What is back pain?

Quick Answer
Acute or chronic and usually severe musculoskeletal pain centered along the spine, usually in the lower back but also common in the neck and upper back.
Expert Answers
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Causes and Symptoms

Most back pain is caused by disk problems, but the disk problems themselves have a wide variety of causes and manifestations. Annular bulge, disk herniation, muscular spasms, and strain from overexertion are just a few of these causes. Among these manifestations are sudden and persistent attacks of sharp, debilitating pain that exaggerate spinal kyphosis, may create scoliosis, and make standing up or bending over without assistance either impossible or very difficult.

The more the lumbar spine approaches either kyphosis or scoliosis, the more out of alignment the natural curvature of the whole spine becomes and the more pain results. Scoliosis or uncontrollable listing to one side is a frequent symptom of disk damage, usually either annular bulge or herniation.

Referred pain may appear from any lumbar radiculopathy, but the two most common presentations are in the thigh, from pinching the femoral nerve between L2 and L4 vertebrae, and as sciatica, from pinching the sciatic nerve between L4 and the sacrum. Shooting pains elsewhere in the leg, genital dysfunction, or incontinence and other urinary or bowel complications may result from radiculopathy of any of several other lumbar, sacral, or lower thoracic nerves. In very severe cases, partial paralysis or constant, intolerable pain may occur.

Treatment and Therapy

Many ways of treating back pain exist, and the program of treatment must be adapted to the particular situation of each patient. Good posture is always essential. Learning to sit up straight, perhaps with a lumbar support roll, or a change of habits, such as learning to lift with the legs rather than the back, may be advised. Sometimes drug therapy with painkillers or muscle relaxants, or physical therapy with manipulation and exercises, is the only additional treatment required. As a last resort and in extreme cases, including emergency cases of incontinence or paralysis, surgery to repair a disk may be indicated.

Treatment options come not only from regular medicine but also from alternative, complementary, or allied systems of health care. The McKenzie method of bending the spine backward, thus emphasizing lumbar lordosis, has proved successful. Techniques drawn from chiropractic, osteopathy, yoga, acupuncture, and other styles of therapy have sometimes provided either temporary or permanent relief.

Perspective and Prospects

Low back pain seems to be equally prevalent in all eras and in all countries. Despite socioeconomic improvements in the lives of physical laborers, and despite the fact that a decreasing proportion of people worldwide make their living from physical labor, no concomitant decrease in new low back pain cases has been observed. If anything, there may be a slight increase in the percentage of low back pain cases in industrialized nations since the mid-twentieth century. People with desk-bound occupations and sedentary habits are at great risk for developing low back pain, especially if they slouch in their chairs or fail to protect the natural lordosis of the lumbar spine.

Physicians no longer consider typical low back pain either an injury or a disease. Since the late twentieth century they have understood it as a natural degenerative condition that can usually be delayed by good posture habits and managed by physical therapy, strength-building exercises, painkilling drugs, and lifestyle changes.

Bibliography

Borenstein, David G., Sam W. Wiesel, and Scott D. Boden. Low Back and Neck Pain: Comprehensive Diagnosis and Management. 3rd ed. Philadelphia: Saunders, 2004. Print.

Brennan, Richard. Back in Balance: Use the Alexander Technique to Combat Neck, Shoulder, and Back Pain. London: Watkins, 2013. Print.

Burn, Loic. Back and Neck Pain: The Facts. New York: Oxford UP, 2006. Print.

Cailliet, Rene. Low Back Pain Syndrome: A Medical Enigma. Philadelphia: Lippincott, 2003. Print.

Chevan, Julia, and Phyllis A. Clapis. Physical Therapy Management of Low Back Pain: A Case-Based Approach. Burlington: Jones Bartlett Learning, 2013. Print.

Fishman, Loren, and Carol Ardman. Back Talk: How to Diagnose and Cure Low Back Pain and Sciatica. New York: Norton, 1997. Print.

Hasenbring, Monika I., Adina C. Rusu, and Dennis C. Turk, eds. From Acute to Chronic Back Pain: Risk Factors, Mechanisms, and Clinical Implications. Oxford: Oxford UP, 2012. Print.

Hodges, Paul W., Jacek Cholewicki, and Jaap H. Van Dieën. Spinal Control: The Rehabilitation of Back Pain—State of the Art and Science. New York: Churchill Livingstone/Elsevier, 2013. Print.

Hutson, Michael A. Back Pain: Recognition and Management. Boston: Butterworth-Heinemann, 1993. Print.

McGill, Stuart. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, Ill.: Human Kinetics, 2002. Print.

Twomey, Lance T., and James R. Taylor, eds. Physical Therapy of the Low Back. New York: Churchill Livingstone, 2000. Print.

Waddell, Gordon The Back Pain Revolution. 2nd ed. New York: Churchill Livingstone/Elsevier, 2004. Print.

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