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 Pains & Aches

June 2010
Back Up
Managing Lower Back Pain
Dr A Jayavelu
 
To say that back pain is a common problem is to state the obvious. Research says that 50 to 80 percent adults would have experienced at least one episode of back pain during their lifetime. Back pain is estimated to affect 15 to 20 percent of adults every year.

Neurological Causes
  • The most common neurological cause for back pain is the compression of the nerve root.
  • Spondylosis is the major - about 70 percent – cause of nerve root compression.
  • Disc prolapse or rupture is found guilty of 20 percent of all neurological back pain causes.
  • The rest are due to other lesions pressing upon the nerve roots.
Non-Neurological Causes
The non-neurological disorders that can produce back pain include
  1. Muscle strain
  2. Ligament sprain
  3. Pain in the facet joints (joints which help support the weight and control movement between individual vertebrae of the spine)
  4. Internal disc disruption
  5. Fracture of the spine
  6. Infections of the vertebrae
  7. Compression fracture of the vertebra
  8. Pregnancy
  9. Dysfunction of the sacroiliac joint (a joint in the pelvis)
  10. Sacral (a large triangular bone at the base of the spine connecting to the pelvis) stress
  11. Certain muscle diseases
Treatment
Because the reasons of back pain are many, correct diagnosis is necessary to plan the appropriate treatment, which varies according to the disease process.
  • Nonsurgical conservative management: Up to 90 percent of the patients improve with conservative treatment alone, which doesn’t involve radical surgeries. The treatment is aimed to alleviate pain, improve function and prevent recurrences. These include activity modification and medication.
  • Surgical intervention is considered only in cases where medical management has failed to give relief after four to six weeks of medical management, or a compression of the spinal cord is noted, or a lesion is suspected as the pain generator.
Alternative Treatment
  • Although these modalities lack much scientific support, they are widely practised.
  • There is no evidence that manipulation or mobilisation of the cervical and the lumbar spine done alone or with various physical agents are effective in relieving the symptoms.
  • However, massage therapy reduces the pain and improves the function to some extent.
  • The effectiveness of acupuncture remains unclear and controversial.
  • Exercise therapy is not effective for acute lower back pain, but may be beneficial when it is chronic.
  • There is no scientific evidence that lumbar supports prevent back pain, but it is found to be better with it.
  • The current evidence on Galvanic current, TENS (electrical nerve stimulation through the skin) and permanent magnets is either lacking, limited or conflicting.
Management of Chronic Back Pain
Chronic non-malignant pain is less a symptom of a disease than a disease in itself. Accordingly, successful treatments rely more on treating neural causes of pain amplification, psychological causes of disability, and the secondary result of psychiatric illness. Such treatment includes education about the disease, biofeedback and relaxation trainings, medications, psychotherapy and treatment of psychiatric illnesses.


11 Risk Factors for Back Pain
  1. Increasing age
  2. Gender: Back pain is more common in women.
  3. Occupational factors: 37 percent of lower back pain is due to occupational
  4. Heavy physical work,particularly long static working postures, heavy lifting,twisting,exposure to low-frequency whole body vibration-all contribute to this.
  5. Low level of physical activity and attempting unaccustomed work.
  6. Psychological factors, including work dissatisfaction and monotonous work.
  7. Depression
  8. Obesity or high BMI (greater than 30) is an independent predictor of development of low back pain and disability from pain.
  9. Smoking
  10. Drug abuse
  11. History of chronic headache

Dr. A. Jayavelu is Consultant Neurologist at Apollo Hospitals, Bilaspur


    
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