What is Back Pain?

Back pain is a common condition that can range from a chronic dull ache in the back to a sharp, debilitating pain. Back pain can stem from back injuries, arthritis, osteoporosis, hereditary conditions and other issues, and is a leading cause of disability worldwide. 

Baptist Health is known for advanced, superior care for patients with orthopedic conditions and the diagnosis, treatment and management of back pain. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Symptoms of back pain can include:

• Muscle ache or tightness
• Shooting or stabbing pain in the back, especially when performing certain motions
• Pain that radiates down the leg
• Limited flexibility or range of motion of the back
• Numbness or tingling in the legs, feet or toes

Severe low back pain associated with any of the following symptoms can indicate a rare, emergent condition called cauda equina syndrome. In patients with cauda equina syndrome, something compresses on the spinal nerve roots. Immediate evaluation and surgical treatment is required to prevent lasting damage leading to incontinence and possibly permanent paralysis of the legs. If you have severe low back pain with any of these symptoms, immediately go to the emergency room for evaluation and treatment: 

• New onset of pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.
• Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia).
• Recent problems with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence).
• Sexual dysfunction that has come on suddenly.

Diagnosis

If you are experiencing back pain, we perform a physical examination and ask questions about symptoms. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

X-rays: A common imaging test of bones or joints.

Flexibility tests: These reaching and bending tests help indicate range of motion. Often X-rays are taken during different positions such as flexion or extension.

CT scan: X-rays and computers are used to create cross-sectional images of the back that show the spine, blood vessels and soft tissue. 

Magnetic Resonance Imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the affected area.

Blood tests: If your back pain is accompanied by a fever or infection, or in other rare cases, blood tests may be ordered to help determine the cause of the back pain. 

Causes

Back pain may have a number of causes, including: 

• Bad Posture
• Cancer in the back or spinal column
• Kidney stones
• Lack of exercise
• Pregnancy
• Repeated heavy or improper lifting 
• Sleep positions that put a strain on your back
• Smoking
• Standing or sitting in the same place for long periods of time
• Sudden awkward movement causing muscle or ligament strain
• Traumatic injury

Risk Factors

Risk factors that can contribute to back pain include:

Age: Back pain becomes more common once you reach age 35 or 40. 

Arthritis: In this condition, cartilage between joints wears away or becomes inflamed. This can cause vertebrate to rub against one another and cause back pain.

Fibromyalgia: This condition causes tender, achy muscles, joints and tendons, particularly in the spine.

Obesity: Excess weight puts added stress on your spine, increasing your risk for back pain. 

Osteoporosis: In this condition, which is particularly common among women, the bones become increasingly brittle and porous as they age, which can result in spinal fractures that cause back pain.

Scoliosis: In this condition, the spine is curved, which may be caused by genetic conditions like muscular dystrophy and cerebral palsy, abnormalities such as one leg being longer than the other, muscle spasms, inflammation or degenerative conditions. This may cause back pain depending on the severity of the curvature. 

Prevention

You can help prevent many types of back pain in these ways:

Maintain a healthy lifestyle: Exercise regularly, maintain a healthy weight, get plenty of calcium and vitamin D and reduce stress.

Care for your back: Practice good posture and sleep positions, avoid heavy lifting and use proper lifting techniques.

Quitting smoking: Smoking interferes with oxygen and nutrient delivery to muscles and joints.

Prognosis

The prognosis for people with back pain depends upon the cause and severity of the pain. In many cases, back pain may only last a few days or weeks, and can be treated with over-the-counter medications and other at-home remedies. More severe chronic pain may require surgery or treatment by a pain management specialist. 

Treatment and Recovery

Back pain treatment depends on the cause, location and severity of your back pain. The main treatments for back pain are:

Medication

Over-the-counter pain relievers and anti-inflammatories such as aspirin, acetaminophen, ibuprofen and naproxen sodium are commonly used to treat back pain. Topical pain relievers may also be used for muscle pain. For more severe pain, your doctor may prescribe narcotics, cox-2 inhibitors, muscle relaxants or cortisone.

Heat and Cold

Applying heat increases the supply of oxygen to the affected area and relaxes muscles, while applying cold reduces inflammation and numbs deep pain. 

Exercise

Treatment for chronic back pain often includes an exercise regimen designed to improve flexibility and extension of the back muscles, widen the space between the vertebrae, develop muscles that support the spine and improve aerobic fitness. 

Behavior Modification

Practicing proper techniques when lifting heavy objects, maintaining good posture, using body pillows and sleeping in positions that reduce strain on your back, moving around frequently, stretching, eating healthy, reducing stress and quitting smoking can all help manage and improve back pain. 

Traction

Using pulleys and weights to pull the vertebrae apart stretches the back and can offer temporary pain relief. 

Transcutaneous Electrical Nerve Stimulation (TENS)

For certain types of back pain, using low-voltage electrical currents to stimulate the nerves in your back can provide temporary relief by overloading nerve receptors and blocking or scrambling normal pain signals. 

Intradiscal Electrothermal Therapy (IDET)

In this procedure, a wire called an electrothermal catheter is inserted into the intervertebral disc. A current is then passed through the wire, heating the disc to strengthen the collagen fibers that hold the disc together and kill pain receptors. 

Surgery

Depending on the cause of your back pain and effectiveness of other treatments, your doctor may recommend the following procedures:

• Laminectomy/discectomy: If your back pain is caused by a slipped or herniated intervertebral disc, your doctor may surgically remove the disc relieve compression on the nerves in the spine. In some cases, the disc may be replaced with a synthetic disc. 
• Spinal fusion: After a discectomy, the spine often needs to be stabilized. This is usually done by replacing the intervertebral disc with bone from a cadaver or from your own hip or pelvis, or by using a synthetic substitute. In some cases, bone morphogenic proteins may be placed in the affected area to stimulate bone growth and eliminate the need for grafts. The adjoining vertebrae are then fused together with metal rods and screws. 
• Laser surgery:  In this procedure, a laser is used to remove intervertebral disk tissue, reducing the size of the disc and relieving pressure on the nerves.
• Vertebroplasty: If your back pain is being caused by a fracture of the spine, a cement-like mixture called polymethylacrylate can be injected into the fracture to stabilize the spine and relieve pain. 
• Kyphoplasty: In this procedure, a balloon is inflated in the damaged area of the spine to help restore its proper size and shape. This is followed by a vertebroplasty.

While vertebroplasties can often be done as an outpatient procedure under mild anesthesia, most spinal surgeries require a short hospital stay followed by physical therapy to help regain strength and mobility. Depending on the surgery, it may take weeks or months to fully determine if your back pain was treated successfully. 

Complications

Complications from back pain may include the following:

Disability: Back pain is the most common reason for disability in working adults. 

Nerve damage: Some conditions that cause back pain may result in nerve damage if left untreated. 

Depression: Chronic back pain can disrupt work, sleep and other activities, resulting in emotional distress, anxiety and depression. 

Weight gain: The reduction in mobility caused by back pain often results in a reduction in physical activity, which can lead to weight gain, obesity and related complications such as an increased risk for diabetes and heart disease. 

Transitional Syndrome: When one or more segments of the spine are not working properly, additional stress is put on neighboring segments which can cause these segments to degenerate and back pain to spread to other areas