When to Worry About Back Pain: Understanding the Signs and Symptoms”

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What is Back Pain?

Back pain is one of the most common reasons for seeking medical treatment and is a leading cause of disability worldwide. It may range from muscle aching to a shooting, burning, or stabbing sensation. In addition, the pain may radiate to other parts of the body or worsen with bending, twisting, lifting, standing, or walking. It can affect men and women of all ages and may be a result of injury, activity, or an underlying medical condition. There are two types of back pain:
● Acute back pain, which starts and develops suddenly, lasts for up to 6 weeks and does not cause ongoing problems
● Chronic or long-term back pain, which develops over a longer period, lasts for over 3 months, and causes ongoing problems

How do we assess back pains?

A. History and Clinical Examination
During history and clinical examination, a medical professional is likely to examine a person’s back and assess their ability to sit, stand, walk and lift their legs. Additionally, the person may be asked to rate the pain on a scale of 0 to 10 and how well they are functioning with the pain. These assessments help determine the source of the pain, the maximum range of movement or activity a person can do before pain forces them to stop and whether you have muscle spasms. They can also help rule out more serious causes of back pain.

B. Physical Examination
A physical examination assesses a person’s ability to carry out simple tasks with limited or no pain in the back. It may consist of a test on gait and posture, range of motion, palpitation or percussion of the spine, heel-toe walk and squat and rise, palpation of the sciatic notch, and a straight leg raising test to identify possible secondary causes of back pain.

C. Radiological Examinations
● X-Ray
A procedure that uses electromagnetic waves to generate black and white images of bones, to identify any alignment issues or broken bones
● CT Scan
A procedure that uses X-rays to generate three-dimensional images of bones, muscles, tissue, tendons, nerves, ligaments and blood vessels, to show problems in these areas that are linked to back pain
● Magnetic Resonance Imaging (MRI)
A procedure that uses radiofrequency waves in a strong magnetic field to generate two- and three-dimensional images of bones, muscles, tissue, tendons, nerves, ligaments and blood vessels, to show problems that are linked to back pain
● Bone Scan
A procedure that uses radioactive substances, which is injected into a vein and collected in the bones, to help detect bone problems, such as tumors or compression fractures, with the aid of a special camera

D. Blood tests
These can help determine whether you have an infection or other condition that might be causing your pain.

E. Nerve conduction study (NCS)
Nerve conduction study (NCS) is a test that involves placing small electrodes close to nerves, where electrical impulses transmitted by nerves are monitored. It is typically used to test for nerve compressions, as well as distinguish between nerve root disease and peripheral nerve disease.

How to Treat Back Pain?

There are three broad categories of back pain treatment: non-invasive (a conservative procedure that does not enter the body), less-invasive (a procedure that enters the body by puncturing the skin or by inserting instruments), and invasive (a procedure that involves surgery). Generally, non-invasive treatments are often used to try to cure the disease first. Then, if non-invasive treatments are not effective enough, less-invasive treatments and invasive treatments will be carried out.

Non-Invasive Treatments
A. Medication
Over-the-counter medications, nonsteroidal anti-inflammatory drugs and antidepressants may be taken to relieve any discomfort as a result of back pain.

B. Physical Therapy
Applying heat, ice, ultrasound, and electrical stimulation may be able to reduce pain. As the pain improves, a physical therapist may also recommend some posture-improving and muscle-release techniques, as well as flexibility and strength exercises for the back muscles and tissues. Even after the pain is gone, it is encouraged to continue to practise the techniques and exercises regularly to prevent back pain recurrence.

Less-Invasive Treatments
A. Injections

Cortisone, an anti-inflammatory drug which can help to reduce inflammation around the nerve roots, may be injected into the space around the spinal cord. Other injections such as Botox, may also be used to numb painful areas by paralyzing any sprained muscles in spasm.

B. Nucleoplasty
Performed with X-ray imaging guidance, nucleoplasty involves the use of a needle which removes a small amount of excess disc tissue by emitting radio waves that generate heat and shrink the soft tissue. This relieves pressure on the nerves, in turn improving mobility and reducing back pain brought on by a slipped disc.

C. Annuloplasty
During annuloplasty, energy and heat are applied via fine radiofrequency needles to the damaged discs in the spine. This causes the damaged disc wall fibers to shrink and thicken to seal any damages and also numbs the nerves to effectively reduce back pain.

D. Radiofrequency Ablation
Radiofrequency ablation involves the use of an electrical current produced by a radio wave, to reduce pain signals from that area by heating up a small area of nerve tissue to reduce pain signals from that area.

Invasive Treatments
A. Surgery

Although rare, surgery can be carried out for people who have severe back pain that does not go away with the use of other non-invasive or mildly invasive treatments. Depending on the cause of the back pain, different types of surgery can be carried out:
● Fusion: The joining of two vertebrae with a bone graft inserted between them. The vertebrae are splinted together with metal plates, screws, or cages.
● Artificial disk: An artificial disk is inserted to replace the cushion between two vertebrae.
● Diskectomy: The removal of a portion of a disk which may be irritating or pressing against a nerve.
● Partially removing a vertebra: The removal of a small section of a vertebra which may be pinching the spinal cord or nerves.

When to Seek Help
Back pain typically gradually improves within a few weeks with home treatment, proper body mechanics, and self-care. However, it is recommended to seek help if the back pain:
● Persists past a few weeks
● Is severe and does not improve with rest
● Spreads down one or both legs, especially if the pain extends below the knee
● Causes weakness, numbness, or tingling in one or both legs
● Is accompanied by unexplained weight loss
● Causes new bowel or bladder problems
● Is accompanied by a fever
● Follows a fall, blow to your back or other injuries

As the saying goes, “Prevention is better than cure.” To keep yourself safe from back pains, practise the following prevention methods:
● Maintain good posture. When standing, maintain a neutral pelvic position and avoid slouching. When sitting, keep your knees and hips level. Avoid heavy lifting and movements that twist or strain your back.
● Exercise. Regular low-impact aerobic activities can increase strength and endurance in your back and allow your muscles to function better.
● Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
● Maintain a healthy weight. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain.
● Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.


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Sarah Taylor

Obstetrics & Gynaecology