Back Pain

Back pain is a very common disease that accounts for the fifth most common cause of symptoms in people who visit hospitals. It is reported that 80% of people experience back pain at least once in their lifetime and 50% of workers experience back pain every year.

Most back pains do not show major problems or complications, but some can be serious illnesses that cause complications or disabilities. Back pain can occur in a wide range of age groups, and pain can take many forms, such as a painful waist or break, or a pain that extends to the legs.

30% of people with back pain do not go to the hospital, but 70% have severe symptoms that eventually lead to the hospital. 90% of people with acute back pain return to work within three months, but in many cases symptoms recur and experience functional dysfunction.

Therefore, if you have severe pain, take painkillers. If the pain persists or worsens, you should visit a hospital for proper diagnosis and treatment.

The human spine is divided into four parts: the cervical spine, the thoracic spine, the lumbar spine, and the sacral spine. All 25 vertebrae are vertically connected, acting as pillars that support the center of our body. Normally, the vertebrae of the neck and waist form a curve that is naturally curved forward, and the vertebrae of the chest form a curve only after naturally bending backward.

Skeletal structure

The vertebrae are connected to each other by strong fibrous tissue called ligaments, and various muscles such as the “vertebral muscle” are surrounded around the vertebrae, allowing for exercises such as straightening, bending and straightening the lower back.

Vertebrae and spinal nerves

Between each vertebra there is cartilage called discs, which absorb the impact on the spine. And inside each vertebra there is an empty space called the “vertebral canal”, where the spinal cord descends from the brain, passing a pair of spinal nerves between each spine.

Causes and Risks

1. Causes

Back pain is not an independent “disease” caused by one cause, but a “symptom” caused by a variety of triggers.

Causes that cause back pain include:

1) Physical / mechanical causes

This can lead to pain because the spine supports heavy weights and exercises in various directions. The most common of these forms of pain is the degeneration of the intervertebral disc, which occurs due to the damage and degeneration of the intervertebral disc located between the vertebrae with age. As the intervertebral disc degenerates, the ability to absorb shocks between the vertebrae decreases, resulting in back pain when moving or exerting back.

Other possible causes include spasms and sprains in the muscles of the lower back and rupture of the intervertebral discs, called disc herniation.

2) Trauma

Lumbar sprains, such as sore back and spine, and lumbar fractures with broken vertebrae are typical examples of back pain caused by trauma.

Lumbar sprains are a sudden, extreme back pain caused by excessive exercise, such as lifting objects or suddenly straightening or turning in the wrong position, which is the result of injury to the ligaments or muscles that support the spine.

Lumbar fractures can occur when you fall down or have a car accident, especially in people with osteoporosis.

3) Deformation or disease of the spine

Scoliosis or kyphosis usually does not cause serious pain until middle age, but over time, deformity of the spine becomes more severe, which can cause serious problems later in life.

Inflammatory diseases such as osteoarthritis (degenerative arthritis), rheumatoid arthritis or ankylosing myelitis, vertebral dislocation in which the spine moves forward as the vertebral bone weakens, and spinal canal stenosis that compresses the vertebral nerve passing through it as the vertebral tube narrows slowly The back can also cause back pain.

On the other hand, osteoporosis does not cause pain by itself, but it causes pain secondarily by making bone damage such as vertebral fractures easier.

4) Infection / Tumor

Although not common, osteomyelitis can cause pain by infecting the bone marrow in the spine and its interior or causing inflammation of the intervertebral discs. On the other hand, tumors that develop in the spine itself or cancer that has spread to the spine from other organs can also cause fractures or invade surrounding tissues, causing back pain.

5) Other factors

• Pregnancy: Back pain can occur due to increased weight and uncomfortable postures in late pregnancy.
• Kidney stones / Urinary stones: Stones in the kidneys or urinary tract can cause extreme back pain.
• Endometriosis: Endometriosis, in which endometrial tissue proliferates inside the abdominal cavity, can cause pain in the lower abdomen, pelvis, and back, depending on the menstrual cycle.
• Fibromyalgia: Pain and fatigue in large areas of muscle. Back pain occurs when the muscles in the lower back are involved.
• Physical / Mental Stress: Stress causes a variety of symptoms throughout the body. Particularly under stress, even the same pain may be more severe or longer than the intensity of the symptoms and the duration of the pain.

2. Risk factors

Back pain is a very common condition that can occur to anyone. In particular, people with the following factors are at higher risk of developing back pain:

1) Age

Most people first experience back pain between the ages of 30 and 40 years. And later with age, back pain is more and more common.

2) Physical condition

Back pain is more common in people who usually do not exercise well or are unable to exercise. In particular, people who rarely exercise but only do radical sports on weekends are at higher risk of back injuries or back pain than those who normally exercise.

3) Dietary Factors and Obesity

People who have high-calorie foods that are high in fat and who don’t exercise too much are more likely to become obese, which results in increased weight on their lower back.

4) Genetic factors

The risk of disc herniation is also known to be related to hereditary disposition.

Symptoms

Symptoms of back pain can range from being unable to freeze due to extreme pain to not being able to feel anything unusual unless you are moving too hard. Depending on the cause of the back pain, the age, symptoms, symptoms and accompanying symptoms of the patient may vary.

Some back pain may be worse when you are moving, while some back pain may be worse when you sleep at night, and depending on the type, your back may be stiff and motionless when you wake up in the morning.

In addition to pain in the lower back, other organs, such as the abdominal organs, may appear, or they may be accompanied by disorders of the bladder. Pain, numbness, and radiation pain may occur in areas other than the lower back, such as calf, calf, or toes, and, in severe cases, lameness or muscular atrophy.

On the other hand, systemic symptoms such as fever and weight loss may occur.

Most back pain often improves over time without special treatment. However, if you experience any of the following symptoms, it may be a serious illness or back pain that requires immediate medical attention.

• Numbness
• If the pain is severe or does not improve with pain medication or rest
• When back pain occurs due to obvious damage such as falls or trauma
• Muscle weakness, pain, or paresthesia of the lower extremities
• If you have any abnormalities in bladder function such as urination disorder
• Accompanied by fever and weight loss with no known reason

Diagnoses

To diagnose back pain, the doctor listens to the patient’s medical history and conducts a physical examination. If necessary, additional tests, such as radiography, are done.

1. History taking

Your doctor will check your medical history and ask about any symptoms of pain, other comorbidities, and whether someone in your family has a similar condition.

The questions the doctor asks for the diagnosis and evaluation of back pain include:

• Have you recently fallen or fallen from a high place?
• Does symptom or pain improve or worsen when lying down?
• Are there activities or postures that worsen or alleviate the symptoms?
• Is there any time of day when symptoms are particularly severe or alleviated?
• Does anyone in your family have a history of back pain or arthritis?
• Have you had back pain or had surgery on your back or back in the past?
• Do you have pain or numbness or numbness in one or both legs?

Especially if you have fever, weight loss, pain in lying posture, sustained morning stiffness, and acute bone pain, you may suspect a systemic disease.

2. Physical examination

Some of the physical examinations performed by doctors for patients with back pain include:

Observe standing or walking posture

Check for neural reflexes such as deep reflexes to check for abnormalities in the nervous system

Press on the back to check the area where the pain is particularly severe and to check for fibromyalgia

Check strength and numbness

Examine the lower limbs for stimulation of spinal nerves

3. Image and other inspection

After the medical history and physical examination, if the doctor decides it is necessary, the following tests may be performed.

1) Radiography

Radiographs of the lumbar spine are the most commonly used tests for the diagnosis of back pain. Radiography allows you to easily identify bone abnormalities, including fractures of the spine, osteoarthritis, and antagonism of the spine.

However, in 67% of normal people aged 50 years, the intervertebral disc gap was narrowed on the lumbar X-ray, and in 20%, the spine and joint were deformed due to aging. An abnormality does not necessarily mean it is the cause of back pain.

2) Magnetic Resonance Imaging (MRI)

MRI is a test that uses a magnetic field to take a cross-sectional image of your body. Unlike regular radiography, which only shows bone images, MRI is a great help in identifying the cause of back pain because it shows the surrounding tissues, such as the intervertebral discs, ligaments or tendons, nerves and blood vessels. However, as mentioned in the radiological examination, abnormal findings in the imaging test are not necessarily the cause of back pain, and since the MRI test itself is an expensive test, it requires a back pain or surgery that does not respond to treatment. This is done only when it is absolutely necessary for patients who are diagnosed with cancer, patients suspected of having cancer or infection, etc.

3) Computed Tomography (CT)

CT is a test method that produces a cross-sectional image by computing the data acquired using radiation. CT, like MRI, is often used to identify intervertebral hernia, microscopic spinal fractures, tumors and inflammations involving the spine.

4) Blood Test

Blood tests are not commonly used to diagnose back pain itself. However, it can be done to distinguish diseases that show certain abnormalities in blood tests, such as inflammation, rheumatoid arthritis.

4. Things to remember in the diagnosis of back pain

Abnormal findings on radiography, MRI, CT, etc. do not necessarily cause back pain. Indeed, as reported by 90% of all patients with MRI, abnormalities are found in normal people without back pain.

Therefore, the cause of back pain is determined by a comprehensive review of the patient’s medical history and physical examination findings rather than being reliant on imaging tests.

On the other hand, some patients may not be able to determine the exact cause even after performing all possible tests. In these cases, the doctor may look to see what causes worsening or alleviation of the patient’s back pain, and then monitor the progression, with treatments that improve the patient’s symptoms first.

Treatments

Most back pain patients improve with symptomatic therapy alone, with 60% of patients healed within 7 days, usually within 4 weeks, and 90% of patients with conservative treatment. And for many patients with back pain, it is helpful to try to get back to everyday life as much as possible, rather than just lying in bed.

If symptoms worsen or do not respond to treatment, you should revisit to consider the possibility of medical / systemic illness. You should also take a good look at your body to see if your motor / sensory function does not decrease, if urination or defecation does not decrease, or if your pain does not increase. You should.

1. Acute back pain and chronic back pain

The treatment of back pain usually depends on whether the pain you complain is acute or chronic.

1) Acute back pain

Acute back pain means back pain that improves within six weeks, the most common form of back pain. Acute back pain is a sudden back pain caused by falling, falling from high places, or squeaking back.

Acute back pain occurs suddenly, but symptoms often improve in a short time.

Acute back pain often goes away on its own without special treatment, even with pain medication. Therefore, living your daily routine without too much pressure may help reduce joint stiffness and pain and help you recover faster.

On the other hand, exercise therapy or surgery is not recommended for most acute back pains.

2) Chronic back pain

Chronic back pain refers to back pain that lasts for more than three months, regardless of whether it occurs suddenly or slowly at the beginning. Chronic back pain is relatively less common than acute back pain.

Treatment for chronic back pain is largely divided by whether or not surgery is needed. Most chronic back pain does not require surgery, and non-surgical treatment is given as much priority as possible prior to surgery. However, in the event of tumors, infections, nerve compressions, etc., surgical treatment is chosen.

2. Non-surgical treatment

1) Hot or cold pack

Applying heat or cold to the affected area may help relieve pain, although it does not cure the cause of the back pain itself.

Heat dilates blood vessels, improving blood circulation in the affected area, relieving muscle spasms, and altering pain sensations. Cold, on the other hand, has the effect of constricting blood vessels, calming inflammation in the affected area, and diminishing sensations, alleviating pain.

2) Exercise therapy

Exercise therapy is not recommended for acute back pain. However, chronic back pain is known to be effective in reducing pain and reducing recurrence.

On the other hand, some patients may be exacerbated by symptoms or burden on their backs. Therefore, it is necessary to consult a doctor and prescribe the exercise that is appropriate for you.

The types of exercises for the treatment of back pain include:

① Flexing movement

Flexing exercises are designed to bend the torso to widen the gap between the spine, reduce pressure on the nerves, stretch the muscles in the back and hips, and strengthen the muscles in the abdomen and buttocks. In particular, strengthening the muscles of the abdomen is known to reduce the burden on the spine.

② Stretching movement

Stretching exercises are exercises that lower your back and reduce radiating pain. An example of stretching exercises is lifting your upper body and legs back in a prone position.

③ stretching exercises

The purpose of stretching exercises is to stretch the back muscles and tissues such as ligaments. These exercises help to reduce back stiffness and broaden your range of back movement.

④ other aerobic exercise

Aerobic exercise has the effect of strengthening the cardiopulmonary function and the body’s metabolism by activating the heartbeat and breathing exercise. In general, it is recommended that aerobic exercise be done at least three times a week, lasting at least 30 minutes at a time. Examples of aerobic exercise include breaking, walking, jogging, and swimming. However, depending on the patient, exercising more than 30 minutes at a time can be unreasonable, and violent body movements can damage the lower back. Exercise especially when running, which can put a strain on the intervertebral discs of the spine.

3) Physical Therapy / Auxiliary Equipment

The typical method used to treat back pain is traction therapy. Traction therapy involves pulling the spine to widen the gap between the spine and the spine, causing the protruding disc to retract and relieve symptoms. However, the effects of long term treatment are still controversial, as the effects of traction therapy are often temporary.

In addition, you can wear assistive devices, such as corsets or waist guards, which are used to limit waist movement, support your abdomen, and correct your posture. However, such a method can be effective when used in a limited manner only in patients immediately after surgery, and when used in the treatment of chronic back pain for a long time, it may cause weakness of the lower back muscles and stiffness of the lower back joint, which may cause negative results. You should.

4) Lifestyle correction

It is important not only to treat back pain, but also to prevent back pain, to maintain the correct posture and tips so that you do not hurt your back in various situations such as lifting or sitting things. Along with this, proper exercise and rest, good sleep, good nutrition and even quitting smoking can help.

5) Drug therapy

For the treatment of back pain, a variety of drugs can be used. Some of these can be purchased and used by pharmacies yourself, but others may need to be prescribed by a doctor.

Painkillers are used to relieve pain and can range from general painkillers such as aspirin and tylenol to narcotic painkillers. Muscle relaxants and antidepressants are also used to treat chronic back pain, but the effects remain controversial among experts.

6) Injection treatment

If the above treatments do not cure chronic back pain, the following injection therapy may be recommended to reduce the pain.

① neuromuscular block

Neuromuscular blockade may be considered if the spinal nerve is compressed by surrounding tissues, such as the spine or discs, and pain in the lower back or lower extremities. Relieves back pain symptoms by injecting medication into the area where pain occurs, blocking the pain nerve area.

② intra-articular injection

Inflammation of the joints that connect the spine with the spine can cause back pain. These patients can be relieved of back pain by injecting local anesthetics, steroids, or joints directly into the joints.

③ trigger point injection

This method is used to treat areas that cause pain when the doctor presses them by hand and then inject anesthetic or a mixture of anesthetics and steroids to treat the area that causes pain.

3. Surgical Therapy

Surgery is considered the first priority if all of the above treatments fail or depending on the cause. Surgery may be considered, especially if the pain is constant, or in situations where daily or work life or normal sleep are difficult.

The diseases that are the target of surgery include:

1) Intervertebral herniation

Disc herniation, commonly referred to as “disc,” is a disease in which the intervertebral discs between the vertebrae and the vertebrae are damaged, causing the inner jelly-like nucleus to escape and compress the adjacent spinal nerves. When disc herniation occurs, nerve compression causes severe lower sciatica and lower back pain.

In patients with intervertebral herniation, surgery removes the nucleus pulposus or removes the posterior arch of the back of the spinal canal. Interbody fusion or total intervertebral disc replacement may be performed. Recently, minimally invasive treatments have been developed and performed using an endoscope, microscopic microscope, or laser.

2) Spinal stenosis

Spinal stenosis is a disease in which the spinal cord, the space through which the spinal cord passes, becomes narrowed by causes such as osteoarthritis, causing pain by pressing the spinal cord or nerves passing through it. Spinal canal stenosis not only causes pain, but also causes paresthesia, bladder, and digestive problems. In extreme cases, walking disorder may be caused by pain in the lower limbs.

The ultimate treatment for spinal stenosis requires surgery such as resection of the back of the spinal canal to relieve nerve pressure. In the case of a wide range of plaque resection, fusion is performed to correct intervertebral instability. Symptoms may improve slightly without surgery, but they are not a complete treatment.

3) Spinal displacement

This disease is a condition in which the vertebrae move away from their original position and move forward, causing the nerves to be pinched between the vertebrae and the vertebrae. Patients with anterior spinal dislocation may have back pain, but nerve compression may cause severe sciatica.

Spondylolisthesis is similar to spinal canal stenosis, and you can perform spinal fusion surgery to fix the spine where the dislocation has occurred to stabilize the spine.

4) Spinal fractures

Severe back pain can occur if the spine is fractured due to falls, falls, or traffic accidents. In particular, fractures of the spine occur more often in patients whose bones are weakened by osteoporosis. In addition to severe back pain, vertebral fractures can also damage the fractured bone by compressing the spinal cord or nerves passing through it.

Spine fractures, which do not cause special neurological compression, can be recovered through prolonged bed rest, but surgery is performed if the spine is not stable or there are signs of nerve compression.