Pain is an uncomfortable or unpleasant sensation in the body. Pain can be mild or debilitating and make you feel a sharp, throbbing, lancinating, or dull ache. The amount of pain you experience won’t be the same as another individual because people have different threshold levels to pain. Pain is basically a protective mechanism by our body that indicates something wrong is going on within the body system. Pain can be simply classified into acute and chronic pain.
Acute pain has a sudden onset and is mostly localized specifically. Patients with acute pain experience sharp pain and this usually won’t last for more than six months. Some examples of acute pain are surgery, broken bones, deep dental caries, burns, lacerations, childbirth. Chronic pain on the other hand is slow in onset and is generalized pain. Chronic pains are continuous in nature and give you dull aching pain. Chronic pain may last for weeks, months, or years. Thus, people with chronic pain have physical effects that make them lead to poor quality of life where they have limited ability to move around, lack of energy making them fatigue. Some examples of chronic pain are back pain, cancer, migraine, nerve pain, arthritis. Chronic pain can be divide into two types inflammatory nociceptive pain and neuropathic pain. Inflammatory nociceptive pain is due to damage that happens to tissue whereas neuropathic pain is due to diseases affecting one’s nervous system. Chronic pain affects both mentally and physically and those having chronic pain express a sense of anger, anxiety, fear which eventually leads them to mental depression.
How do we feel pain?
When we touch hot object-specific receptors in the skin send the message through nerves such as A-delta fibers (carries acute pain) and C fibers (carries chronic neuropathic pain) to the spinal cord and these massages are finally received by certain centers in the brain where the sensation of pain is registered and brain sent back messages to the muscle to keep away from the hot object to prevent further damage to tissues.
What is Back pain?
One of the most common chronic pain is back pain. It is the third most common reason for visiting a doctor. Statics have reported about half the working population of America experiences back pain at some point each year. Back pain affects people of all ages. Worldwide, back pain is one of the main reasons that prevents many people from engaging in work as well as other everyday activities. Worldwide, low back pain has increased by 54% between 1990 and 2015.
There are many risk factors for developing back pain such as age, lack of exercise, obesity, medical conditions, improper lifting, psychological conditions, and smoking. Chronicity of back pain increases with the age mainly starting by the age of 30. Lack of exercise weakens your muscles of the back and gradually causes pain. Obesity causes stress on your spine bone. Medical conditions such as cancer and osteoporosis increase pain and pathological fracture of spine bone. If you lift a heavy object using your back where you are supposed to lift it by bending and putting the pressure over your legs. People with psychological conditions such as depression and anxiety have a great risk of getting back pain. Both active and passive smokers tend to develop back pain because as you smoke it can cause coughing which leads to disc herniation and also it causes decreased blood flow to your spine leading to osteoporosis.
Back pain can be divided into upper back pain and lower back pain. Upper back pain is also known as thoracic spine pain. Upper back pain is caused by maintaining poor back posture eventually leading to loss of strength of back muscles. The strength of back muscles can be restored by correcting your posture and doing exercise. Upper back pain can be because of the use of muscles over the back leading to muscle stain .irritation and inflammation of the muscles. Traumatic injuries such as car accidents, industrial accidents, lifting things incorrectly can cause upper and lower back pain. A herniated disc can be a reason for upper and lower back pain, but mostly lower back pain. Discs are soft cushions that are seen between every vertebra. Excessive pressure on the spine causes this disc to slip out and compress the neighboring nerves evoking extreme pain and numbness in your arm and legs. Osteoarthritis is the wearing off cartilage between the spinal bones and causing frictional movements between the spinal bones which causing pain and tingling sensation over your legs and arms. Spinal infections where there is a collection of bacterial microorganisms between the spinal cord and spinal bone eventually forms into an abscess known as a spinal epidural abscess. This abscess increases in size and compresses the nerves leading to pain. In rare cases of lung cancer, back pain was reported. Abnormal curvature of the spine known as scoliosis which may be due to muscular dystrophy or birth defects can also cause back pain. Osteoporosis is a condition where your bone becomes porous and brittles leading to fracture of your spine’s vertebrae.
Back pain and overall health
Back pain is a major public health problem around the world. All age groups are affected, including children and adolescents, with 1%–2% of adults in the United States being disabled as a result of it. Back pain can deteriorate your mental, physical, and social wellbeing. Studies that measure the burden of diseases (BoD) are studies that rank diseases that cause death and disability. Lower back pain is noted to be the leading cause of disability in the world. Back pain restricts one from moving around and this again results in weight gain. Lack of moment in the legs and muscles causes muscle wasting and resorption of bones. This worsens your back pain and decreases your confidence to be socially active.
Back pain can be an indicator of the dehydration that your body is suffering from. Dehydration causes back pain. Our soft gelatinous cushions that are placed between vertebrae called the disc is rich in water. Throughout the day, your spine faces natural wear and tear, the water within the disc gets leaked out but gravity pulls the water down your spine and allows your disc to get rehydrated. These disc between the vertebrae helps by absorbing the shock when excess pressure comes on the spine and also helps in mobility of the spine. While your body experiences dehydration because you are not drinking enough water, the gelatinous material within your disc loses water, gets shrink, and makes the disc unable to hold your body weight which causes the disc to get collapsed and compress the neighboring sensitive nerves and pain arises.
Kidney disease can cause back pain. If you have blockage or infection in your kidney it leads to stretching of coverings of the kidney (known as the capsule of the kidney). This stretching is due to the swelling that happened to the kidney due to retained urine or decreased urine flow this will results in pain that radiated into your groin area.
One of the most effects of back pain is sex. Worldwide it is reported that most people with back pain have less sex and decreased drive towards sex because it triggers or worsens the back pain. Some sex positions like doggy style, spooning, or side sex style( if you have pain while the extension of back) and motions like thrusting your back or supporting the weight of your partner may not safe for people who have back pain or injury. So you should take care while engaging in sex or it can cause more strain and stress to your back.
Management of back pain
Your doctor will take a detailed history regarding the onset of the condition, your lifestyle, your medical conditions, and drug history (drugs such as Ambien taken for a sleep disorder, Atenanol and Propananol for blood pressure known to cause back pain. A thorough physical examination will be carried out to make sure of the severity of the condition. Your doctor will access your ability to stand, walk, and lift your legs. You will be asked by your doctor to rate your pain on a visual analog scale where you can rate your pain from a score of 1 to 10. These assessments pinpoint the location of pain, the possibility of muscle spasms and give your doctor an idea about your medical condition and can plan a suitable treatment plan along with your lab reports.
Your doctor would advise you to take some lab tests if he/she suspects an underlying medical condition is involved in your back pain. X-ray images of your spine show the alignment of your bones and whether you have fractured bone or arthritic changes in bone. X-rays alone won’t show problems with your spinal cord, muscles, nerves, or discs. MRI or CT scans can help to reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels. These advanced radiological techniques give a 3-D view of the spine. Blood tests can help determine whether you have an infection or other condition that caused you pain.
Bone scans are rarely advised if your doctor suspects that you may be suffering from osteoporosis. Electromyography (EMG) uses to measure the response of your muscle to the electrical impulse produced by nerves. This test helps you to confirm the compression of a nerve in a herniated disc.
According to the test results, your doctor will decide to treat your condition either conservatively or surgically. Conservative management consists of medication and physical therapy. You should strictly follow the instruction of your doctor. You should not decide and change the dosage of the drug.
Over the counter drugs such as Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly prescribed to relieve back pain. Drugs like ibuprofen or naproxen sodium are commonly prescribed. Take these medications only as instructed by your doctor. If you find yourselves getting better after taking the medication take advice from your doctor. If you still have mild to moderate back pain and your symptom is not relieved by using NSAID, your doctor would prescribe you muscle relaxants. For mild pain, topical pain relievers in the form of creams, ointments, or patches deliver pain-relieving effect on applying your skin
Opioid drugs, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don’t work well for chronic pain. Opioids work well for generalized pain.
Pregabalin is commonly used to relieve pain caused by nerve damage so if you have neuropathic pain in your back your doctor might prescribe you with pregabalin.
Some types of antidepressants like tricyclic antidepressants, such as amitriptyline have been shown to relieve chronic back pain.
If you feel any side effects of the drug such as drowsiness, dizziness, allergic reactions, headaches, constipation, confusion, slowed breath you should take advice from your doctor immediately
You need to take the necessary training from a physical therapist who can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Adequate exercise can help you keep out your pain from returning. Physical therapists will educate you about how to modify your movements during an episode of back pain to avoid pain symptoms while continuing to be active.
Your doctor may advise cortisone injection a (strong anti-inflammatory drug) if other measures of medication don’t relieve your pain and if your pain radiates to your leg. Cortisone injection helps to relieve the pain by decreasing inflammatory actions around the nerve. The pain relief may be temporary and only lasts for a maximum period of two months.
Radiofrequency neurotomy is a procedure where a fine needle is inserted through your skin so the tip is near the area causing your pain. Radio waves are passed through the needle to the neighboring regions of the damaged nerve, this will interrupt the delivery of pain signals to the brain.
Implanted nerve stimulators are devices implanted under your skin that can deliver electrical impulses to certain nerves to block pain signals.
If the pain is associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. These procedures are usually reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn’t responded to other therapy.
