forms of back pain and is also a very effective tool used in prophylaxis, in preparing the body and training the supporting muscles.
Physiotherapy procedures are recommended from the first day after back pain. Heat applications (heat therapy), and cold applications (cryotherapy or cryotherapy) are used successfully to vascularize the affected area and other procedures such as teak, ultrasound, and laser. in order to reduce local inflammation and to stimulate the regeneration of affected cells.
The physiotherapist will provide valuable advice for maintaining a correct posture, learning muscle relaxation techniques, encouraging stretching, and strengthening the back muscles. Also, through physiotherapy, you will know how to perform specific movements to prevent the recurrence of back pain, without giving up your favorite activities.
By strengthening the muscles that support the spine, pressure in the spinal disks and joints is eliminated. The abdominal muscles, in turn, help support the spine and align the hip correctly.
E. Manual therapy
Manual therapy is another form of treatment to relieve back pain. Bits of exercise help reduce muscle tension, stimulate tissue circulation and oxygenation, and improves the range of motion in the problem area. Moreover, manual therapy reduces stress, anxiety, and pain.
The pressure applied by the therapist reduces muscle spasms. However, if the muscles do not respond to pressure, it means that there is inflammation. This may require drug treatment, which is why it is advisable to consult a doctor.
F. Other forms of treatment
If medications do not work or if the pain is deep, your doctor may recommend invasive forms of treatment, such as:
Cortisone injections – Your doctor will inject cortisone into your spinal cord to help reduce pain. The injection reduces inflammation at the root of the nerves, but pain relief lasts no more than two months;
Radiofrequency therapy – consists of inserting a small needle into the skin so that the tip is as close as possible to the site of pain. Subsequently, this needle transmits radio waves to the affected nerves, preventing the pain signal from reaching the brain;
Implantation of a device for nerve stimulation – consists in inserting a small device under the skin. It transmits electrical impulses to the nerves to block the pain signal;
Surgery – is indicated in chronic back pain, associated with leg pain or progressive muscle weakness. Such procedures are especially recommended for people with a herniated disk or spinal stenosis.