BACK PAIN

Overview & Facts

Back pain is a common occurrence and have many causes, some of which are self-inflicted due to a lifetime of bad habits. Other causes include accidents, muscle strains, and sports injuries.  More often than not, they share the same symptoms regardless of the cause.

Causes

  • Arthritis, nerve and muscular problems, and degenerative disc disease.

Back pain may be relived with pain medication.

Types & Symptoms

Types of Back pain

  • Lower, middle, or upper back pain or low back pain with sciatica.

Symptoms of back pain include:

  • Constant aching or stiffness in any part of your spine, starting from the base of the neck all the way to the tail bone
  • Localized, sharp pain in the neck, upper back, or lower back — especially after picking up heavy objects or participating in other strenuous activity; (pain in the upper back may also be a heart attack symptom or other life-threatening conditions.)
  • Chronic ache in the middle or lower back, especially after sitting or standing for extended periods
  • Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
  • Having pain or muscle spasms in the lower back causing the inability to stand straight

Inform your physician immediately if you experience:

  • Numbness, tingling (electricity like sensation), or weakness in your groin, arms or legs
    • May signify spinal cord damage
  • Pain extends downward along the back of the leg
    • May be sciatica
  • Pain increases when you cough or bend forward at the waist
    • May be herniated disc
  • Pain is accompanied by fever, burning during urination, or frequent and/or urgent urination
    • May have an infection
  • If you begin to have bowel or bladder control problems; seek immediate medical help.

Other “red flags” include:

  • A history of cancer
  • Unintentional weight loss
  • Medications that weaken immune system such as steriods
  • A history of trauma
  • Worsening pain that does not get relieved by rest
  • Pain of more than a month
  • Nighttime pain
  • Unresponsive to earlier back pain therapies
  • A history of IV drug use

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.

What Are the Symptoms of Sciatica?

Common symptoms of sciatica include:

  • Pain in the rear or leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness, or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A shooting pain that makes it difficult to stand up

Low back strain is one of the main causes of back pain, whether acute or chronic. It is the affectation of the muscles and ligaments supporting your spinal column usually caused by stretching them too far causing microtears in the tissue. This causes them to become weakened and less stable, causing lowback pain.

Low back strain can be caused by:

  • Extreme physical exertion
  • Falls
  • Bending or crouching repeatedly
  • Lifting heavy objects incorrectly

Other causes are emotional stress, improper posture, being overweight, out of shape, sitting in the same position for long periods of time or severe cough.

Nighttime back pain may be an indication of a serious spinal problem.

Most people with back pain are able to adjust their sleeping habits to cope with the pain. This is not the case with those with nighttime back pain as the hurting does not disappear no mater what adjustments are made. In some cases they may even worsen or for others pain starts only when they lie down.

Diagnosis & Medications

DIAGNOSIS

Physician may do/request:

  • History & Physical Exam
    • Ask you questions about symptoms
  • For skeletal defects
    • X-ray
  • For Soft tissue or disc damage
    • Computed Tomography Scan (CT Scan)
    • Magnetic Resonance Imaging (MRI)
  • For Nerve or Muscle damage
    • Electromyogram (EMG)
  • For infection and sytemic problems
    • Blood and Urine Tests

 

RECOMMENDED MEDICATIONS

Goals of the treatment program are:

  • Improve sleeping habits
  • Pain and Inflammation reduction
  • Joint strengthening and mobility
  • Prevention of further damage and other complications
Drug Class Benefits Risks
Over-the-counter NSAIDs
(nonsteroidal anti-inflammatory drugs)         

  • Aspirin (Bayer, Excedrin)         Ibuprofen (Advil, Motrin)      
  • Ketoprofen (Actron,Orudis KT)
  • Naproxen (Aleve)
 Relieves pain and reduces swelling Side effects include a risk of ulcers and bleeding. Not for long-term use unless recommended by your health care provider. Take with food.
Over-the-counteracetaminophen

  • Tylenol
  • Panadol
  • An ingredient in Excedrin
 Relieves pain They can also cause liver toxicity in high doses. Not for long-term use unless recommended by your health care provider.
Over-the-counter combined sleep aids/pain drugs

  • Advil PM (ibuprofen and diphenhydramine)
  • Tylenol PM (acetaminophen and diphenhydramine)
 Relieves pain and helps with sleep These drugs help you sleep by including an antihistamine, an ingredient in cold medicines that may also work as a sedative. However, according to the National Institutes of Health, the effectiveness of antihistamines as a sleep aid is not well established and they can have side effects like daytime drowsiness and decreased cognitive function. Not for long-term use.
Opioid painkillers

  • Codeine
  • Morphine
  •  OxyContin (oxycodone),Percocet (oxycodone with acetaminophen)
  • Vicodin (hydrocodonewith acetaminophen)
 Relieves more severe pain Side effects include nausea, constipation, and a risk of addiction. Some of these medicines can disrupt the natural sleep cycle, reducing the amount of deep sleep you get.
Muscle relaxants

  • Flexeril(cyclobenzaprine)
  • Lioresal (baclofen)
  • Skelaxin (metaloxalone)
  • Soma (carisoprodol)
 Relieves more severe pain Relieves pain from spasm and helps with sleep. Side effects include drowsiness, dry mouth, constipation and confusion. Should not be used for long-term pain relief.
Benzodiazepines

  • Ativan (lorazepam)
  • Dalmane (flurazepam)
  • Halcion (triazolom)
  • Klonopin (clonazepam)
  • Restoril (temazepam)
  • Valium (diazepam)
 Used to reduce anxiety, benzodiazepines can also aid with sleep. These drugs are not for long-term use. Side effects can include daytime sleepiness, cognitive impairment, and dependence. They can also reduce the amount ofREM sleep.
Nonbenzodiazepine hypnotics

  • Ambien (zolpidem)
  • Lunesta (eszopiclone)
  • Sonata (zaleplon)
 Aids with sleep, while not causing the same disruptions to the sleep cycle that benzodiazepines do; they are generally considered to be safer for longer use. Side effects can be similar to those of benzodiazepines, although generally less severe.
Anticonvulsants

  • Gabitril (tiagabine)
  • Carbatrol, Tegretol(carbamazepine)
  • Neurontin (gabapentin)
  • Topamax (topiramate)
 Originally used to preventseizures, these drugs can also help with nerve pain. Side effects include drowsiness and dizziness. You should never stop taking these medicines abruptly.
Antidepressants

  • Aventyl, Pamelor(nortriptyline)
  • Desyrel (trazodone)
  • Elavil (amitriptyline)
  • Serzone (nefazodone)
  • Cymbalta (duloxetine)
 Reduces pain, particularly for headache, nerve pain, and fibromyalgia; some can aid sleep.

Cymbalta is approved for musculoskeletal pain.

 These drugs may not be effective for other types of pain, like sports injuries orback pain. Antidepressants are powerful drugs that can have serious side effects. Talk to your health care provider about side effects you should watch out for.

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