Back pain can affect any portion of the spine, from the neck to the buttocks. Some causes of back pain are related to systemic or rheumatic illnesses, and others are caused by aging, injury, muscle strain, and spinal deformity. Back pain is considered chronic if it lasts for more than 3 months.
How common is back pain?
In a cross-sectional, Internet-based survey involving a large sample of U.S. adults, researchers found that chronic pain affected 31% of those surveyed. The prevalence of chronic pain was slightly greater in females (34%) than males (27%), and it increased with age. Chronic back pain has increased in the general population over the last two decades. In a recent study, 10% of adults had some form of back pain.
What symptoms are associated with chronic back pain?
The symptoms associated with chronic forms of back pain include:
- Mild to severe pain that comes and goes
- Dull, aching pain
- Sharp, shooting pain
- Burning, searing pain
- Back stiffness
- Pain that radiates to the hips, thighs, legs, and/or feet
What causes chronic back pain?
For many patients, the exact cause of pain is hard to identify, since it can originate in the bones, intervertebral discs, soft tissues, and/or nerves. Causes of chronic back pain include spinal arthritis, fibromyalgia, compression fractures, spondylitis, spondylolisthesis, herniated disc, bulging disc, spinal stenosis, and degenerative disc disease.
Who is at risk for back pain?
Certain people are at increased risk for developing chronic back pain. Risk factors include:
- Working a job that requires lifting or operating heavy machinery
- Driving a truck
- Certain sports (cross-country skiing)
- Older age
How is back pain diagnosed?
The doctor must decide if the back pain is related to bones, nerves, muscles, or organs. First, the Chicago pain clinic doctor takes a history, asks questions about your symptoms, and conducts a thorough physical examination. Imaging tests used to diagnose back pain include x-rays, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and bone scans.
How is back pain treated?
The treatment of back pain focuses on alleviating discomfort, improving quality of life, and enhancing functionality. Treatment options include:
- Physical therapy – After an injury or for certain back conditions, physical therapy is prescribed. The therapist uses cold packs, heat therapy, ultrasound, and electrical stimulation for pain relief. In addition, exercises are used for flexibility and strengthening.
- Mechanical back supports – Used for a limited time, these support braces help with back pain.
- Medications – For chronic pain, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Other medicines used include topical analgesics, muscle relaxants, tricyclic antidepressants, and narcotic painkillers.
- Epidural steroid injection (ESI) – With this procedure, the Chicago pain center doctor inserts a small needle into the space around the spinal cord and injects a corticosteroid agent. In a recent observational study involving patients with chronic low back pain, researchers evaluated ESIs with methyl prednisolone 80 mg and 0.5% bupivacaine (anesthetic). They found that success rate for the procedure was 84%, with improved functional status and less pain.
- Facet joint injections (FJIs) – Facet joints are tiny joints along the posterior aspect of the spine. With FJIs, the doctor inserts small needles into these joints and injects a steroid agent, with or without an anesthetic medication. The therapeutic efficacy of FJIs was studied recently, where 74% of patients reported a positive, immediate effect.
- Transcutaneous electrical nerve stimulation (TENS) – This unit delivers mild electrical current via patches attached to the skin. The device is worn outside the body, and is simple to use. According to one recent study, TENS had an 82% efficacy rate for the treatment of chronic back pain.
- Surgery – Depending on the cause of back pain, surgery may help. To relieve nerve pressure, a discectomy (removal of disc) is performed. For serious spinal arthritis and other conditions, two or more bones of the spine are fused together in a spinal fusion procedure. Vertebroplasty involves injection of bone cement to fix a compression fracture of the vertebra.
- Spinal cord stimulation (SCS) – For patients with failed back surgery syndrome (FBSS), a spinal cord stimulator can be surgically implanted in the body. This involves several wires that run from the unit to attach to electrodes along the spine, which are also surgically implanted. In a large review of many studies, SCS had a 75% efficacy rate at 97 months follow-up. In addition, 94% of patients reported they were satisfied with SCS.
Borbach C, Schmid MR, Elfering A, et al. (2006). Therapeutic efficacy of facet joint blocks. Am J of Roentgenology, 186 (5).
Freburger JK, Holmes GM, Agans RP, et al. (2009). The rising prevalence of chronic low back pain. Archives of Internal medicine, 169(3), 251-258.
Jamadar NP, Ganesh K, Sandeep G, et al. (2013). Efficacy of epidural steroid injections in management of chronic low back pain. Ind J of Basic & Appl Med Res, 8(2), 903-911.
Johanne DB, Le TK, Zhou X, et al. (2010). The prevalence of chronic pain in United States adults: Results of an internet-based survey. Journal of Pain, 11(11), 1230-1239.
Lee AW & Pilitsis JG (2006). Spinal cord stimulation: Indications and outcomes. Neurosurgical Focus, 21(6).
Rigoard P, Delmotte A, & D’Houtaud S (2012). Back pain: A real target for spinal cord stimulation? Neurosurgery, 70(3), 574-585.