BACK PAIN TREATMENT

 

Understanding the lower back

The lower back is also called the lumbosacral area of the back. It is the part of the back between the bottom of the ribs and the top of the legs.
Most of the lower back is made up from muscles that attach to, and surround, the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a disc. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel-like centre. The discs act as shock absorbers and allow the spine to be flexible
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  Strong ligaments also attach to nearby (adjacent) vertebrae to give extra support and strength to the spine. The various muscles that are attached to the spine enable the spine to bend and move in various ways.
The spinal cord, which contains the nerve pathways to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body.

What are the types of low back pain?

Nonspecific low back pain

This is the most common type of back pain. The majority of cases of sudden-onset (acute) low back pain are classed as nonspecific. This is the type of back pain that most people will have at some point in their life. It is called nonspecific because it is usually not clear what is actually causing the pain. In other words, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe. This type of back pain is discussed further below.

Nerve root pain - often called sciatica

This occurs in less than 1 in 20 cases of acute low back pain. Nerve root pain means that a nerve coming out from the spinal cord (the root of the nerve) is irritated or pressed on. (Many people call this a trapped nerve.) You feel pain along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot. The pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
About 9 in 10 cases of nerve root back pain are due to a prolapsed disc - often called a slipped disc. (A disc does not actually slip. What happens is that part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. The prolapsed part of the disc can press on a nerve nearby. See separate leaflet called Prolapsed Disc (Slipped Disc) for details.) Other less common conditions can cause pressure on a nerve to cause nerve root pain.

Cauda equina syndrome - rare, but an emergency

Cauda equina syndrome is a particularly serious type of nerve root problem. This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the back passage (anus)), and weakness in one or both legs. This syndrome needs urgent treatment to prevent the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you suspect cauda equina syndrome.

Less common causes of low back pain

Inflammation of the joints (arthritis) of the spine sometimes causes back pain. Osteoarthritis is the common form of arthritis and usually occurs in older people. Ankylosing spondylitis is another form of arthritis that can occur in young adults and causes pain and stiffness in the lower back. Rheumatoid arthritis may affect the spine, but you are likely to have other joints affected too.
Various uncommon bone disorders, tumours, infections, and pressure from structures near to the spine occasionally cause low back pain. (Less than 1 in 100 cases of low back pain.)

What is the cause of nonspecific low back pain?

Nonspecific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.
To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is nonspecific back pain which means there is no serious problem or disease of the back or spine.

What are the symptoms of nonspecific low back pain?

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement. Sometimes it can develop for no apparent reason. Some people just wake up one day with low back pain.
Although nonspecific back pain is sometimes called simple back pain, simple does not mean that the pain is mild. The severity of the pain can range from mild to severe. Typically, the pain is in one area of the lower back but sometimes it spreads to one or both buttocks or thighs. The pain is usually eased by lying down flat. It is often made worse if you move your back, cough, or sneeze. So, nonspecific low back pain is mechanical in the sense that it varies with posture or activity.
Most people with a bout of nonspecific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further bouts of pain (recurrences) from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain (discussed in more detail later).

How is nonspecific back pain diagnosed?

Most people who develop low back pain that comes on suddenly (acutely) have nonspecific low back pain. If there are no other associated symptoms and the pain is not too bad, many people are confident to just 'get on with it' and treat it themselves - and indeed most get better quickly. However, if in doubt, see your doctor for a check-over and advice.
A doctor will usually want to ask questions about your symptoms, and examine you. Basically, the symptoms are usually as described above, with no other worrying symptoms to suggest anything serious or another cause of back pain (such as the ones listed below). The examination by a doctor will not detect anything to suggest a more serious cause of back pain. Therefore, a doctor can usually be confident from his or her assessment that you have nonspecific back pain.
As a general guide, if any of the following occur then it may not be nonspecific low back pain, and there may be a more serious underlying cause. But note: the vast majority of people with low back pain do not have any of the following symptoms or features. They are included here for completeness, and as an aid to what to look out for and to tell your doctor should they occur.

• Pain that develops gradually, and slowly gets worse and worse over days or weeks.
• Constant back pain that is not eased by lying down or resting.
• Pain that travels to the chest, or is higher in the back behind the chest.
• Weakness of any muscles in a leg or foot.
• Lack of feeling (numbness) in any part of your bottom or leg.
• If you have taken steroid tablets for more than a few months.
• Symptoms that may indicate an inflammatory (arthritic) cause such as ankylosing spondylitis. The main ones are:
  • Pain which is worse in the second half of the night or after waking.
  • Stiffness, in addition to pain, of the back muscles in the morning after getting up from bed that lasts for more than 30 minutes.
  • The pain is eased (and not made worse) by activity.
• Symptoms that may indicate cauda equina syndrome. The main ones are, in addition to back pain:
  • Numbness around the back passage (anus) -the saddle area.
  • Bladder symptoms such as loss of bladder sensation; loss of bladder control, incontinence, loss of sensation when passing urine.
  • Incontinence of poo (faeces, stools, or motions).
• Symptoms that may indicate a fracture in the spine The main ones are:
  • Back pain following major trauma such as a road accident or fall from a height.
  • Back pain following minor trauma in people with osteoporosis.
• Symptoms that may indicate infection or spread of cancer affecting the spine. The main ones are:
  • Onset of pain in a person aged over 50 years, or under 20 years.
  • Pain that remains when lying down; aching nighttime pain disturbing sleep.
  • Symptoms or problems in addition to pain such as:
    • If you have or have had a cancer of any part of the body.
    • General symptoms, such as fever, unexplained weight loss, etc.
    • If you inject street drugs.
    • If you have a poor immune system. For example, if you are on chemotherapy or have HIV/AIDS.

Do I need any tests?

Usually not. Your doctor will usually be able to diagnose nonspecific low back pain from the description of the pain, and by examining you. Therefore, in most cases, no tests are needed. There is no test that can prove or confirm nonspecific low back pain. In fact, some doctors argue that tests can actually do more harm than good when the diagnosis is nonspecific low back pain. For example, the technical jargon used to report on some scans can sometimes sound alarming, when in fact the scan is just showing what would be normal for a given age and not a cause for pain.
Current UK guidelines are clear that routine tests such as X-rays and scans should not be done if the diagnosis is made of nonspecific low back pain.
Tests such as X-rays , scans or blood tests may be advised in certain situations. This is mainly if there are symptoms, or signs during a doctors examination, to suggest that there may be a serious underlying cause for the back pain.

Source:-  http://patient.info/health/nonspecific-lower-back-pain-in-adults