Back pain—there’s no one solution for relief

Sadly, many people suffer from back pain. Three-quarters of all Americans will experience back pain at some time in their lives

The pain can be everything from a dull ache, stabbing pain, shooting pain, burning, or a combination of all these symptoms. Regardless of the exact symptoms, back pain can be so debilitating that an individual cannot stand, walk or function. 

The location of the pain can occur in the middle of the back, lower back, or even the back of the neck. Back pain can also be sudden in onset, known as acute (a few days or weeks in duration), or longstanding, known as chronic (defined here as more than 12 weeks of symptoms). 

Symptoms may originate in the back, but may radiate to the hands, arms or legs. Besides pain, neurologic symptoms such as numbness and weakness may also occur.  

Most back pain originates within the lower back or what’s known as the lumbar region. This space contains five bones, known as vertebrae, which provide support to the weight of the upper body. These bones are cushioned by cartilage-like structures known as vertebral discs. 

Some nerve roots for motor function and sensation also exit from the spinal cord in between the bony vertebrae. Ligaments, tendons and spinal muscles stabilize the entire vertebral structure. 

Similar structure is within higher areas in the back, or thoracic spine region, as well as the neck and cervical spine. Any of these components can become damaged, which may lead to pain and loss of function. There is no one solution for providing pain relief, since the causes of back pain vary.

Causes of back pain

Causes may include injury to the following structures:

• Ligaments and muscles
• Intervertebral discs (cushions between the vertebrae)
• Nerves
• Vertebral bodies or vertebrae aka the bony structures that make up the spine
• Other organs, causing referred pain from organs like the kidneys with renal stones

Degenerative issues

• Vertebral disc degeneration 
• Arthritis 
• Vertebral joint disc leading to bone wear and tear (aka spondylosis) 

Nerve injuries (not due to trauma)

• Narrowing of spinal column
• Infections
• Nerve compressions

Non-spine causes

• Kidney stones
• Tumors
• Pregnancy 
• Chronic pain conditions

Treatment (some are advanced therapies

• Medications for acute or chronic pain; anti-inflammatories; topicals
• A note about topicals: Many contain Ibuprofen (Motrin) or Lidocaine. It is important to note what is contained within theses topicals, since too frequent application may lead to toxicity.
• Self-management: compresses, exercise, massage 
• Physical therapy
• Acupuncture
• Spine manipulation and mobilization
• Spinal injections
• Surgeries, of which there are many
• Implanted nerve stimulators

Enhanced therapies

Enhanced therapies are usually guided by medical evaluation that will include an examination as well as diagnostic studies. Some of the studies to guide enhanced therapies include:

• X-rays
• CT scan
• MRI
• Nerve conduction studies
• Nerve blocks

Therapy considerations

• Steroid or local anesthetic injection: technical procedure that requires a specialist 
• Opioids: addiction potential
• Muscle relaxants: can have side effects such as drowsiness 
• Antidepressants: takes multiple doses and time to work
• Surgery: surgical complications and failed procedure
• Biofeedback: difficult to master for some people 

Seek medical help when there is: 

• Persistent or worsening back pain 
• Neurologic symptoms such as numbness, weakness or tingling
• Changes in bowel or bladder function

Surgery

Usually recommended when medications and therapy have failed and the patient’s loss of function is persistent. Also sometimes required if nerve compression is severe or a fracture has occurred and is damaging structures. 

Surgery may fail 20-40% of the time, may take a long time to recover from, and may not fully resolve the symptoms. One has to be realistic with their outcome goals depending on the cause of their pain or loss of function.3

Outlook

The recovery from debilitating back pathology can be complicated and long. Something within an individual’s control is strengthening exercises to improve muscular spine stability. These activities also strengthen the ligaments and tendons that provide support to the spine. 

A positive outlook combined with seeking help early on is essential for improvement. Lifestyle changes may also be required to improve outcomes. These include altering job-related factors, physical fitness, and optimizing mental health.