David S. Klein, M.D.

Back Pain

Back pain is one of the most common complaints that brings a patient to seek medical care.  Of the many causes of back pain, the most common involve the superficial nerves of the hip and external rotators of the thigh. We will be posting individual articles on these topics. The first of which is published in MD News, July, 2005:

www.suffernomore.com/articles/Gluteus%20Medius.doc

Klein, DS: Back and hip pain due to Superior Gluteal Neuropraxia and Gluteus Medius Syndrome. MD News, July 2005.

What is Back Pain?

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is defined as 'pain that persists for more than 3 months.' Cause of the pain may be difficult to determine.

If your back aches, you're not alone. Four out of five adults experience at least one bout of back pain at some time during their lifetime. In fact, low back pain is the fifth-leading cause of trips to the doctor in the United States.In addition, back injuries are the leading cause of work-related disability. Even though back pain is rarely life-threatening, the annual cost in terms of lost productivity, medical expenses and workers' compensation benefits runs into the tens of billions of dollars in the United States.Although back pain is common, it's also quite possible for you to prevent most back problems with simple steps such as exercise and adopting new ways to sit and stand. Even if you've injured your back before, you can learn techniques to help avoid recurrent injuries.

What is the prognosis?

Most patients with back pain recover without residual functional loss, but medical attention may be required  if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Very commonly recurring back pain results from improper body mechanics.  Gait retraining, postural work and physical rehabilitation may be effective modalities. Maintaince of correct posture may employ the use of inexpensive spints and taping devices. Work-related injuries may be caused or aggravated by heavy lifting, vibration, repetitive motion, and awkward posture.

What conditions are associated with low back pain?

Bulging disc (also called protruding, herniated, or ruptured disc):  The intervertebral discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column. A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated. Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root. Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time. Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease. Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition. Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward. Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety. Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

How is back pain treated?

Most low back pain can be treated conservativel, that is, without surgery. Treatment involves using anti-inflammatory drugs, muscle relaxants, anti-convulsants, diuretics and analgesics. The goal of treatment is to restore proper function and minimize pain and discomfort.

Many different medications and medication combinations are used to treat acute and chronic low back pain. Many effective medications are available without prescription, and many 'natural' supplements have remarkable ability to treat or control pain and related symptoms.   In the most refractory and serious of cases is  surgery considered.

David S. Klein, MD, FACA, FACPM, FACMIMS
Director, Pain Center of Orlando
www.suffernomore.com