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House Calls / Dr. Michael Schwartz

Published 9:36 am, Sunday, October 21, 2012
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Back pain is a very common ailment which affects as many as 80 percent of the U.S. population at some point in their lives. Statistically, it affects as many as 65 million Americans each year and is one of the most common reasons for medical visits. Back pain can be acute or chronic and can be debilitating. However, despite technological advances in imaging and testing, it may be difficult to diagnose and treat.

Back pain is divided into four different areas: Cervical (neck), thoracic (upper back),; lumbar (lower back) and sacral (tail bone). Most commonly, pain arises from inflammation of muscles or connective tissues and may include the joints, bones or spinal canal. In general, back pain may be preceded by an injury or a bending or twisting motion (e.g. a car injury, lifting weights, playing sports or carrying heavy objects). However, pain can occur without an obvious trigger, making the diagnosis more difficult.

The cause of back pain may be determined by a thorough history and a physical conducted by a physician or other medical professional. Regardless of cause, pain can severely limit activity, cause you to miss work and affect one's quality of life.

Causes of back pain

Obesity: Probably considered the No. 1 cause of back pain, excessive weight places a large amount of stress on the back as well as the entire body.

Injuries: Spinal fractures, ligament strain and muscle tears are usually a result of accidents, falls or overuse.

Arthritis: Degenerative disc disease from osteoarthritis or osteoporosis are a common cause of back pain, especially in the elderly. Joints and cartilage often lose their lubrication resulting in chronic bone changes.

Psychological: Patients with stress, anxiety and depression report a higher incidence of back pain. Symptoms are thought to be caused by muscle spasm (fibromyalgia).

Infections: Urinary tract infections, gallbladder disease and bone infections are just a few causes of back pain.

Mechanical: Spinal deformities are common causes, including sciatica, scoliosis, disc herniation and spinal stenosis.

Rashes: Herpes zoster (shingles) is a rare cause of back pain. The rash is commonly seen on one side of the body and can be severe.

Cancer: In rare cases, some cancers can spread to bones resulting in pain.

Treatment

Anti-inflammatory medication: Ibuprofen and Aleve are two common medications used to reduce pain and speed healing of musculoskeletal injuries. If needed, prescription medications are also available for more severe cases.

Muscle relaxants: Most muscle relaxants are by prescription only. These types of medications help reduce pain by relaxing muscle fibers.

Pain medicine: Over-the-counter medications such as Acetaminophen (e.g. Tylenol) can be helpful to reduce the discomfort of back pain. However, for severe pain, medications containing codeine (or similar derivatives) may be needed.

Antidepressants: Several antidepressants have unique properties which can decrease back pain by alleviating stress and stabilizing the nerves signaling pain.

Weight loss: Diet and exercise have been shown to decrease the severity and frequency of back pain.

Consultations

Orthopedic physicians/pain specialists: In addition to an extensive physical exam, these health-care professionals can order tests and can also inject medication into the area of pain or perform surgical techniques to treat the underlying cause. Procedures include trigger point injections, nerve blocks and spinal cord stimulators.

Chiropractors: Manipulation of the spine has been shown to reduce the severity and duration of back pain.

Acupuncture: This ancient form of therapy offers patients an alternative treatment and often reduces pain by over-stimulating nerves around the painful areas.

Physical therapy: Various techniques performed by physical therapist include massage, range of motion exercises, ultrasound and electrical stimulation. All of these are designed to reduce swelling and relax muscles.

Recommendations

Proper lifting: Lifting with an object close to your body and using your legs will reduce the likelihood of back injuries.

Raise your seat height at work: Many individuals work in chairs which are too low for their desks. Raising your seat by 3 inches will reduce stress on the neck and back.

Don't place a phone between your shoulder and neck: Wedging a cell-phone or hand-held device between your neck and shoulder causes spasm of the neck and back. Avoid this practice.

Avoid carrying heavy bags or briefcases: Carrying heavy bags places a great deal of strain on the entire back.

Wear a weight belt and exercise: Abdominal muscles support and stabilize the body core. If you are planning to lift heavy objects, a weight belt is essential in decreasing your risk of injury.

Back pain can severely affect ones quality of life. If you develop back pain, visit your doctor. He or she will be able to determine the best course of action to get you back on your feet.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at www.drmichaelbschwartz.com.