Back pain is one of the most common cause, for which, people seek medical advice, all over the world. The age group of patients suffering from Back pain ranges widely from early adulthood to very old aged. Also socioeconomic status of the patients, do not matter, when it comes to this debilitating symptom. It equally affects rural and urban population of both sexes.
Simple back pain which subsides over few days with over the counter drugs, hot water bottle application, simple massage with gel etc.,is not the problem. This subgroup of back pain is commonly called musculoskeletal pain. In contrast, it is the chronic pain, over few weeks, which is difficult to manage with home remedies and compel the patient to seek medical advice. In this blog, I am trying to make you understand about causes and treatment of chronic back pain in detail.
What causes back pain?
Firstly, we need to know that most common cause of chronic back pain is disc disease or slipped disc in common language. Disc is a fibrocartilage cushion structure which act like shock absorber, between two vertebral bones. Most commonly, it is a tear in outer part of disc which causes back pain. In most of these cases, tear heals on its own, over few weeks and pain resolves. In some cases, the inner part of disc herniates and come out to cause pressure over the adjacent nerves. There nerves relays current to legs, hence significantly herniated discs causes leg pain also. This leg pain is known as sciatica in general. Again, in most of the cases over the next weeks, the herniated part of disc becomes dry, and come back to its natural position so, pressure over nerves relived and hence leg pain subsides. But when this doesn’t happen patient, suffer from chronic back pain for months or sometimes years.
Other than disc disease, important causes of chronic back pain are infection, trauma, arthritis or cancer deposits in back bone.
When to urgently see your spine doctor?
Let us find out what are the red alerts or the conditions in a patient with low back pain when it becomes extremely important to consult a spine surgeon on urgent basis.
- Urinary symptoms like inability to pass urine
- Weakness in leg, foot or toes
- Saddle anaesthesia meaning loss of normal touch or other sensation near anal area.
- Severe pain which is not subsiding in any position and associated with fever
- Pain not subsiding after trauma to spine
- Chronic back pain in a cancer patient
Who needs MRI Scan ?
Musculoskeletal pain , as described earlier subsides in few days. Apart from simple radiological investigations like Xray of your back , in most of such cases there is no need to go for MRI. Patient with chronic back pain, which appears to be originated because of disc disease or patient with above mentioned red alerts need MRI scan of your lower spine to decide further treatment plan. MRI shows the condition of your back in detail with disc herniations, nerves compression etc.
What are non-surgical options for chronic back pain?
Cold and Heat application: Application of ice or a cold pack can ease initial inflammation and muscle spasms due to any cause. Ice is most effective for the initial few hours after the back pain has started. Applying heat through heating pads, hot water bottle etc. ,can help relieve painful muscle spasms after the first 48 hours. Some people find alternating hot and cold packs provides good benefit.
Pain medications. Non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen are used to treat pain and inflammation. But we should be careful with excess use of such medications as they have some harmful side effects. Sometimes painkillers stronger than NSAIDs are used to get relief. Muscle spasms may accompany a lumbar herniated disc, and hence muscle relaxant medicines may offer relief from the painful spasms.
Physical therapy: It is important in teaching targeted stretching and exercises for relief in back pain. This can also teach the patient to perform ordinary activities, such as lifting and walking, in a safer way.
Epidural injections : These are injection given in your spine under radiological guidance by a trained doctor. It is targeted near the disc and nerve roots. The effects vary, and in general pain relief is temporary.
What are the surgical options ?
There are a number of different surgical options available for disc or spine surgery. Which one is best for you depends on many factors like your clinical findings, MRI findings etc. It also depends on experience and skill of your spine surgeon.
Following type of surgeries are commonly done
1. Microdiscectomy – this can be considered as gold standard surgery for disc disease. Herniated part of disc is removed under magnification using operating microscope.
2.Endoscopic disc surgery- This is minimally invasive surgery for you disc using endoscopy for better visualisation of structures
3 . Fusion surgery- this involves joining the bony part of spine using bone graft. some kind of implant material like screws and cages are then put to strengthen the fused section.
So, if you are suffering from chronic back pain then it is time to consult a good spine surgeon to get rid of your pain. In our centre we offer all kinds of treatment for the patients of disc disease and other spine problems. You can send your queries and questions to us and our team of experts will be give you opinion about back pain treatment.
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