What is Back Pain?Most back pain is caused by muscle strain, trauma, or deformity. About 10 percent of back pain is caused by a systemic illness. Back pain can develop anywhere from the top of the neck to the bottom of the spine. The pain can be in one small area or spread across a wide area. It may also spread out from a central point.
Back pain has many causes, including degeneration of vertebrae, infection, tumor, overuse, and trauma. The exact cause of pain may be difficult to identify, since it can emanate from soft tissue, bone, disc, or nerves. Risk factors for low back pain include jobs that require repetitive lifting, exposure to vibration produced by vehicles or industrial machinery, and cigarette smoking. Certain sports, like cross country skiing, and prolonged vehicle driving are also associated with back pain. Diseases such as spinal osteoarthritis, spondylitis, and osteoporosis, can also cause pain. Some of these diseases are more prevalent in the elderly, so older people are at higher risk for back pain.
High rates of depression, anxiety, alcoholism, and divorce have been associated with back pain. Studies are unclear, however, whether these problems are the cause or the result of the disability.
Back pain is the most prevalent medical disorder in industrialized societies.
- Low back pain disables 5.4 million Americans and costs at least $16 billion each year.
- Impairment of the low back is the most frequent cause of activity limitation in people under 45.
- About 80 percent of all people will experience at least one episode of back pain in their lifetime.
- Seventy percent of people with back pain recover within a month. Symptoms persist for more than six months in only 4 percent of the cases, but this group accounts for 85 percent of the cost of low back pain.
- About half of the people with chronic back pain return to work.
Physicians should determine whether pain is musculoskeletal, neurological, or from one of the organs. This diagnosis is based on a careful history and physical examination. Injection of a local anesthetic and/or steroid into soft tissue or joint spaces can be helpful in diagnosing and treating back pain. Imaging procedures that assist in identifying the pain source include the x-ray, bone scan, computerized tomography, CT myelogram, and magnetic resonance imaging. Electrical studies are sometimes helpful. Expensive imaging procedures are generally reserved for patients whose diagnosis is not apparent with more conventional diagnostic techniques, like physical examination.
Over-The-Counter (OTC) pain relievers, such as aspirin, acetaminophen, and non-steroidal anti-inflammatory drugs, are often the only treatment necessary for back pain. Patients should avoid any activity that increases the pain. For persistent pain, assistance from a rheumatologist should be obtained. Treatment should be directed at the specific cause of pain. Management techniques include pain relievers, anti-inflammatories, antidepressants, muscle relaxants, and rehabilitation exercises. Mechanical back supports are usually recommended for limited periods of time in certain situations, such as post-operative patients. If these techniques fail within a reasonable time, injections with local anesthetics and steroids can be helpful. Surgery can be very helpful when non-operative therapy fails. Spinal cord stimulators and morphine pumps have been used in some patients whose pain does not respond to more conservative therapy.
Rheumatologists are appropriate physicians to complete evaluation of patients with back pain and to plan a treatment program. Since surgery is indicated for only a small percentage of patients, it is likely that a rheumatologist can significantly impact the cost of back pain by reducing hospitalization, expensive imaging procedures, excessive physical therapy visits, and surgery.
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