What Is Back Pain?

Back pain is an all-too-familiar problem that can range from a dull, constant ache to a sudden, sharp pain that leaves you incapacitated. It can come on suddenly – from an accident, a fall, or lifting something too heavy – or it can develop slowly, perhaps as the result of age-related changes to the spine. Regardless of how it happens or how it feels, you know it when you have it. And chances are, if you don’t have it now, you will eventually.

What causes back pain?

The causes of back pain can be complex. Some causes of back pain include accidents, muscle strains, and sports injuries.

Are farmers more susceptible to back pain?

Farmers appear to be at an increased risk for low back pain in comparison to the general population. Farmers are involved in a wide variety of tasks that put strain on the lower back. Such tasks include operating heavy equipment (often for long periods without a break), lifting heavy objects, and daily exposure to the same repetitive motions.

What Is the Difference Between Acute and Chronic Pain?

Pain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example – is acute pain. Acute pain comes on quickly and often leaves just as quickly. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.
Chronic pain, on the other hand, may come on either quickly or slowly, and it lingers a long time. In general, pain that lasts more than 3 months is considered chronic. Chronic pain is much less common than acute pain.

What can I do to prevent low back pain?

Experts estimate that approximately 80 percent of us will experience significant back pain sometime in our lives. Back pain is the second most frequent complaint in doctor's office visits (after the common cold) and it results in more lost productivity, both at home and at work, than any other medical condition.
Fortunately, back pain usually is preventable. While back pain can result from inevitable situations such as trauma or illness, it also can be caused by lifestyle factors that you may be able to control. The use of proper lifting techniques, a healthy diet, and regular exercise are some of the keys to promoting good back health. Take a look at your everyday habits to reduce the risk factors that may be causing your back pain.

• Keep your back muscles fit
  
  Stretch and strengthen the muscles that support the spine, including those in the abdomen and lower back. Exercising can make the back more resistant to strain and injury.



• Always lift properly
  
  When lifting, keep your back straight and bend only at the knees. This shifts the weight of what you are lifting to your legs, thus taking the pressure off of your spine and back muscles. And always try to keep the item you are lifting close to your body, even if it's light.



• Watch your weight
  
  Excess weight can put a strain on your back by stretching and weakening the muscles. It can increase the risk of back pain and prevent quick healing of injuries.
  If you smoke, quit
  Nicotine has been shown to increase the risk of disc degeneration and back pain. It also can slow or prevent recovery byreducing the amount of blood flow to tissues that are trying to heal.
  Avoid sitting for long periods of time
  The discs in your back are under the most pressure when you are sitting. While sitting, keep your upper back straight and your shoulders relaxed. Try to take short walks periodically if you must sit for great lengths of time.



• Relax!
  
  Stress can cause your back to tighten, and can prolong your recovery once the hurting begins. Imagine yourself in a tranquil place and take a vacation in your mind… your back will thank you!

How do people find the best care for their back pain?

That's a really good question and a hard question. How do you get people who know enough about pain and how do you get your primary-care doctor to refer you out to the proper folks? There aren't enough specialists, and a lot of insurance companies don't pay for patients to go to outside specialists.
My suggestion is for patients to contact some of the major pain-advocacy organizations, like the American Pain Foundation and the National Pain Foundation, and they can help patients find physicians throughout the country. They even have directories.

I have chronic back pain and have had several back surgeries over the years including a fusion. My problem was damage to the sciatic nerve and scar tissue. I have had a morphine implant pump for the last 10 years. Do you know of any long-term problems for using morphine for years? It has made me be able to continue to work and care for my family.

You said the magic words. I believe that the best treatment is one that allows you to function better at your daily activities. There are some patients whose function deteriorates when they take strong pain medicines. Clearly your function improves. There are some side effects of long-term morphine treatment. These include some rare problems such as mechanical failure of the pump and infection. the more common problems you might encounter include constipation, drowsiness and decreased sexual function. That being said, many patients tolerate morphine for many years without any problems.

What are the risks of surgery?

Back surgery is less risky now because less invasive procedures are used for the majority of patients with disc disease. Nevertheless, surgery is invasive and requires anesthesia, which also poses a risk by itself. For a more detailed discussion, please click here.

What do I need to know about epidural steroid injections?

Epidural steroid injections involve the placement of cortisone solution adjacent to the inflamed nerve root through the use of a long needle which is passed through the skin of the back. Bruising is common, and discomfort is minimized through the use of anesthesia. This procedure is much less invasive than surgery, and can result in symptom relief for those patients with radiculopathy (e.g. sciatica due to disk herniation).

Is chiropractic effective for sciatica?

The summary of the AHCPR panel was as follows: "The evidence for effectiveness of manipulation varies depending on the duration and nature of the patient's presenting symptoms. For patients with acute low back symptoms without radiculopathy, the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms. For patients whose low back problems persist beyond 1 month, the scientific evidence on effectiveness of manipulation was found to be inconclusive. For patients with radiculopathy, the scientific evidence was also inconclusive about either the effectiveness or the potential harms of manipulation. Finally, the panel offered the opinion that, for patients with acute low back problems and findings of possible progressive or severe neurologic deficits, assessment to rule out serious neurologic conditions is indicated before initiating manipulation therapy."

Is acupuncture effective for treatment of sciatica?

The AHCPR stud did not find acupuncture to be useful for patients with acute sciatica. The following quote is from the AHCPR report: "Invasive needle acupuncture and other dry needling techniques are not recommended for treating patients with acute low back problems."
Is my back pain mechanical or inflammatory?
Patients with disk herniation can have both components contributing to their pain and neurologic dysfunction. Mechanical malfunction may require surgical correction. Inflammatory components may fail to resolve even after successful surgery.
Are there special risks to fusion surgery?
Patients can experience additional disk herniations above and below the area of fusion following fusion surgery.
Should I choose an orthopedic surgeon or a neurosurgeon to do my surgery?
There are many qualified spinal surgeons in either category. Your choice depends more on the individual surgeon's training, experience, and expertise.