Pain in the back, especially long-lasting or severe pain.
Pain felt in or along the spine or musculature of the posterior thorax. It is usually characterized by dull, continuous pain and tenderness in the muscles or their attachments in the lower lumbar, lumbosacral, or sacroiliac regions. Back pain is often referred to the leg or legs, following the distribution of the sciatic nerve.
Back pain is a common affliction experienced by the majority of individuals at some point in their lifetime. It is often challenging to provide an exact diagnosis since the pain tends to improve with rest and is initially managed with pain-relieving medications, like analgesic drugs, before any diagnostic tests such as X-rays are administered. In situations where a definitive diagnosis is lacking, medical professionals may employ the term “nonspecific back pain” to characterize the condition.
Nonspecific back pain stands as a prominent contributor to the significant number of working days lost due to illness in the United Kingdom. Individuals most susceptible to experiencing back pain are those engaged in physically demanding occupations that entail frequent heavy lifting and carrying, as well as those who endure prolonged periods of immobility or engage in awkward bending postures. Furthermore, individuals who are overweight face a higher risk of back pain due to the additional strain on their backs caused by the increased weight load, coupled with the tendency to possess weaker abdominal muscles that typically offer support to the back.
The origins of nonspecific back pain are attributed to a mechanical dysfunction that impacts one or multiple components of the back. These underlying issues can encompass ligament strain, muscle tear, injury to a spinal facet joint, or the occurrence of a disc prolapse, commonly referred to as a slipped disc.
Apart from the pain originating from the injured structure itself, the accompanying muscle spasms can lead to pain and sensitivity across a broader region. This can give rise to temporary scoliosis, an atypical sideways curvature of the spine.
Both abnormalities affecting a facet joint and the prolapse of an intervertebral disc have the potential to trigger sciatica, characterized by pain originating in the buttock and extending down the back of the leg, all the way into the foot. This condition arises from the compression of a sciatic nerve root as it exits the spinal cord. The pain is known to intensify during coughing, sneezing, or straining. Furthermore, pressure on the sciatic nerve can induce a pins-and-needles sensation in the affected leg, along with weakness in the muscles controlled by the affected nerve. In rare cases, pain may radiate along the femoral nerve situated at the front of the thigh.
The presence of osteoarthritis within the spinal joints can give rise to persistent back pain. Similarly, ankylosing spondylitis, an inflammatory condition impacting the spine, can manifest as back pain accompanied by stiffness and a reduction in back mobility. Another potential source of discomfort is coccydynia, characterized by pain and tenderness at the base of the spine. This condition may arise following a fall with an impact on the coccyx, during pregnancy, or sporadically for unknown causes.
Fibrositis is a term of imprecise nature that is sometimes employed to depict muscle pain and tenderness, which can potentially affect the back. The symptoms of fibrositis tend to worsen in cold and damp weather and occasionally coincide with a general feeling of malaise. Unlike other causes of back pain, fibrositis does not involve muscle spasms or limitations in back mobility. Treatment with nonsteroidal anti-inflammatory drugs often leads to improvement in fibrositis symptoms.
Pyelonephritis, an infection of the kidneys, can give rise to back pain, accompanied by discomfort and tenderness in the loin region. Additional symptoms may include fever, chills, and pain during urination. On the other hand, the presence of spinal cancer can result in persistent back pain that disrupts sleep and remains unrelieved even with rest.
Individuals experiencing back pain and sciatica are typically encouraged to maintain mobility to the best of their ability. Utilizing a firm mattress for sleeping and taking analgesic drugs can provide relief from pain. However, if the pain persists, becomes highly severe, or is accompanied by leg weakness or issues with bladder control, it is crucial to seek immediate medical advice.
During a back examination, tenderness in particular regions or a decrease in back mobility may be observed. The presence of weakness or diminished sensation in the legs suggests nerve root compression, necessitating immediate investigation.
X-rays of the spine can provide insights into various conditions such as intervertebral disc narrowing, osteoarthritis, osteoporosis, ankylosing spondylitis, compression fractures, stress fractures, bone cancer, or spondylolisthesis (vertebral displacement). However, they are unable to reveal damage to ligaments, muscles, facet joints, or discs. To identify nerve root pressure, which may be caused by conditions like disc prolapse, myelography, CT scanning, or MRI scans are employed.
If a specific cause is identified for the back pain, the treatment will be tailored to address that underlying cause. In the case of acute nonspecific back pain, research suggests that early resumption of normal activities, with the aid of analgesic drugs, yields the best outcomes. Prolonged bed rest should be avoided, with a recommendation not to exceed two days. However, chronic nonspecific back pain often poses greater challenges in treatment. Approaches may involve the use of aspirin and similar medications, nonsteroidal anti-inflammatory drugs, muscle relaxants, acupuncture, or spinal injections. Additionally, exercise, spinal manipulation, the utilization of a surgical corset, or even spinal surgery may be considered depending on the individual case.