Chronic Back Pain
About Chronic Back Pain
It is estimated that America spends more than $48 billion dollars each year for the treatment and relief of back pain alone. Back pain is the leading cause of work related disabilty and the number one contributor to lost time at work in the United States. Back pain has even surpassed more work related absences than the common cold. The headache is the only other medical aliment in the country that has been more commonly treated and diagnosed.
Back pain is usually considered to be chronic when it has lasted for a duration of more than 3 months. It may have resulted from an injury, a serious infection, cancer, arthritis, neurological damage, or a number of different underlaying aliments. However, this is not the case for all people who are suffering from chronic pain, many people do not have an explaination for how or why their pain has come about. We will discuss more reasons for why people may suffer from chronic back pain in a later in this chapter.
How is Chronic Pain Diagnosed?
To diagnose chronic pain you will need to first speak with your doctor, by explaining your families medical history and having a thourough medical examination done he/she may be able to identify any dangerous conditions that may be associated with why you are having pain. During the examination you should describe any previous conditions you feel may be contributing to why you are in pain. Go into detail about any movements or events that bring on pain, where the pain is located, how severe it is, how long the pain usually last, and any physical limitations that it may cause during your normal daily activity. By doing this he/she will be able to give you the best assessment and a treatment plan for your condition. Your doctor may also perform a back examination, this mostly consist of examining the spine, a neurological test to pin point the cause of pain, and testing your range of motion.
There are many different methods used to determine what may be causing you to be in pain, the following are the most common:
* Bone Scans - these are used to test and diagnose for fractures, infection, and disorders in the spine. The test consist of injecting a small amount of radio active material in to the body. This material will collect in the bones, most particularly in the areas conataining an abnormality. You are then scanned and images are sent to a computer to identify areas with abnormal blood flow, irregular bone metabolism, and to measure levels of diseases in the joints.
* Ultrasounds - also called a sonography, uses a high frequency of sound waves to produce images of the inside of the body. The images may show tears in soft tissue, ligaments, muscles, and tendons in the back. The echoes from the sound waves are displayed as a visual on a small screen in real time.
* CT Scans - also known as computerized tomography are used to diagnose damage to the vertebrae, spinal stenosis, and ruptured disc. These test may be conducted at a hospital or within a mobile command unit. The test consist of X-rays passing through the body at a varity of different angles to produce images called slices, these are picked up by a computerized scanner. The images produce a two-dimensional picture of the back that a physican can use to determine the source of your pain.
* X-Rays - are most likely the first imaging device to be used, a technician passes a concentrated beam of ionized radation through the body that can produce an image within minutes. The images show the clear bony structure of the spine and can be used to determine if there are any broken bones, injured vertebra, or fractures. This may be performed at a hospital, doctor's office, or health clinic.
* MRI - this is know as magnetic resonance imaging, the scanning equipment creates a magnetic field around the body, this in turn causes the water molecules inside your bodies tissues to realign. Radio waves are then passed through the body to detect the relaxation of the molecules, the molecules then move back into a random alignment which triggers a resonance signal at different angles throughout the body. A computer then processes the resonance and creates a three-dimensional image of the scanned tissue. It can differentiate between soft tissues, bone, and fluid filled spaces. This procedure is used to evaluate a patient for conditions such as injury or disease to tissue, neveres, blood vessels, muscles, ligaments, and bone degeneration in the lumbar region. This type of test is most often used to diagnose conditions that may need immediate and urgent surgical treatment.
* EMG - known also as electrodiagnostic procedures, this is a type of nerve conduction test that includes electromyography (EMG) and evoked potential studies (EP). The EMG test uses two sets of electrodes that are placed over a particular muscle, very fine needles are then inserted to measure the electrical activity transmitted from the brain/spinal cord to a particular part of the body. When the first test is conducted a mild shock is used to stimulate the nerve of the particular muscle, the second electrode is then used to record the nerves electrical signal. An EP test is quit similar and uses two electrodes as well, the first set is used to stimulate a sensory nerve while the other is placed on the scalp to record transmissions to the brain. These test can be used by the doctor to determine wether or not nerve damage is the result of your pain.
* Thermography - is used to determine wether there is a presence or absense of a nerve root compression, it involves the use of infrared sensors to measure temperature changes on each side of the body or a particular organ inside the body.
Causes of Chronic Back Pain
There are many conditions that can cause you to have chronic pain, back pain is not the only one. The following list are only a few that may result or contribute to back pain or other areas of the body. This list of conditions should always be diagnosed and treated by a physician or specialized health care provider. Most of the following are considered to be very serious and cannot be diagnosed from reading a few web pages. If you feel you are experiencing one or more of the symptoms from the list please see you doctor to determine that your health is not at risk.
* Spinal degeneration - this can result from normal wear and tear of the body, it can also lead to narrowing of the spinal canal. Symptoms of spinal degeneration are pain in the back after standing for long periods of time or walking a long distance. You may also experience stiffness when you awake in the morning or sitting still for a long period of time.
* Spondylitis - caused by inflammation or severe infection of the joints in the spine, this can cause an abnormal amount of stiffness and chronic lumbar pain. Other painful conditions that can result from infection or inflammation of the lumbar area are osteomylitis which is a severe infection of the spine and sacrolitis which is inflammation of the sacroiliac joints.
* Skeletal Irregularities - these type of irregularities include conditions such as scoliosis, which is where the spine curves from side to side, lordosis an abnormality that affects the arch of the lower back, and kyphosis causes the curve of the upper back to become severely rounded. These conditions cause strain on the vertebrae of the spine and can result in severe and excruciating pain.
* Sciatica - this is where the nevere that extends down the spinal column and carries nerve fibers to the leg, called the sciatic nerve, becomes compressed between a herniated or ruptured disc. This causes a painful, shock like, or burning sensation in the lower back. This pain can extend down to the buttocks and may reach even as far as the feet. This condition in extreme cases has even be known to cause loss of motor control of the legs due to the interferance of the nerve signaling. This can also be caused by tumors, degeneration of the nerve root, cyst, or metastatic disease.
* Osteoporosis - is a progressive decrease of the density and strenth of the bones inside the body. This is a metabolic disease that causes brittle, porous bone to chip and fracture. This disease primarly effects women of caucasian descent, women are four times more likely to suffer from osteoporosis than men.
* Bulging Disc - as we get older and disc begin to weaken or degenerate, cartilage can then begin to bulge, it can then be pushed into the spinal cord or a nerve causing severe pain. This results from the intervertebral disc always being under an extreme amount of pressure. These conditions are also sometimes refered to as protruding, ruptured, or herniated disc. The most common area for this to occur is in the lower lumbar section of the spinal column.
* Fibromyalgia - results in widepread musculoskeletal pain, this is a chronic disorder and effects multiple points of the body. It most particularly effects the hips, neck, back, shoulders, and knees. It causes the person to suffer severe pain, morning stiffness, anxiety, and fatigue. There will be a section dedicated to this disorder in a later chapter.
Treatment Options for Chronic Back Pain
There are many different options avaliable for the treatment of chronic pain. Some are considered to be invasive procedures, while others may be simple as going to see your chiropractor. Most treatments depend on the beliefs of the patient and what type of plan he/she has discussed with their doctor. This is usually refered to as a treatment plan, it can consist of multiple different procedures, surgeries, or medications. As for now we will not discuss the types of different procedures, I plan to dedicate a section of this site to the many different types in the pain managment chapter. As most of these can be used to treat more than just back pain alone.
Preventing Chronic Back Pain
Though back pain cannot always be prevented there are many different steps you can take to lessen your chance of having severe or overwelming pain later in life. Most pain occurs from using poor and improper body mechanics, this refers to lifting techniques, slouching when you sit, and can even result from the way you walk. Most often these types of injuries can be prevented by participating in a regular exercise program, having the correct posture, and using na approved and proper lifting technique when lifting heavy objects.
Many work related back injuries are caused by events, such as standing in awkward positions for a long period of time, repetitive lifting of heavy objects, constant forceful vibrations, and using repetitve motions to just name a few. Risk for these types of injuries can be greatly reduced by using protective/preventive devices and techniques. You could purchase a back brace for jobs that require repetative heavy lifting, though most employeers provide these for their employees. The brace helps the back stay straight and promotes proper lifting, by not allowing the back to bend forward they force the spine to remain straight and force you to use the legs to lift. Always avoid bending over to lift objects if at all possible, place items on shelves or an elevated surface to prevent from having to bend over for them later.
Using proper lifting techniques to lift heavy objects can greatly reduce your chance of injury. Though it is impossible to always aviod lifting you can recude the strain it puts on your spine by using the following procedures; first position the body with a balanced stance and your feet shoulder width apart, then keep your heels on the surface and bend your knees while getting as close to the object as possible; secure your grip on the object you are going to lift, this prevents you from having to adjust your stance to get a better grip once you begin to lift; gradually begin to lift the object by slowly extendig the legs, focus on using the abdominal and buttocks muscles to assist you during this process; secure the object as close to the body as possible, this creates a lower sense of gravity; once standing use your feet to point in the direction you wish to go, never twist or jerk your body in the direction your trying to go to; once you put the object down you use the same steps just that you perform them in reverse. Another step that you can use to avoid injury is to divide your weight into smaller portions if at all possible, move fewer objects at a time rather than picking up just one heavy load. If this is not possible use a lifting partner to assist you in moving heavy and awkward objects. This can also cause you to use less energy and helps to preserve your strength and stamina, in return this helps you to work more efficently.
It's also very important to know the limitations of your body, if you know that you are going to be performing strenuous activity you should stretch your muscles. It should take atleast ten minutes or so to do the proper amount of stretching to loosen the body up. This will help to prevent you from pulling or straining the muscles needed to perform these types of activities. You should also excercise daily and eat healthly foods, this will help the body to stay fit and boost the immune system. By doing this you can reduce your bodies risk of injury, this will also help if you do become injured by speeding up the healing and recovery process. During your normal work day take short and frequent breaks to allow the muscle to relax, if you become stiff and sore you know that you have been in that position for to long. This will allow you to have the stamina to continue to work pain free throughout the day. Most importantly is after work make sure you get plenty of rest, purchase a good firm mattress and sleep with you knees elevate to help relieve strees on the back while you sleep. These tips should help you to keep your back healthy and strong, hopefully preventing you from suffering years of unnecessary pain and discomfort.
Back Pain Research
The U.S. Department of Health and Human Services, is the nation's leading source for the funding of neurological research and disorders of the brain. Their scientist are researching different types of medications to treat daily pain that last for longer than six months. They are also seeking different ways to approach the health care of lower back and chronic pain. These studies are being used to measure a patients satisfaction, restoration of daily function, and the amount of relief they are currently being provided. Other research is being used to compare surgical and nonsurgical treatments to measure the improvements and quality of life they provide to there patients.
A study is also being conducted to see if low-dose radation can improve surgical results and increase the reduction of scarring around the spinal column. While other organizations continue to study wether or not neurological and spinal injury increase the sensitivity to pain or increase the pain threshold, this is also being used to determine how the affects of spinal fractures that have been repaired contribute to damage and repair of the conditions of the spinal canal and the openings around the spinal roots.
There are also studies being conducted for people with degenerative disc disease, they are performing spinal disc replacement surgeries to see how this can help with this crippling disease. Compared to other forms of back surgery this is procedure has few complications and tends to have a shorter recovery time. The procedure consist of having the damaged disc removed and having a metal/plastic disc placed into the spine in its place. The following sites and links are resources that can be used to seek treatment in or around your area.
Links and Resources