The lumbar area is the most common area for pain, as it supports most of the weight in the upper body. The pain may be characterized as a dull ache, shooting or piercing pain, or a burning sensation. Back pain is common, with back pain joint swelling nine out of ten adults experiencing it at some point in their life, and five out of ten working adults having it every year. Americans will experience back pain at some point in their lifetime.
It is the most common cause of chronic pain, and is a major contributor of missed work and disability. However, it is rare for back pain to be permanently disabling. Additionally, it is the single leading cause of disability worldwide. Back pain may be classified by various methods to aid its diagnosis and management. The duration of back pain is considered in three categories, following the expected pattern of healing of connective tissue. There are many causes of back pain, including blood vessels, internal organs, infections, mechanical, and autoimmune causes. The spinal cord, nerve roots, vertebral column, and muscles around the spine can all be sources of back pain.
The anterior ligaments of the intervertebral disc are extremely sensitive, and even the slightest injury can cause significant pain. Back pain can be caused by the vertebrae compressing the intervertebral discs. Approximately 98 percent of people with back pain are diagnosed with nonspecific acute back pain in which there is no serious underlying pathology. Radiculopathy occurs when there is irritation in the nerve root, causing neurologic symptoms, such as numbness and tingling. Disk herniation and foraminal stenosis are the most common causes of radiculopathy.
The space between the vertebrae becomes more narrow, resulting in compression and irritation of the nerves. Referred pain occurs when pain is felt at a location different from the source of the pain. This persistent state maintains pain even after the initial injury has healed. Treatment of sensitization typically involves low doses of anti-depressants. Obesity, sedentary lifestyle, and lack of exercise can increase a person’s risk of back pain. People who smoke are more likely to experience back pain than others. Poor posture and weight gain in pregnancy are also risk factors for back pain.
In general, fatigue can worsen pain. X-rays and other medical imaging scans. In most cases of low back pain, medical consensus advises not seeking an exact diagnosis but instead beginning to treat the pain. This assumes that there is no reason to expect that the person has an underlying problem.
In most cases, the pain goes away naturally after a few weeks. Typically, people who do seek diagnosis through imaging are not likely to have a better outcome than those who wait for the condition to resolve. Elevated CRP levels are associated with infection. CT scan of the spine, showing calcification of the longitudinal posterior ligament.
Imaging is not typically needed in the initial diagnosis or treatment of back pain. There is moderate quality evidence that suggests the combination of education and exercise may reduce an individual’s risk of developing an episode of low back pain. Lesser quality evidence points to exercise alone as a possible deterrent to the risk of the onset of this condition. The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual’s ability to function in everyday activities, to help the patient cope with residual pain, to assess for side-effects of therapy, and to facilitate the patient’s passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long-term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better. Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them.