BACK PAIN

It would not be wrong to say that everyone has or will complain of back pain at some time in their lives. Indeed studies have shown that 80% of the population does suffer from this condition. The encouraging fact however is that only a very small percentage of these people do need medical or surgical intervention. This depends on the actual cause of the pain

Causes of Back Pain

These can be divided into the subsequent simple categories:

  • Traumatic

  • Infectious

  • Tumors

  • Mechanical

  • Metabolic

Traumatic

Trauma means injury. The patient will give a history of pain, which will be localized, to site of the injury. Depending on the severity of the injury there may be associated neurological symptoms as well. Also there may be broken bones, slipped discs or pulled muscles. The last being most common cause of pain (95%). Patients are usually in the younger age groups. Treatment depends on the amount of pain and residual disability.

Infectious

These can be acute or chronic. Acute infections are very painful conditions involving the discs. They usually occur in patients with low resistance, very young or very old and people who have had instrumentation of the spine. These patients will; have constant pain and can have associated fever. Hence treatment will be to treat the infections with antibiotics or surgical drainage.

The commonest chronic infection in Pakistan is tuberculosis. Indeed in the lower socio-economic group, this is endemic. It can be passed on to the higher socio-economic group by the servants and maids. TB can be slow and insidious sometimes. Also may have an atypical presentation with very little changes seen on X-rays. TB needs long term treatment with anti-tubercular drugs. Delay in diagnosis may lead to complications with permanent disability. Once the diagnosis is made, and treatment started, the results are quite satisfactory unless the patient is non-compliant or indeed the bacteria are resistant to the prescribed drugs. Surgical intervention is needed if there is danger of cord compression or instability of the spine due to vertebral collapse.

Tumors

These can be primary or secondary (metastatic). Primary tumors are rare. Examples are multiple myeloma and plasma cell cytcma. However, Multiple myloma is found to occur in people above 50 years of age. This is a kind of bone marrow tumor. Treatment is chemotherapy. Prognosis is good.

Metastatic tumors are more common. In women, the commonest cause is breast cancer. Therefore, proper history and breast examination is a must in women with suspicious e-rays. In men, the common cause is prostate cancer and they too should be thoroughly investigated if suspicions are raised. Other cancers that can spread to the bones are thyroid, kidneys, lungs, liver and ovaries etc.

Mechanical

Mechanical back pain is the pain due to any abnormality other than the above mentioned causes of back pain. This is the reason for pain in 90-95% of people presenting to our clinics. This list can be very long but the main causes are due to bad posture and unhealthy habits.

Furthermore, bad posture is mainly responsible for the pain in the younger population. This is the cause seen mostly in people who spend long hours sitting in one position. The reason of sitting can be their jobs, studies, travel and sitting in front of the computer for long hours. Over a period of time, such people develop joint stiffness in the lower lumbar region and the sacroiliac joints. The result is pain when they do any kind of physical activity they are not used to doing.

Back Pain

The pain is also the result of spasm in the surrounding muscles. This in turn then leads to pain going along the hip and back of thigh area. The patients then believe they are suffering from “sciatica”. This is not true. By definition, sciatica is pain in the distribution of sciatic nerve due to pathology involving the nerve roots or the never itself, other signs like weakness and loss of sensation and reflexes may also accompany this condition, in fact Sciatica is now considered to be an old terminology and should not be used.

Treatment involves posture correction, change in life style and measures to correct the factors affecting posture. For example, weight reduction, regular exercise, properly placed desks and workstations, lumbar support during travelling, frequent breaks in long journeys, stop smoking and specialized exercises for the back.

Metabolic

Osteoporosis is loss of calcium from the bones, occurs due to age and hormonal imbalance. As we grow older, our bone mass keeps on decreasing. There are various reasons for this, more commonly seen in women above the age of 35 years. Furthermore, the reason for this is that in developing countries, girls are married at very early ages. They have multiple pregnancies, insufficient and inappropriate diet and a sedentary lifestyle. Statistic has shown that on an average the annual bone loss is 0.2 to 0.3% per year. However after the menopause, it may be as high as 5%. So this is why it is absolutely essential to have a healthy diet rich in calcium and vitamin D. be active, has exposure to sunlight as this converts the vitamin D into its active form and space pregnancies by 2-3 years.

CONCLUSION

Back pain is a common problem

Its cause should be sought and treated accordingly on time

Treatment is fairly simple most of the time

Stay active

Avoid prolonged stationary positions

Change your working habits

Have a healthy diet rich in calcium and vitamin D

Stop smoking

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