Back pain- Its causes, features, investigations

Back pain is common in humans because of upright posture. Back pain is uncommon in children, when present it indicates some organic disease, but in adults, it is mostly due to psychological factors play a key role in producing back pain. In teenagers back pain that arises due to wrong posture and trauma or injury. Ankylosing spondylitis and disc prolapse are common in adults, while in elderly persons metabolic bone disease, degenerative arthritis, osteoporosis are the usual cause.

It is very common in ladies, who had many pregnancies, in these ladies’ nutritional osteomalacias and lack of exercise becomes the factor for it. People in sedentary jobs are more prone to it.

Causes of back pain:

Metabolic causes:

1. Osteomalacia.
2. Osteoporosis.

Degenerative cause:

1. Osteoarthritis.

Congenital cause:

1. Spondylolisthesis.
2. Spina bifida.
3. Facet tropism.
4. Spondylolysis.
5. Lumbar scoliosis.
6. Transitional vertebra.

Neoplastic cause:

1. Malignant: Multiple myeloma lymphoma, Secondaries.
2. Benign: Eosinophilic granuloma,osteoid osteoma.

Traumatic cause:

1. Vertebral fractures.
2. Sprain, strain
3. Disc prolapse.

Inflammatory cause:

1. Ankylosing spondylitis.
2. Tuberculosis.
3. Seronegative spondarthritis (SSA).

Referred pain:

1. Gynecological disease.
2. Genitourinary disease.

Other causes:

1. Due to the wrong posture.
2. Functional back pain.

Symptoms of back pain:

1. Stiffness: It is very common in very painful back, prominently present in ankylosing spondylitis which is aggravated in the early morning.
2. Neurological: Paraesthesias (pins an needle sensations), weakness, numbness may be due to nerve lesion or due to disc prolapse.
3. The psychological status of patients must be judged to rule out hysteria.

Features of back pain :

Localization: Pain that arises from injury to muscle or tendon is localized (means situated in an area where the injury occurred), but which arises from deeper structures is spread to a nearby area of the body. Sometimes it is referred to dermatome of the lower limb, in the association with neurological signs, indicates toward entrapment of the nerve.

The onset of pain: History given by the patient is of great value, like any history of trauma/injury indicates traumatic pathologies, like a sprain, strain, fracture, etc. Disc prolapse is present in 40-45% of cases, trauma may occur from daily routine activities also.

Location of pain: Mainly located in the upper back or middle and lower back. It is due to degenerative spondylitis and disc prolapse is found in the lower lumbar spine, while the pain of infection and injury found in the dorso-lumbar spine.

Progress: Pain is maximum in onset and then subside gradually in the traumatic conditions or in case of acute prolapse of the disc. In disc prolapse, there are remissions and exacerbations of the, while which is caused by spondylitis or arthritis is of constant in nature and increased by activity, but the which arises due to the infection or tumors has a progressive course, and nothing gives relief.

Most back pains are relieved by the rest and increased by activity, but some back pains become worst after rest and relieved by activity for example, which occurs in seronegative spond-arthritis (SSA) and ankylosing spondylitis. If aspirin helps to relieve back pain which is severe at night, it indicates a benign tumor. In spinal stenosis pain is started by walking or standing and relieved by rest.

Investigations for back pain:

There is no use of X-ray in acute backache which is of less than 3 weeks duration, but it is mandatory in the cases which last for more than 3 weeks.CT and MRI scans are also useful but reserved according to the history of patients as they are expensive also. Blood investigations can be done according to the history and symptoms given by the patient.

Principles of treatment of back pain:

1. Rest: Complete bed rest in hard bed is very helpful but of no use after 2 weeks after that slow movement using aids is preferred.
2. Homeopathy medicines: Due to no side effects and no nephrotoxicity in contrast to allopathic medicines the homeopathic treatment is very beneficial.
3. Physiotherapy.

How to relieve back pain naturally:

1. Milk with turmeric, turmeric is a proven anti-inflammatory and anti-arthritic natural agent, half teaspoon of turmeric in a glass of warm milk gives excellent results.
2. Green tea with ginger.
3. Cherry juice, almond, walnut, chia, and sunflower seeds.
4. Use sweet potatoes, oranges, blueberries, strawberries, tomatoes.
5. Avocado oil, and olive oil.
6. Fish like salmon, sardines
7. Avoid standing/sitting in the same posture for long hours.
8. Adequate sleep.
9. Yoga and meditation and stretching exercises.
10. Hamstring muscle stretching.
11. Capsaicin cream, for local application on the area of pain.
12. Acupuncture.
13. Essential oil like wintergreen oil, chamomile oil, yarrow oil, eucalyptus oil, ginger oil, menthol, and piperment oil can be used topically mixed with jojoba or olive oil.