Back Pain is a common complaint, affecting up to 70% of adults in their lifetimes. Regardless of age, it’s significantly more common among adults aged between 35 and 55. Research shows that back pain may be painful and uncomfortable but it is not usually serious. Regardless, back pain can cause a significant physical and emotional drain on an individual and hamper one's quality of life. Symptoms include muscle aches, shooting or stabbing pain in the back, burning pain that radiates down your leg, and limited flexibility or range of motion.Most American adults will experience an episode of back pain at some point in their lives. The tendency to develop back pain increases with age, and so, as Americans live longer, and maintain increasingly sedentary lifestyles, the incidence of back pain in the population grows. It is important that individuals suffering from back pain understand the nature of their symptoms and the treatment options available to them.
Understanding the Symptoms of Back Pain
Level of Pain The experience of pain varies in intensity from individual to individual – it may be mild, moderate, severe, or somewhere in between.
Duration of Pain The pain can be acute - occurring for a short period of time, episodic – recurring now and then, or chronic – experienced for a sustained period of time generally longer than 3 months. The level of pain can vary from mild to severe when the problem is episodic or chronic.
Location Back pain can occur anywhere on back, but is generally described as axial or radicular. Axial back pain usually occurs at the position of the spine, anywhere from the coccyx to the neck, and is the most common manifestation of back pain. Axial pain is usually focal, occurring in one region of the back. Axial pain usually starts acutely but can then become chronic. Radicular back pain tends to radiate outward from the spine into the lower extremities such as the arms or down the legs, as in sciatica. Both axial and radicular pain can be experienced in the lower back, the middle of the back, or in the upper back, extending to the shoulders and neck.
Quality of Pain and Associated Symptoms Back pain can be experienced as dull or sharp, deep or shallow, and can be accompanied by numbness, tingling, and burning sensations. It can also be accompanied by limited mobility and other biomechanical issues.
Common Causes of Back Pain
Strain: The human back comprises a complex structure ligaments, muscles, tendons, bones, and disks. Segments of the spine are also cushioned with cartilage-like pads. Straining, lifting, and awkward movement of any of these components can lead to muscle spasm, compression, and pain.
Structural problems: The human back's structural components might rapture, bulge, or abnormally curve the spine and its discs. When these structural issues occure, there will be more pressure on nerves resulting in back pain.
Everyday activities or poor posture: An individual’s daily activities lead to poor posture habits being acquired. Poor postures include; bending awkwardly, carelessly pushing, pulling, and lifting things, overly tensing muscles, standing for long periods, sitting in hunched position for a long time as when driving, and bending down for long periods. All of these poor biomechanics can eventually make one strain the back, leading to back pain.
Spasms, Inflammation, and Compression: Spasms are involuntary contractions of muscles and can result from poor posture, overexertion, trauma, and weakness in the core. Inflammation of the muscles and ligaments is the body’s natural swelling response to injury and disease. It can indicate an underlying issue, which ought to be treated, but can also present a problem in itself. Spasms and inflammation can place undue stress on the musculoskeletal and neurological structures of the back, causing pain, or can be painful in their own right. Compression of the spinal discs either mechanically or due to spams and inflammation, can also contribute to back pain.
Chronic Illnesses: Diabetes, high blood pressure, high cholesterol, and other chronic illnesses can contribute a “degenerative cascade,” in which there is a negative interplay of the muscle, bone, cardiovascular, nerve, and ligament tissues. Such conditions can increase the risk of back pain and its severity.
Cancer of the spine: If there is a tumor located on the spine, it may press against a nerve, resulting in pain. Any small discomfort the spine nerves get results to back pain due to the interruption of their compatibility. This will include infections of the spine.
Other causes: Sleep disorders, bad mattresses, drug abuse.
A pain management specialist has a number of diagnostic tools at their disposal:
Performance of a detailed medical history and history of symptoms, such as when and how the symptoms began, and the presence of any other conditions.
Blood tests can show markers of inflammation. Inflammation may be caused by an autoimmune disorder, which ought to be ruled out or brought under control.
Diagnostic imaging techniques such as X-rays, CAT scans, and MRIs show the structural integrity of the back. Imaging may uncover a compression fracture, changes in the spinal discs, swelling, degeneration, bulging, and herniation.
Observation of the spine can help to confirm or rule out the presence of a condition such as scoliosis and kyphosis.
Functional Exercise – Strengthening the core, including the abdominal and oblique muscles, can help to mitigate the risk of injury to the spine and muscle spams resulting from overexertion or weakness. When the core is weak, the lower back muscles are left unsupported, resulting in potentially harmful strain on the back. Strengthening the back can also help to increase range of motion and flexibility. Options for exercise include water aerobics, stretching, aerobic exercise, and strength training. When engaging in exercise, it is especially important to maintain mindful biomechanics.
Mindful Biomechanics refers to the conscious correction of poor posture and movement habits when laying down, sitting, standing, walking, and lifting and carrying things. A pain management specialist or physical therapist can help to coach a patient in proper biomechanics and come up with strategies to avoid movements and positions that contribute to back pain.
Weight Loss - Excessive weight puts additional strain on the back. Losing pounds can help to prevent back pain.
Overall Bodily Health - As with many conditions, maintaining a generally healthy lifestyle such as a sensible diet, abstinence from tobacco, and regular exercise, can help to mitigate the risk and severity of back pain. Maintaining an appropriate body weight can help to reduce strain on the back.
Reducing Stress - Reducing psychological stress is very important in reducing the impact of back pain. Stress can heighten sensitivity to pain, make muscle spams more severe, and contribute to poor biomechanics.
Lifestyle changes (see above)
Oral Medication – Prescription and over the counter medication may be used to control inflammation and pain. The specific types of medication used are based on each individual’s specific medical history and physical needs.
Acupuncture and Massage Therapy may help some patients.
In addition to lifestyle changes, a common first approach is the ordering of a course of physical therapy, which can help to control some symptoms. When lifestyle changes or physical therapy fail to achieve the desired results, a pain management specialist can provide a patient with a number of options suited to their particular medical history and symptoms. The physicians at New York Neurology Associates believe in a holistic and generally conservative approach to treating back pain, combining lifestyle changes with minimally invasive procedures, and minimizing the use of oral medication when other methods are available. The focus is on eliminating pain in a minimally-invasive manner in order to avoid the need for surgery and medications that often cause side effects. Below are some treatments offered at New York Neurology Associates:
Corticosteroid/ Epidural Injections - Injections of corticosteroid medication and anesthetic can help with the recovery process. These treat back pain by reducing pain directly as well as by reducing inflammation.
Facet Blocksare a type of spinal injection of the joint between vertebrae.
Trigger Point Injections introduce medication, primarily anesthetic, directly into the muscles that are inflamed
Medial Branch Blocks are injections of medication into the tissue around the nerve
Radiofrequency Ablation is usually done as a follow up to trigger point injections or medial branch blocks. For more information, please see our post on how Radiofrequency Joint Ablation can help to treat back pain.
Botox Injections for Back Pain - Botox injections for back pain may be used to address a number of back pain issues from chronic pain to pain caused by muscle spasm. Botox works by blocking the nerve receptor from sending and receiving signals to the brain which allows a person to feel pain. The process of receiving Botox injections for the treatment of back pain is fairly simple. Generally speaking, individuals experience relief in the first three days after receiving the injections. Although experiences vary by individual, relief usually lasts between three and six months, at which point the procedure is repeated. Your doctor can provide personalized information on what to expect from Botox treatment for back pain and whether the treatment option can work for you based on your medical concerns.
The pain management specialists at New York Neurology Associates use a holistic approach where all potential modalities to alleviate pain are incorporated into a treatment plan throughout a patient's life. Any changes to patients’ symptoms will be addressed on an ongoing basis. Integrating lifestyle changes with a range of treatment options allows the patient to minimize degeneration and lay the ground for improvement.
If you or a loved one suffers from back pain, call New York Neurology Associates for more information at (646) 679-6609, or schedule a consultation by clicking the link below.
Dr. Pascal Saremsky, a pediatric neurologist at New York Neurology Associates, discusses the nature of autism spectrum disorders and the ways in which quality of life can be improved for those living with autism.