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for Back Pain
What is Back Pain? Back pain is one of the most common medical problems. It effects most people sometime in their life. Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis pain caused by a serious arthritic condition.
Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other vertebrae stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.
Is there any treatment for back pain?
Most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain.Effective pain relief may involve a combination of generic prescription drugs and over-the-counter remedies. Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. Bed rest is recommended for only 1–2 days at most. Individuals should resume activities as soon as possible. Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculo-skeletal injuries.
What is the prognosis of back pain?
Most patients with back pain recover without residual functional loss, but individuals should contact a medical doctor or possibly a doctor of chiropractic medicine if there is not a noticeable reduction in pain and inflammation after 72-hrs of self-care and medication. Recurring back pain resulting from improper body mechanics or other non traumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury, knee injury and help maintain healthy vertebrea, healthy back and avoid spinal injuries.What research is being done about back pain?
The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of heath related to the National Institutes of Health, which conduct pain research in laboratories at institutes of health and also support pain research through grants to major medical institutions across the country. At this time researchers are hard at work examining the use of different drugs to effectively treat back pain, in particular, chronic pain that has lasted at least 6-mos or more. Other studies are comparing different health care approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or certified massage therapist work. These studies are measuring symptom relief, restoration of function, and patient satisfaction. Other research is comparing standard surgical treatments to the most commonly used standard non-surgical treatments to measure changes in health-related quality of life among patients possibly suffering from spinal meningitis or spinal stenosis.Anatomy
The human spine (or backbone) is made up of small bones called vertebrae. The vertebrae are stacked on top of each other to form a column. Between each vertebra is a cushion known as a disc. The vertebrae are held together by ligaments, and muscles are attached to the vertebrae by bands of tissue called tendons.
Openings in each vertebra line up to form a long hollow canal. The spinal cord runs through this canal from the base of the brain. Nerves from the spinal cord branch out and leave the spine through the spaces between the vertebrae.
The lower part of the back holds most of the body's weight. Even a minor problem with the bones, muscles, ligaments, or tendons in this area can cause pain when a person stands, bends, or moves around. Less often, a problem with a disc can pinch or irritate a nerve from the spinal cord, causing pain that runs down the leg, below the knee, called sciatica.
Vertebra
is any of the bony or cartilaginous segments that make up the spinal column and have a short more or less cylindrical body whose ends articulate by pads of elastic or cartilaginous tissue with those of adjacent vertebrae and a bony arch that encloses the spinal cord.Compression fractures of the back are broken vertebrae, which are the bones of the spine.
Causes, incidence, and risk factors of broken vertebrae
Vertebrae are the bones of the back. In a compression fracture of the vertebrae, the bone tissue of the vertebral body collapses. More than one vertebra may be affected. This condition may be caused by osteoporosis (the most common cause), tumor, or trauma to the back.
When the fracture occurs as a result of osteoporosis, the vertebrae in the thoracic (chest) and lower spine are usually affected, and symptoms may be worse with walking.
With multiple fractures, kyphosis, a forward hump-like curvature of the spine (like the Hunchback of Notre Dame) may result. Pressure on the spinal cord may occur, producing symptoms of numbness, tingling, or weakness. Symptoms depend upon the area of the back that is affected; however, most fractures are stable and do not produce neurological symptoms.
Symptoms of broken vertebrae
- Back pain with sudden or chronic onset
- Shortened height
- Kyphosis (hunchback)
- Note: There may be no symptoms.
Signs and tests for broken vertebrae
Physical examination may show kyphosis. There is also tenderness over the injured vertebrae.
A spine x-ray shows at least one compressed vertebra that is shorter than the other vertebrae.
If there is no history of significant trauma, a bone density test needs to be done to evaluate for osteoporosis.
If there is concern that the fracture was caused by a tumor eating away at and weakening the bone, a CT or MRI scan is necessary to get a better look at the bone. Also, if the fracture was caused by high-energy trauma (fall from a height, car accident, etc.) then a CT scan is needed to see if there are bone fragments pressing on the spinal cord.
Treatment for broken vertebrae
Most compression fractures are found in elderly patients with osteoporosis. These fractures generally do not cause injury to the spinal cord. Treatment includes treating the osteoporosis with prescription medications and supplemental calcium.
Otherwise, these fractures are treated symptomatically with pain medicines. Some practitioners employ back braces, but these may weaken the bones more and predispose the patients to more fractures in the future.
While surgery is rarely needed, there is a new, minimally invasive technique that can help patients with intractable pain from osteoporotic compression fractures. A large needle is inserted with X-ray guidance into the compressed vertebra. A balloon is inserted into the bone through the needle and inflated, restoring the height of the vertebra. Sometimes, cement is injected into the bone to make sure it does not collapse again.
If the fracture is caused by tumor, the tumor may need to be biopsied (a piece of bone surgically removed and examined under a microscope to determine the nature of the tumor) and treated.
Fractures from trauma often require rigid bracing to protect the bone as it heals for 6 to 10 weeks. If there is bone in the spinal canal, surgery to remove the bone and fuse the vertebra together to stabilize the spine may be necessary.
Surgery is almost always necessary if there is any loss of function because of bone pressing on the spinal cord or spinal nerves.
Expectations / prognosis for broken vertebrae
Most compression fractures from trauma will heal in 8 to 10 weeks with rest, bracing, and pain medications. This recovery time is extended by many weeks if surgery is necessary.
Osteoporotic fractures usually become less painful with rest and pain medications, but some do cause chronic pain and can be a source of great disability.
For compression fractures caused by tumors, the outcome depends entirely on the type of tumor involved and is variable. Some common tumors that involve the spine include breast cancer, prostate cancer, lung cancer, and lymphoma.
Complications of broken vertebrae
- Spinal cord or nerve root compression
- Kyphosis (hunchback)
- Failure of the bones to fuse (if surgery is necessary)
Calling your health care provider for broken vertebrae
Call your health care provider if you have back pain and suspect you may have a compression fracture.
Prevention for broken vertebrae
Treating and preventing osteoporosis is the most effective way to prevent these fractures.