Chronic Back Pain

Chronic Low Back Pain

If you suffer from lower back pain, you are not alone. Around roughly 80% of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed days at work. Men and women are equally affected by low back pain and the level of severity can range in intensity from dull constant aches, to a sudden or sharp sensation that can potentially leave a person incapacitated. Chronic low back pain is defined as a pain that persists for 12 weeks or longer, whether after an initial injury or an underlying cause of acute low back pain that has been treated in the past.

What are the causes of low back pain?

Low back pain is most often caused by disc tears. This can further cause disc bulges, degeneration of the disc, dessications and even herniations. Disc tears can further allow for the disc to leak onto adjacent spinal nerves and tissue, causing inflammation on those nerves, thus leading to possible extremity pain, numbness, and tingling.

A vast majority of low back pain is mechanical in nature. Low back pain is associated with spondylosis, which is a term that refers to the general degeneration of the spine, associated with normal wear and tear that occurs in the discs as people age. Some examples of mechanical causes of low back pain are:

Sprains and strains that are cause by overstretching or tearing ligaments and tears in tendon or muscle. Both can occur from twisting or lifting something with improper form.

Intervertebral disc degeneration is one of the most common causes of low back pain and it occurs when the rubbery discs in between the spinal facet joints lose their integrity as part of the aging process. A healthy back has intervertebral discs that provide height, allow for bending and flexion of the lower back, and as the discs deteriorate with age they lose their cushioning.

Herniated (or ruptured discs) that can happen from compression, thus causing a bulge outward or even a rupture and causing low back pain.

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Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure put on the nerve can result in pain, numbness or tingling that travels to other areas of the body, particularly in the extremities. 

Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, which travels from the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain and the sensation can run down to the lower leg. In severe cases, a nerve is pinched between the disc and adjacent bone, additionally causing numbness and muscle weakness in the leg.

Trauma or injury caused by sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn causes an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.

Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time this leads to leg weakness and sensory loss.

Back pain is diagnosed through various test and exam routines. During a medical history and physical exam, a health care provider can attempt to pinpoint the onset, site, and severity of the pain a person has been experiencing. Neurologic tests are conducted to determine the cause of pain and appropriate treatment. Imaging tests are not always used as a sole purpose of diagnosing the exact type of condition a person has due to having chronic back pain. If imaging is ordered, these tests include: x-ray, computerized tomography (CT), myelograms, discography, magnetic resonance imaging (MRI), electrodiagnostics, bone scans, and ultrasound imaging.

How is back pain treated?

This generally depends on whether the pain is acute or chronic. Conventional treatments include: hot or cold packs to help reduce inflammation, activity and strengthening exercises, physical therapy, medications that can range from over-the-counter (NSAIDs) to prescription (codeine), acupuncture, traction by using weights and pulleys to force alignment, spinal manipulation (chiropractic care), nerve block therapies, epidural steroid injections, transcutaneous electrical nerve stimulation (TENS), stem cell therapy and platelet rich fibrin treatments to stimulate regeneration through the body’s own healing capabilities, and surgery.

When other therapies fail, surgery may be considered as an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. Patients considering surgical approaches should be fully informed of all related risks. Surgical options include: spinal laminectomy, vertebroplasty and kyphoplasty, discectomy, foraminotomy, intradiscal electrothermal therapy (IDET), nucleoplasty, radiofrequency denervation, artificial disc replacement, and spinal fusion.

A good treatment plan can help to relieve your discomfort and return you to a pain-free and active lifestyle. If you are looking for help with this condition, request a consultation now with one of our minimally invasive spine specialists.

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