Back pain

Summary on back pain

Back pain is one of the most frequent diseases in the world’s population. It is estimated that 80% of people will suffer from some form of back pain in their lifetime. It usually affects the lower back region, called low back pain, but it can also affect the cervical and thoracic region.
In Brazil, about 36% of the population suffers from back pain. It is more common after the age of 40, but it can affect any individual at any age, being rare in childhood.
It is difficult to pinpoint the exact cause of back pain as the structure of the spine is complex. There are numerous causes of back pain, ranging from postural deviations, poorly executed exercises, muscle and nerve problems and even bone metastasis of some tumors.

Some risk groups for back pain are: women, elderly, obese, sedentary and smokers.

The symptoms are clear and are characterized by pain in the back regions, which may lead to reduced flexibility and stiffness of the spine. Usually the diagnosis is simple, made directly by the doctor. However, in some cases, the health professional may require more specific tests to investigate in depth the causes of pain. The lower back (lumbar region) is often the most painful place, as this is where the spine bears the most weight.

Back pain can reduce the patient’s daily activities, being constantly one of the causes of professional reclassification.

Treatments can be based on medication (such as anti-inflammatories, corticoids, myorelaxants and opioids), physiotherapy and physical exercises, surgery or alternative treatments. Plants such as white willow and arnica and also homeopathy are indicated. Patients should not self-medicate, but seek proper assistance, as many analgesic medications cause severe side effects.

It is important that the patient always controls his weight, maintains a good posture, avoids smoking, has healthy lifestyle habits and practices sports. These measures help in the treatment and prevent the appearance of new pains. It is always important that the patient with back pain seeks a doctor, so that he can make the proper diagnosis and indicate the best treatment.

News : Study says acetaminophen is not effective in acute low back pain

Definition

Back pain, also known as dorsalgia, is a painful condition that mainly affects the lumbar region (lower back). In this case, we are talking more precisely about low back pain, but back pain can also affect the cervical (upper back) and thoracic (middle back) regions.

Strictly speaking, it is not a disease, but a symptom originating from the locomotor system, such as nervous, muscular, catilaginous, spinal disc or osteoarthritis problems.

Back pain is rarely very severe and usually resolves after a few days with medication or other treatments. It is important to differentiate back pain from herniated disc, which is a specific disease that arises when the soft elements of the spine (vertebral discs, nerves) are pressured by poor posture, overload, muscle weakness, etc.

Cause of disability
In most countries of the world, back pain is the main cause of disability, as noted in the leading English newspaper The Economist , in an edition published in January 2020. Back pain has its main origin in the form of work in Europe and the United States and is partly responsible for the “opioid crisis” with the addiction of many Americans in the 2010s, according to The Economist .

Epidemiology

Back pain is considered the most common chronic disease among Brazilians, affecting around 36% of the population, according to data from the National School of Public Health. Of these, about 68% seek treatment. This type of pain can occur at any age, being rarer in childhood and more common after the age of 40. In young people and adolescents, the incidence of back pain has increased due to postural errors, obesity, sedentary lifestyle, etc.

According to the World Health Organization (WHO), it is estimated that more than 80% of the world’s population will suffer at least one episode of back pain during their lifetime and that, at this very moment, at least 50% of people have some type of back pain. of back pain. According to surveys, this is the first cause of medical consultation. Back pain is second only to headaches, according to data from worldwide studies.

It is always important to be alert to back pain, because, according to doctors, the percentage of people who seek treatment is small and back pain can hide a more serious illness in some cases, with cancer or tuberculosis.

Age
Chronic back pain usually first affects middle-aged people (around 40 years old).

Costs
To cure back pain and also neck pain, Americans spend each year about 88 billion dollars (USD), according to an edition of the British magazine The Economist published in January 2020. Annual costs of cancer treatment are approximately 115 billion dollars (USD).

Causes

Notes:
In about 85% of cases, back pain does not have a specific cause clearly identifiable by the physician, such as an accident. This type of back pain is rightly described as “non-specific”. In other words, these back pains do not have a clear physical origin, which also opens the door to a more psychological cause of the illness, the concept of psychosomatic illness.

Back pain is a complex disease for which we still don’t know all the causes. There are numerous factors that can trigger these symptoms:

– Muscle problems (e.g. muscle contracture, muscle strain)

– Poor posture or everyday posture mistakes

– Postural deviations, such as cervical lordosis, lumbar lordosis and dorsal kyphosis

– False moves

– Psychological problems such as stress or psychological shock. Stress can be a cause of back pain with a clear psychosomatic factor, such as, for example, a troubled marriage or a period of unemployment.

– Osteoporosis

– Osteoarthritis (in the cartilage region)

– Arthritis

 Pregnancy (due to weight gain)

 Intervertebral disc injuries

 Metastasis (in case of cancer )

– Tuberculosis , especially bone

– Obesity and sedentary lifestyle

– Falls, accidents and fractures

– Congenital problems such as scoliosis

– Irregularities in the composition of the spine structure

– Bad physical exercises

– Disc herniation

– An abdominal aortic aneurysm.

A particularly rare condition, but one that deserves attention, is the so-called “Cauda Equina Syndrome”. This is a neurological condition that affects nerves that send information to the lower regions of the body (lower back and legs) and may be related to back pain. In addition, spinal column infections, although rare, can cause pain, usually accompanied by fever.

A recent study conducted by the Institute of Bioengineering of Catalonia linked back pain with a lack of nutrients in the spine. One of these nutrients is glucose. Excessive pressure on the spinal joint discs reduces the amount of glucose and increases the amount of lactic acid, which interrupts cell nutrition and begins the degenerative process, causing pain.

Groups of risk

Although back pain can strike anyone at any age, some groups are more prone to developing this type of condition. Some risk factors can increase the chances of back pain:

– People who perform strenuous physical work or who handle very heavy loads.

– Age: usually people of advanced age are more likely to develop back pain. This is due to a natural wear and tear of the elements of the spine (bones and cartilage), making pain more likely.

– Smoking : data published in the American Journal of Medicine indicates that smokers, especially younger ones, are more likely to have back pain. Although the causes are not completely understood, it is believed that there is a decrease in blood flow to the spine, in addition to an increased risk of osteoporosis and an increase in the circulation of substances that cause pain in the smoker’s body.

– Women may experience more back pain due to female hormones, especially estrogen. In addition, women after menopause are at greater risk of developing osteoporosis, which is one of the factors that causes back pain.

– Obesity : obese people are at increased risk due to the overweight that is on the spine.

– Sedentary lifestyle : sedentary people who do not have strong back muscles are more likely to suffer from back pain.

– Stress : people who are stressed and very anxious suffer more from back pain. Stress causes the release of hormones that increase pain perception, in addition, it causes muscle tension. Muscle tension causes reduced blood circulation and, consequently, acid residues are not removed from the site. This accumulation causes pain and discomfort.

Symptoms

Symptoms of back pain are generally:

– Muscle pain in the back region

– Stiffness of the spine

– Persistent pain after standing or sitting for a long time, after performing physical exercise or handling heavy loads

– reduced flexibility

– Inability to keep the spine straight

– Feeling of “popping” in the back

In some cases, back pain can radiate to other regions, such as thighs and legs. In this situation, the most common cause is nerve compression, which may be associated with a herniated disc.

Back pain symptoms can be acute (present for less than 4-6 weeks) or chronic (greater than 6 weeks). Chronic pain is rarer and in such cases a doctor should be consulted.

Most back pain resolves naturally within 4 to 6 weeks.

Diagnosis

No specific tests are usually needed to diagnose back pain. The doctor can examine the patient and check for any irregularities with the spine. If a more serious illness is suspected, blood and urine tests may be needed to prove whether or not there is some other factor causing the illness (such as infections).

Imaging exams, such as X-rays, help visualize the spine and allow the doctor to assess whether there are any changes in bone structures, such as fractures, dislocations, hernias, etc. Magnetic nuclear resonance and computed tomography allow the analysis of tendons, muscles, nerves, ligaments and vertebral discs.

Bone scanning allows the doctor to see if there are tumors from metastases or fractures due to osteoporosis. Electromyography is an examination of the nerves whose results show whether there is nerve compression due to hernias or other factors.

Complications

People with chronic back pain have limited daily activities, which is one of the factors for professional reclassification. This can generate feelings of unhappiness and frustration in the patient since, in many cases, he is no longer able to carry out his daily activities normally.

Chronic patients may also present postural alterations, degeneration of vertebral discs or even  fibromyalgia .

Treatments

Depending on the type of back pain and its intensity, the doctor may adopt some specific treatment.

drug treatment

 Non-steroidal anti-inflammatory drugs (NSAIDs): for example based on diclofenac ,  ibuprofen and acetylsalicylic acid . These medications are available in the form of capsules, pills and even creams and gels for massages. Do not hesitate to take pills and use a cream at the same time, as this allows you to calm the pain more quickly. A side effect of these medications is burning in the stomach. If this happens, talk to your doctor so they can prescribe an antacid (such as omeprazole) or reduce your dose of medication.

– Paracetamol , to be taken in pill form, mainly against pain or in case of arthrosis.

Attention, according to an Australian study published in July 2014, in the leading journal The Lancet , taking paracetamol for acute low back pain is no more effective than placebo. Read: Study says acetaminophen is not effective in acute low back pain

 Painkillers more potent than NSAIDs, such as corticoid derivatives to be taken orally, plasters or injected. Another class of pain medications are opioids (codeine, hydrocodone, tramadol). These should be used for a short period of time and under medical supervision.

 Myorelaxants. These can be recommended by doctors, especially in the case of neck pain ( torticollis ). Attention, these drugs have a sleep effect, so avoid driving if you take them.

– Low doses of antidepressants, mainly tricyclics such as amitriptyline, have been shown to be effective in chronic pain regardless of their effect on depression .

Physiotherapy and physical exercises

The physiotherapist can apply a number of treatments and techniques to the patient with back pain, such as heat, cold, electrical stimulation and muscle relaxation techniques. Physical exercises also help with symptoms, as it strengthens musculature, increases flexibility and regulates posture.

A relatively new treatment is pulsed radiofrequency, which is said to have good results in back pain and also herniated discs. It consists of using radio waves to create molecular friction and controlled heat.

Another approach is the use of a spinal decompression machine. A strap is attached to the patient and provides traction in the spine region, leading to decompression of the vertebral discs.

Surgery 

In some cases patients may require surgery, such as in cases where there is nerve compression or anatomical problems. Types of surgery involve:

– Fusion of vertebrae to eliminate pain, which can be done through metal pins.

– Partial removal of a vertebral disc, especially in cases of nerve compression.

– Partial removal of a vertebra, when there are also cases of compression of soft structures of the spine.

Among the surgical methods there is spinal cord stimulation, performed through electrodes inserted in the posterior region of the spinal cord. The analgesia mechanism seems to occur mainly by inhibition of nervous impulses and is mainly applied in neuropathic pain.

Critical note on surgery
Surgery is rarely recommended because it is often ineffective and expensive, according to an article by The Economist published in January 2020.

General note on treatments
According to an article by The Economist published in January 2020, doctors often prescribe painkillers. They also perform many surgeries. However, relatively often, medications and surgery do not relieve back pain in the long term. However, for most back pain, the ideal treatment is not medical (medicines, surgery), it is based, for example, on stretching exercises or on regular physical exercise. It is also about being patient to lessen the pain.
Doctors also perform a lot of unnecessary MRIs, which leads to unnecessary surgeries, according to The Economist .

Alternative therapies 

Nowadays, several alternative therapies are available. Massages, acupuncture and chiropractic are complementary and auxiliary treatments for patients with neuromuscular disorders.

Relaxation techniques, yoga and cognitive therapy also help the patient, especially in cases where back pain has an emotional background.

For chronic back pain, it is important to consult a doctor, as he has several treatments available and will adapt therapy depending on the cause.

Read below the interview about non-surgical treatment for back pain and other spine problems:

Herbal medicine

The following medicinal plants have proven to be effective in treating and alleviating back pain.

– arnica , to be used in the form of an ointment.

-chili pepper , to be used in the form of an ointment or poultice (seems to be very effective).

-the white willow , thanks to an anti-inflammatory compound, to be taken in the form of tablets or capsules.

– devil’s claw , to be taken in pill form.

Tips

– In case of back pain, do not hesitate to adopt alternative treatments to complement classical therapy or phytotherapy. You can consult an osteopath, have massages, yoga, stretching or even acupuncture (useful in case of pain). These methods or techniques can help with stress, a possible cause of back pain (see also Causes above). Psychotherapy can also be effective in combating stress.

 Maintain a correct posture. Avoid lying down or sitting in uncomfortable positions for a long time. Talk to the doctor and see which positions are best for you to carry out your day-to-day activities. Many hours in the same position can aggravate symptoms. Always have a physical education professional monitoring your exercises.

– If you need to exercise to improve back pain, start with light activities and increase the intensity at your own pace.

– Always see a doctor if you have back pain. It can be due to a simple problem, such as posture or the way you sleep, but it can also hide something more serious. Do not hesitate to talk to an expert on the subject.

– If you already have cases of back pain, avoid heavy and impactful activities, such as carrying weights or running. If your job requires this, talk to people who can help you with this type of activity.

– Perform movements and physical exercises correctly. Bad practice of physical exercises can aggravate symptoms.

Hot and cold for back pain

– Apply cold compress to relieve pain. Cold reduces inflammation and acts as a local anesthetic. Use cold packs (Cold Pack), available at pharmacies. It is advisable to use cold at the onset of inflammation and pain. Apply for example for 15 minutes every three hours. Avoid applying cold directly to the skin, use a small fabric bag to avoid direct contact between the skin and the cold bag.

– A few days after the onset of inflammation and especially back pain, it is possible to use heat to improve symptoms such as pain, heat improves blood circulation. Use hot packs available at pharmacies. Apply for 15-20 minutes several times a day and avoid applying very hot packs. It is also possible to continue the application of the cold bag, alternating with the hot one, for example.

Prevention

 When carrying heavy objects, keep your spine straight and always bend your knees.

 If you work in an office, for example, try to change your position frequently, as always maintaining the same position is not good for your back. It is also advised to get up regularly.

– Adjust your work table so that it is at a comfortable height, so that you do not have your arms and neck stretched or too shrunken.

– Manage stress  and anxiety.

– Avoid smoking .

– Constantly stretch. Ask a trained professional what the best way to do them.

 Sleep on a good mattress, with a good pillow and a good sommier according to your case (talk to the doctor to find out if it is better hard or soft).

 Wear comfortable shoes that are firm on your feet.

 Control your weight.

 You can use a lumbar belt, this allows you to relieve back pain.

– Practice sports regularly (such as bodybuilding, walking, cycling, water aerobics or swimming). Sport is an excellent ally in cases of back pain. In fact, the practice of sports or exercises strengthens the musculature and exerts a preventive effect against this condition.

In recent studies, carried out in Denmark, Finland and Iran, researchers related back pain with low muscular resistance of the spine. Studies suggest that exercises are done for the trunk, with more repetitions and less load. This includes back and abdominal exercises designed to strengthen the muscles and increase their endurance.

– Stretch, if possible do these stretching exercises for 15 minutes a day.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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