Globally backache is the leading cause of absence from work or an appointment to the doctor, which in serious cases can also cause disability of the person affected. It can affect people irrespective of their age and can be uncomfortable and crippling. Back pain can arise due to injury, physical exercise, some prevalent medical conditions, or occupational hazards.
The probability of developing back pain increases as people age; this is further increased by the risk of developing degenerative disk disease at an older age.
Causes of Back PainSome of the most common causes of back pain include:
- Strain or Spasms: Spasms or strains occur when lifting heavy stuff, lifting inappropriately, or making a sudden and unnatural movement. Back pain arises from such spasms, strain, or injury. Common causes of back pain from strain include:
- Strain to either ligaments or the muscles.
- Muscle spasm.
- Unnatural stress on the muscles.
- Damaged discs.
- Fall or injuries that lead to fractures.
- Underlying medical condition or issue in the skeletal structure: Problems in fissured or swollen disks, and any underlying disease conditions like arthritis, kidney diseases, or osteoporosis can lead to back pain.
- Posture and Movement: The movement and posture of a person can highly influence the likelihood of them developing back pain. In people who do desk jobs, there is an increased risk of developing pain in both the back and shoulder in the long run if they hunch too much. Common activities like twisting, sneezing, driving, or even sitting or standing for an extended period can cause back pain. Not being able to sleep properly either because of the mattress or because of a sleep disorder can also cause back pain.
Clinical features of Back PainYou will feel pain anywhere in the back, and sometimes the pain can radiate up to the buttocks and down to the legs. Depending on the nerve affected, the pain will be felt in additional parts of the body in addition to the back.
Diagnosing Back PainBack pain and associated symptoms usually go away on their own after a few days, however persistent back pain that impairs day-to-day function should be brought to the attention of your health care provider.
The diagnosis of the underlying cause will be made by your doctor with the help of a detailed history and physical examination.
Imaging: Imaging tests like X-ray, CT scan, or MRI may be required in cases where back pain has been caused by trauma or has been persistent for a very long time. Imaging tests also help detect the presence of underlying conditions such as arthritis and osteoporosis which may lead to back pain.
Nerve conduction test: It helps measure electric impulses in the nerves of the back. The test helps detect the presence of nerve compression caused by a herniated disc.
Bone scan: It helps diagnose bone tumors and compression fractures caused due to bone weakening, which lead to back pain.
Management of Back Pain:Depending on the cause and type of back pain, your doctor may prescribe:
- Over the counter pain medications: OTC NSAIDs like Ibuprofen, naproxen can help relieve back pain. However, overuse of these drugs should not be done as they may result in serious side effects. Topical pain killers can also be used to reduce pain.
- Muscle relaxants: For back pain not responding to OTC pain killers, these drugs may be useful.
- Antidepressants: Drugs used in depression-like amitriptyline and duloxetine have shown to be useful in reducing chronic back pain. However, their efficacy in chronic pain is still being studied.
- Opioid drugs: These drugs are usually used in acute cases of back pain and are not suitable for long term pain management owing to the side effects.
- Steroid injection: Steroid injection is indicated in severe cases of back pain or back pain radiating to the legs that do not respond to other pain-reducing medications. The pain relief following steroid injection lasts about 3 months.
Physical Therapy For Back PainPhysical therapy helps reduce pain by strengthening and improving the flexibility of your back and abdominal muscles. These therapies also help improve posture and reduce chronic pain caused as a result of prolonged improper posturing. Your therapist will also teach you exercises and techniques to prevent back pain from recurring.
Surgery For Back PainSurgical measures are required in cases of chronic back pain not relieved by medications and physical therapy, which have led to various complications and significant difficulties in carrying out daily tasks. Surgeries are usually reserved for cases of Spinal stenosis and herniated discs.
Recent Advances and Treatment Modalities Currently Undergoing Clinical TrialsVirtual reality: A clinical trial is currently underway to assess the efficacy of home-based- virtual reality therapy in chronic back pain reduction. The participants will receive one of skill-based VR, distraction VR, or sham VR programs and will be assessed for pain reduction and need for anti-pain medications.
Tonal exercise device: A clinical trial to assess the efficacy of incorporating tonal exercise device in chiropractic and clinical care of vague lower back pain is currently underway The participants in addition to clinical and chiropractic care will be taught resistance exercises along with dynamic warm-up and cool-down periods. These exercises which help develop core strength and stability will be performed in the tonal device.
Non-Steroidal Anti -Inflammatory Drugs (NSAIDs): NSAIDs are drugs that are helpful in relieving acute non-traumatic back pain. A clinical trial is currently underway to assess the safety and efficacy of the commonly used NSAIDs in improving symptoms of acute non-traumatic non-radicular low back pain- Ketorolac, Ibuprofen, and Diclofenac. It is currently in Phase-4 of its clinical trial.
Combined Osteopathic manipulative and phototherapy: A clinical trial is currently undergoing which aims at assessing the benefits of combined osteopathic manipulative and phototherapy in improving symptoms of chronic back pain.
It is believed that combining the two modalities provide greater pain relief as compared to other commonly used medications or even the two techniques used in isolation.
Physical activities to heal back pain (PATH): A clinical trial is currently undergoing which aims at understanding the mechanisms that help improve symptoms in chronic back pain and provide specific directions to these groups for optimizing physical activity. In addition to physical intervention, the group will also be provided with emotional support and behavior enhancement skills, which is thought to provide a better outcome as compared to just physical intervention alone.