Back Pain Information Page

Definition

The back is designed both for flexibility and stability—flexibility to allow for motion, and stability to maintain an upright posture. Back pain can arise from damage to any part of the back: vertebrae, ligaments, muscles, tendons, disks or nerves (see "Anatomy of the Back " below). Although the lower back is the most common location for back pain, any part of the back is susceptible to damage. Most back pain will go away within a few days or weeks. Back pain is considered to be chronic whenever it lasts longer than 8 to12 weeks. Treatments for back pain include rest, light physical activity, physical therapy, medications, and in some cases surgery. In the past, long periods of bed rest were prescribed for back pain, but it is now believed that this can actually make the condition worse. 1 to 3 days of bed rest can be helpful, but it is not beneficial for the back to remain inactive for too long. Light activity such as walking is often needed to assist in the healing process. 

Anatomy of the Back

The spine is made up of 24 bones called vertebrae. The top seven vertebrae are referred to as the cervical spine. They are smaller than the other vertebrae, allowing for better movement. The middle twelve vertebrae are referred to as the thoracic spine and are mostly used for rotational motion. The lower 5 vertebrae are called the lumbar spine. They are larger and thicker than the other vertebrae because they must support the most weight. The ligaments are tissues that hold the vertebrae in place. Muscles surround the spine to give it strength and help with movement. The muscles are attached to the spine by tendons. There are discs located between each vertebrae. The nucleus of the disk is filled with a gelatinous substance which allows the disk to act as a shock absorber between each two vertebrae. The spinal cord is comprised of bundles of nerves that run down the spine from the brain through a central hole in the vertebrae. 

Common Causes of Back Pain

Non-Specific Pain

Back pain often seems to have no clear or specific cause. It can be the result of many years of wear and tear on the muscles, ligaments, and discs of the back. Each time that any damage is done to the back, whether due to too little activity, too much activity, or improper use of the back, it repairs itself by creating scar tissue. Since scar tissue is not as strong or as flexible as regular tissue, its presence increases the risk of damaging the back again. Over time the buildup of scar tissue weakens the back, making it increasingly stiff and sore and more vulnerable to serious back problems. 

Strains and Sprains

Another common source of back pain comes from strained muscles, or sprained joints and ligaments. This type of pain occurs from bending too far in any direction, particularly forward, or from frequent bending. It can also be caused by putting too much weight on the spine, especially while it is in a bent position. These strains and sprains produce a soreness in the back that often radiates downward to the buttocks or thighs. The pain often develops during the night and is felt more strongly upon rising. 

Herniated Disks

A herniated or slipped disk occurs when the gelatinous center of the disk is ruptured due to strain, causing the disk to lose its cushioning effect and the nerves of the spinal cord to be pinched. Lower back or lumbar disk herniation is the most common form, occurring about 90% of the time. Upper back or cervical disk herniation occurs 8% of the time, and thoracic disk herniation occurs 2 % of the time. A herniated disk produces sudden and sharp pain from any kind of exertion—even sneezing or coughing can cause pain. The pain shoots down the back and leg and into the calf and foot.

Other Causes of Back Pain

Back pain can also result from: viral infections such as shingles, bladder infections, arthritis, tumors, pre-menstrual syndrome, Paget's disease (bone deformity), ovarian cancer, congenital defects such as scoliosis (lateral curvature of the spine)

Contributing factors to back pain include:

Back Pain Statistics

80% of all people in the United States will suffer from back pain at some point in their life. Back pain is the leading cause of missed work, with more lost work days than the common cold. Back pain is most common in people between the ages of 30 and 50. 75% of people between the ages of 30 and 50 with back problems are male. 10% of people who suffer from back pain have a chronic condition. The 10% of people with chronic back pain account for 80% of the cost of treatment and workers compensation. The cost of back injuries is over 80 billion dollars a year in the United States, due to absenteeism, medical and other related expenses. Back disorders are the number two cause of medical costs to the nation, just behind cardiovascular disorders. Surgery is only helpful for 1% of the people with back pain.

Drugs of "Modern" Medicine and their side effects

Although medications may be used to control pain and reduce inflammation and muscle spasms, they do not to cure the problem. Medications commonly used to treat back pain are:
1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
2. Muscle relaxants
3. Epidural steroid injection.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs are the most frequently used medicines, and include acetylsalicylic acid (aspirin), ibuprofen, and aleve. Acetaminophen is used for people who cannot take anti-inflammatory drugs. Side effects of non-steroidal antiinflammatory drugs include: 

Muscle relaxants 

When back pain is severe, muscle relaxants such as methocarhamol or cyclobenzaprine are used. These drugs help relieve the pain caused by strains and sprains of the back, muscles, and ligaments. Since they act directly on the central nervous system, it is not recommended that these drugs be used for long periods of time, or that they replace rest and light exercise. Side effects of muscle relaxants include: 

Epidural steroid injection

When other medications do not give relief, the back pain is sometimes treated with an epidural steroid injection. Cortisone, an anti-inflammatory drug, is injected into the spinal canal. It is important to know that cortisone can have serious side effects, and the success rate of this treatment usually only about 50%. Side effects of epidural steroid injection include:

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