Oh, My Aching Back!

Back pain is one of the top reasons why people visit a physician or chiropractor. It’s also the number one pain ailment in the U.S. About 80 percent of Americans suffer back pain at one time or another. Over five million Americans suffer chronic, long-term back pain.

Thirty percent of people will have a recurrence of back pain in six months. Forty percent will have a recurrence in one year. Clearly, back pain is a major health malady that may require physical therapy, chiropractic manipulation, acupuncture, massage therapy, self-care and sometimes even medications, neuro or orthopedic surgery.

Back pain can be acute (sudden onset) or chronic (lasting over three months). All patients suffering from severe back pain should have a thorough examination by a qualified physician.

Stress Can Hurt

backpain01According to the Journal of Internal Medicine, 60 percent of patients who seek relief from pain suffer from some form of stress. Stress-reduction techniques and a positive attitude are important to the healing process, especially when the cause of back pain is unknown. The goal of alternative techniques such as meditation and hypnosis is to decrease the perception of pain, as well as reduce the anxiety and depression that can accompany it.

NIH research confirms the relationship between the brain, cognitive function, behavior and its effect on emotions, mental function, and the perception of pain. Stress can hurt.

Plato (428-347 B.C.) considered the mind and body as one, emphasizing that beliefs and emotions affected health and wellness. The Greeks coined the word “holus” which means disease involves the whole person, not just the diseased part.

“If the head and body are to be well, you must begin by curing the soul; that is the first thing,” said Plato.

The mind has a powerful influence on the body. Often the root cause of muscle tension is severe stress—financial, marital, or work-related. Mothers charged with caring for young children and seniors caring for a loved one who has a serious illness feel the most stress, according to a recent national poll.

The most valuable health care provider knows how to distinguish between patients who can get well without heroic interventions and those who can’t. No test can measure the intensity of back pain, although technologies such as x-ray, CT scan, MRI and nerve conduction studies can locate the cause of pain. Often the origin of the pain is unknown and imaging studies may fail to determine its cause.

Common Causes of Backaches

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

  • backpain02Cervical vertebrae: the seven vertebrae forming the upper part of the spine
  • Thoracic vertebrae: the 12 bones between the neck and the lower back
  • Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips. Lumbar vertebrae bear the brunt of carrying the body’s weight.
  • The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae. (WebMD)

Muscle tension and strain are the most common causes of back pain. Injury to the back’s ligaments or muscles is another common cause. Working on a computer, driving, or carrying an infant or toddler can cause muscle fatigue and strain the back. The pain may be associated with spasms in those muscles. It’s usually not related to a serious problem and will go away with time.Muscles in the back and neck can also tighten up in response to an underlying condition such as arthritic joints of the spine.

Lower back pain is common and usually not related to a serious problem and will often go away with time. A few injections and short-term drug therapy may bring quick relief, but unless there is a clear neurological or orthopedic impairment, conservative measures should be tried first.

Good posture, walking, cardio and core strength exercises help prevent or heal back pain.

Patients who suffer back pain can advance their healing through self-care: daily walks or stationary biking, meditation, whirlpools and hot tubs, yoga, tai chi, core strengthening exercises, weight loss, proper rest, and non-addictive anti-inflammatory medications. If the pain doesn’t respond within six weeks, additional treatment options may apply.

Nagging Back Pain

By the time that most people seek drug therapy or surgical care, they’ve already tried everything under the sun to relieve their nagging back pain. Today’s drug therapies and advanced intraoperative techniques help a great deal of people suffering from severe pain due to spinal trauma (accidents) and severe degenerative conditions, e.g., ruptured discs, herniated discs, and lumbar stenosis.

In the not-so-distant past, patients recovering from back surgery had to wear full-body casts. They also had to stay in bed for weeks. Bedbound patients lose about 2 percent of their cardiovascular fitness after a week. And if you’re an athlete, you lose about 30 percent of your cardio fitness staying immobilized for a week. The newest drug and surgical therapies offer less pain and debility and the opportunity to be up and moving the same or next day.

An injection which combines a steroid and a local anesthetic is a common treatment for back pain. Often one or a few injections resolve the pain. Steroid injections, which reduce inflammation, are often tried when physical therapy or anti-inflammatory medication fails, with the aim of avoiding expensive surgery. Some insurance companies require injections before approving surgery. Injections cost $500 to $2,000 each.

Each year, thousands of chronic lower back pain patients undergo lumbar spinal fusion surgery, and the rates have been increasing over the past two decades. Despite a high level of a technical success, there is still a need to improve and regain patients’ habitual functional level and quality of life after surgery. This is when cognitive therapy can help.

Cognitive behavioral therapy (CBT) focuses the relationship between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people suffering from back pain can modify their patterns of thinking to improve coping.

Targeted stem cell therapy is on the cutting edge of medical care for spinal stenosis or deformities. Stem cells are repair cells typically harvested from the patient’s bone marrow which is a rich source of not only stem cells, but also growth factor proteins and the nutrients required for bone healing and spine fusion.

Back Pain in the Golden Years

Back and neck pain is common among seniors. As we grow older, we lose about three percent of our muscle mass each year and a leaner muscle mass means less support for the spine and head. The head typically weighs between six and ten pounds. The job of holding up the spine and head falls mainly to the muscles, spine bones, and other tissues that make up the back and neck.

Often caused by wear and tear, spinal stenosis occurs when spaces within the spine narrow, putting pressure on nerves and causing pain or numbness in the back and the legs. More than a third of people over 60 have some narrowing, research suggests.

Performing about 10 minutes of core exercises daily is important to help maintain a strong spine as you age. A physician, physical therapist, chiropractor, massage therapist, trainer or yoga instructor can teach core exercises to strengthen the back.

If the person’s generally well, they can learn a few balance exercises like standing on one leg while doing squats. Lean your head against the wall for safety reasons.

Exercise, incidentally will also cause some brain cell growth which can be of great value to anyone.

High-intensity intermittent training—one minute speed walking, followed by 30 seconds of slow walking for a span of 30 minutes can increase cardiovascular strength in addition to strengthening the back. But it depends on the person’s general condition. If he or she is having issues with weight or feels extreme pain, they must exercise the best they can. Never give up.

As we grow older, daily core exercise, mild weight-lifting, stretching, and walking have increasing value for balance and the health of the neck and spine. Participate in your own healthcare.

Remember, most back pain heals over time. Time can be a great healer.

Common causes of back and neck pain may include:

  • Muscle tension and strain. Psychological and repetitive physical stress can make muscles tense.
  • Worn joints. Wear and tear over time can result in the development of osteoarthritis which can damage joints.
  • Disk degeneration. With age, the spongy disks that proved cushion between the vertebrae of your spine become stiff, provide less shock absorption and are less effective at evenly distributing pressure to joints, resulting in neck or upper back pain. (Mayo Clinic)

Whatever the cause, chronic back pain can be so intractable that it becomes a continuous presence, a constant “companion” that sets the stage for a host of problems, including:

  • Lost work or home responsibilities;
  • Immobility and muscle wasting;
  • Insomnia;
  • Addiction to pain medicine;
  • Dependence on caregivers;
  • Overuse of the health care system;
  • Unemployment and disability insurance;
  • Anxiety and depression

Conventional treatments

  • Physical and medical massage therapy
  • Chiropractic manipulation
  • Prescription medications
  • Injections
  • Neck or back collar
  • Neuro or orthopedic surgery
  • Cognitive therapy

Seek immediate care

Back or neck pain related to a serious or life-threatening problem is uncommon. However, certain rare situations warrant seeking immediate medical care, including:

  • Sudden change in bowel or bladder control which may indicate vertebrae pressing on spinal nerves in the groin or rectal area.
  • Severe pain or pain related to a head or neck injury. Rear-end auto collisions often result in injuries, as can sports injuries or falls.
  • Pain that radiates to the shoulder or arm, leg weakness, or walking difficulty. Occasionally, the nerves exiting the spine can be compressed or irritated by a bulge from a ruptured (herniated) disk—or from a bony outgrowth from a worn joint.
  • Pain that worsens at night or occurs with fever or weight loss, which may indicate infection or another serious condition.
  • Neck pain that throbs, which may be related to a heart condition.
  • Neck pain before or with a headache, which may indicate a stroke.

(Mayo Clinic Health Letter, Volume 31, Number 8, August 2013)