Chronic Back Pain

Chronic Back Pain

Back pain is considered to be chronic if it has been present for greater than three months. Chronic back pain may originate from an injury, disease or stresses on different structures of the body.

The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. The sensation of pain may also vary. For instance, pain may be achey, burning, stabbing or tingling, sharp or dull, and well-defined or vague. The intensity may range from mild to severe.

Eighty percent of adults will experience significant back pain sometime during their lifetime. Back pain usually involves muscle spasm of the supportive muscles along the spine. Also, pain numbness and tingling in the buttocks or lower extremity can be related to the back.

Many times, the source of the pain is not known or cannot be specifically identified. In fact, in many instances, the condition or injury that triggered the pain may be completely healed and undetectable, but the pain may still continue to bother the patient. Nevertheless, even if the original cause of the pain is healed or unclear, the pain felt by the patient is real.

Common Causes of Back Pain

• Muscle strain. The muscles of the back provide the strength and mobility for all activities of daily living. Strains occur when a muscle is overworked or weak.
• Ligament sprain. Ligaments connect the spiral vertebra and provide stability for the back. They can be injured with a sudden, forceful movement or prolonged stress.
• Poor posture. Poor postural alignment (such as slouching in front of the TV or sitting hunched over a desk) creates muscular fatigue, joint compression, and stressed the discs that cushion your vertebrae. Years of abuse can cause muscular imbalances such as tightness and weakness, which also cause pain.
• Age.”Wear and tear” and inherited factors may cause degenerative changes in the discs (called degenerative joint disease). Normal aging causes decreased bone density, strength, and elasticity of muscles and ligaments. These effects can be minimized by regular exercise, proper lifting and moving techniques, proper nutrition and body composition, and avoidance of smoking.
• Disc buldge. Also known as herniation, can cause pressure on a nerve, which can radiate pain down the leg. This generally responds well to a strengthening and stretching program and rarely requires surgery.
• Other causes of back pain include bladder/kidney infection, endometriosis, cancer, or ovarian problems.

Common Causes of Chronic Back Pain

• Degenerate Disc Disease, could manifest as a bulged disc, herniated disc or just as a light protrusion, compressing the spinal cord or nerve root.
• Spondylolisthesis, narrowing the spinal canal.
  * The first two causes can produce a clinical condition commonly known as Sciatica or sciatic nerve damage.
• Facet joint syndrome, affecting intervertebral joint.
• Sacroiliac joint syndrome.
• Vertebral Cysts, that could compress a nerve root.
• Muscle and ligament strains, after physical activity.
• Chronic hip or knee conditions.
• Cancer that invades bone tissue.
• Chronic infections.
• Back surgeries
• Arachnoiditis after spinal or epidurals for anesthesia.
• Scoliosis.
• Back trauma, including vertebral fractures, anesthesia, sports.

Common Performed Procedures to Treat Chronic Back Pain

• Lumbar Transforaminal steroid injection.
• Lumbar Spinal Nerve block.
• Lumbar Discography/Nucleolysis.
• Facet joint injection.
• Sacroiliac joint injection.
• Epidural injection.
• Myofascial block.
• Trigger points.
• Epiduroscopy.

Treating Chronic Back Pain

Treatments for chronic back pain can vary greatly depending on the type and source of the pain. If a treatable source of the pain is found, then the underlying process can be addressed.

When the underlying cause is either not specifically identifiable or not amenable to treatment, then the symptoms are treated. The goals of the treatment are to reduce pain, improve quality of life and increase function.

Medications used for treatment of pain are multiple and varied. They fall into several different categories. Both non-narcotic and, rarely, narcotic pain medications may be used in the treatment of chronic back pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful with pain control and may help reduce inflammation. Muscle relaxants can also help with chronic pain and may enhance the effects of other pain medications.

Nerve stabilizing drugs (antidepressants and antiseizure medications) are used to treat nerve-mediated pain. All these medications have different side effect profiles and interactions, and should be carefully monitored by a physician.

Coping skills are extremely important in the management of chronic back pain. Chronic pain directly affects all areas of a patient’s life.

Pain affects mood, and a patient’s mood affects his or her ability to cope with pain. Pain also affects how patients interact with other people.

For this reason, teaching patients appropriate coping skills for dealing with anxiety, depression, irritability and frustration can be invaluable.

Procedures ranging from minimally invasive injections to surgery may be used to manage chronic pain.

Complementary medicine also offers a variety of treatments, often helpful in the treatment of chronic pain. These treatments include acupuncture, dry needling, nutritional therapy, use of magnets and many others.

By Luis Rujana