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Back Pain

Know more about Back Pain

Our Neurosciences service treats patients with a variety of ailments such severe back, back problems, chronic back conditions and problems. We are inspired and committed to cutting-edge patient care and the treatment of patients to their satisfaction.

Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

Back pain may have a sudden onset or can be a chronic pain, it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arms and hands as well as the legs or feet, and may include symptoms other than pain. These symptoms may include tingling, weakness or numbness.

Classification of Back Pain

Back pain can be divided anatomically: neck pain, middle back pain, lower back pain or tailbone pain. By its duration: acute (up to 12 weeks), chronic (more than 12 weeks) and subacute (the second half of the acute period, 6 to12 weeks). By its cause: nonspecific back pain, back pain with radiculopathy or spinal stenosis, and back pain associated with another specific cause (such as infection or cancer). Nonspecific pain indicates that the cause is not known precisely but is believed to be due from the soft tissues such as muscles, fascia, and ligaments.

Back pain is classified according to etiology in mechanical or nonspecific back pain and secondary back pain. Approximately 98% of back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology. However, secondary back pain which is caused by an underlying condition accounts for nearly 2% of the cases. Underlying pathology in these cases may include metastatic cancer, spinal osteomyelitis and epidural abscess which account for 1% of the patients. Also, herniated disc is the most common neurologic impairment which is associated with this condition, from which 95% of disc herniations occur at the lowest two lumbar intervertebral levels.

Associated Conditions

Back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation especially in the acute phase, which typically lasts from two weeks to three months.

Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:

  • Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs.
  • Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition.
  • Back pain that occurs after a trauma, such as a car accident or fall, may indicate a bone fracture or other injury. Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma also warrants prompt medical attention.
  • Back pain in individuals with a history of cancer (especially cancers known to spread to the spine like breast, lung and prostate cancer) should be evaluated to rule out metastatic disease of the spine.

A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniated and degenerative disc disease may not be more prevalent among those in pain than among the general population, and that the mechanisms by which these conditions might cause pain are not known. Other studies suggest that for as many as 85% of cases, no physiological cause can be shown.

A few studies suggest that psychological factors such as on-the-job stress and dysfunctional family relations may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.

 

Causes of Back Pain

There are several potential sources and causes of back pain. However, the diagnosis of specific tissues of the spine as the cause of pain presents problems. This is because symptoms arising from different spinal tissues can feel very similar and is difficult to differentiate without the use of invasive diagnostic intervention procedures, such as local anesthetic blocks.

One potential source of back pain is skeletal muscle of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles), muscle spasm and muscle imbalances. However, imaging studies do not support the notion of muscle tissue damage in many back pain cases, and the neurophysiology of muscle spasm and muscle imbalances is not well understood.

Another potential source of lower back pain is thee synovial joints of the spine (e.g.zygapophysial joints/facet joints). These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. However, the cause of zygapophysial joint pain is not fully understood. Capsule tissue damage has been proposed in people with neck pain following whiplash. In people with spinal pain stemming from zygapophysial joints, one theory is that intra-articular tissue such as invaginations of their synovial membranes and fibro-adipose meniscoids (that usually act as a cushion to help the bones move over each other smoothly) may become displaced, pinched or trapped, and consequently gives rise to pain.

There are several common other potential sources and causes of back pain: these include spinal disc herniation and degenerative disc disease and or isthmic spondylolisthesis, osteoarthritis (degenerative joint disease) and lumbar spinal stenosis,trauma, cancer, infection, fractures, and inflammatory disease. The anterior ligaments of the intervertebral disc are extremely sensitive, and even the slightest injury can cause significant pain.

Radicular pain (sciatica) is distinguished from ‘non-specific’ back pain, and may be diagnosed without invasive diagnostic tests. New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI AND CT SCANS.

Management of Back Pain

The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual’s ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy; and to facilitate the patient’s passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.

Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% – 10%) require surgery.

Non-surgical methods are:

  • Exercises
  • Heat Therapy
  • Cold Compression Therapy
  • Medications
  • Massage Therapy

Surgical Interventions are:

  • Lumbar disc herniation or degenerative disc disease.
  • Lumbar spinal stenosis from lumbar disc herniation, degenerative joint disease or Spondylolisthesis.
  • Scoliosis
  • Compression Fracture

Surgery is usually the last resort in the treatment of back pain. It is usually only recommended if all other treatment options have been tried or in an emergency situation. The main procedures used in back pain surgery are discectomies, spinal fusions, laminectomies, removal of tumors and Vertebroplasty.

There are different types of surgical procedures that are used in treating various conditions causing back pain. Nerve decompression, fusion of body segments and deformity correction surgeries are examples. The first type of surgery is primarily performed in older patients who suffer from conditions causing nerve irritation or nerve damage. Fusion of bony segments is also referred to as a spinal fusion and it is a procedure used to fuse together two or more bony fragments with the help of metalwork. The latter type of surgery is normally performed to correct congenital deformities or those that were caused by a traumatic fracture. In some cases, correction of deformities involves removing bony fragments or providing stability provision for the spine. A time-tested procedure to repair common intervertebral disc lesions which offers rapid recovery (just a few days) involves the simple removal of the fibrous nucleus of the affected intervertebral disc.

A discectomy is performed when the intervertebral disc have herniated or torn. It involves removing the protruding disc, either a portion of it or all of it by placing pressure on the nerve root. The disc material which is putting pressure on the nerve is removed through a small incision that is made over that particular disc. This is one of the most popular types of back surgeries and which also has a high rate of success. The recovery period after this procedure does not last longer than 6 weeks. The type of procedure in which the bony fragments are removed through an endoscope is called percutaneous disc removal.

Microdiscectomy may be performed as a variation of standard discectomies in which a magnifier is used to provide the advantage of a smaller incision, thus a shorter recovery process.

Spinal fusions are performed in cases in which the patient has had the entire disc removed or when another condition has caused the vertebrae to become unstable. The procedure consists in uniting two or more vertebrae by using bone grafts and metalwork to provide more strength for the healing bone. Recovery after spinal fusion may take up to one year, depending greatly on the age of the patient, the reason why surgery has been performed and how many bony segments needed to be fused.

In cases of spinal stenosis or disc herniation, laminectomies can be performed to relieve the pressure on the nerves. During such a procedure, the surgeon enlarges the spinal canal by removing or trimming away the lamina which will provide more space for the nerves. The severity of the condition as well as the general health status of the patient are key factors in establishing the recovery time, which may be range from 8 weeks to 6 months.

Back surgery can be performed to prevent the growth of benign and malignant tumors. In the first case, surgery has the goal of relieving the pressure from the nerves which is caused by a benign growth, whereas in the latter the procedure is aimed to prevent the spread of cancer to other areas of the body. Recovery depends on the type of tumor that is being removed, the health status of the patient and the size of the tumor.

I am Experiencing Back Pain; do I Need to Have Surgery?

The most common causes of back pain are sprains and overexertion. Usually, you’ll need to rest your back. Sometimes – though less common – physical therapy is needed. If you have intense pain accompanied by a pain shooting down your leg, then you may have a herniated disc. A disc is a cushion between each of the vertebrae in your spine. Each disc is covered by a tough, fibrous tissue which has the consistency of leather. When the covering ruptures, the inside of your disc, which is “the consistency of crab meat” slips out and presses against nerves in your spine.

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