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The Many Causes of back pain

Most people suffer from back pain at some time in their lives, most commonly in the lower back. Your doctor may have difficulty diagnosing the cause of your backache since there are many back pain causes, some not due to problems with the back itself.  Back pain is one of the most common reasons people go to the doctor. Home treatment and proper body mechanics often will heal your back within a few weeks

Causes of back pain include strains, sprains, spasms, disc herniation (disc related problems), osteoarthritis (osteoporosis), rheumatoid arthritis, ankylosing spondylosis, scoliosis, sciatica, traumatic injury, facet joint pain, spinal stenosis, congenital defects and deformities, and referred pain (from problems with kidneys, uterus, stomach or pancreas).

There may be physical causes of back pain, such as muscle strain (muscle spasm), herniated disc and disc-related problems, facet joint pain, traumatic injury, sciatica, scoliosis, lordosis and kyphosis, spinal stenosis, osteoarthritis, osteoporosis, spondylolysis or spondylolisthesis.

Work-related and accidental back injuries may be difficult to avoid and can lead to partial or total disability, overwhelming medical expenses, and costly workers’ compensation benefits. But even though you may have injured your back, you can still find relief from back pain through various treatments and exercise, and by heeding advice from professionals on how to avoid further injury.

Sometimes there are psychological factors, as well as ‘referred pain’, which can be due to problems with organs located close to the lower back, such as the kidneys, uterus, stomach or pancreas.

Kidney stones can cause intermittent lower back pain and nausea and a kidney infection can cause severe low back pain, discolored urine, and fever. Drink plenty of water and see your doctor as soon as possible.

Since the nerves that serve the female reproductive organs come from the lower area of the spine, women can suffer lower back pain when problems arise with these organs. Menstrual pain and uterine cramps are a cause of back pain (a backache) that can be quite debilitating. Rest, gentle exercise and heat will bring relief.

Back pain diagnosis help decide the best treatment

If you have severe or chronic lower back pain, don’t take any chances. Have your back condition thoroughly evaluated, so that serious medical conditions can be ruled out. Most of the time, nothing serious will be found, but in a small number of cases, back pain is caused by a problem independent of the spine that will require a particular treatment.

Physical examination

First you must describe your back pain as clearly as you can. If possible write a short (1 page) account of your back problem: when it first happened, what seemed to cause it, what seems to aggravate it, when it recurs, what helps, and so on.

The doctor will probably ask you to walk, sit, bend over, bend sideways (to check your mobility) then will ask you to lie face down on an examination table. Here he/she will check your reflexes and do a hands-on examination by probing and tapping your back to find areas of muscle spasming and referred pain.

You will then be asked to lie on your back and the practitioner will raise each of your legs in turn and ask you to bring your knees up to your chest. Any sharp pain will be noted, and if your doctor suspects a fracture, tumour or some disease, he/she may recommend that you undergo one or more of the following procedures.

X-rays for back pain diagnosis

Fractures of the vertebrae, osteoporosis and arthritis, as well as congenital deformities can be diagnosed using x-rays. However ruptured or herniated discs and spinal tumours are more difficult to detect, and muscle strain is impossible.

CAT (or CT) scan: A CAT scan can detect almost any condition – fracture, herniated disc, tumours, bone disease, congenital problems and many others. The CAT scan image is highly detailed, showing soft tissue as well as bone. The procedure is painless. The patient lies in the machine and x-rays are transmitted from many angles, resulting in a composite image. The downside is that appreciable levels of x-rays can be involved.

Myelogram: A myelogram is an x-ray examination to detect abnormalities of the spine, spinal cord, or surrounding structures. A dye that can be seen on an x-ray, is injected into the fluid-filled space around the spinal cord to assist in making a diagnosis.

MRI scan

The Magnetic resonance imaging (MRI) scanner utilises a magnetic field and radio signals to produce highly detailed cross-sectional images of bone and soft tissue. This procedure is also painless and is a particularly safe diagnostic tool because x-rays are not involved.

Bone scan

If your doctor suspects bone cancer, a stress fracture, infection (osteomyelitis), or if the cause of your back pain isn’t clear, he/she may ask you to undergo a bone scan. Tiny amounts of radioactive materials will be injected into your vein and once the material has collected in the bones, the radiation it emits will be recorded by a special gamma camera. A nuclear medicine specialist or radiographer interprets these images.

Electromyography (EMG)

This procedure tests muscle and nerve activity, by inserting fine needles into different muscle groups and measuring the electrical impulses produced by the nerves when the muscles are and rest and contracted.  An abnormal EMG pattern can confirm a diagnosis of a rupture or herniated disc. This procedure may be uncomfortable and can take from one to two hours.

Medical treatment for back pain can involve several disciplines

Since back pain is one of the main reasons people visit a doctor these days, most general medical practitioners have a great deal of experience in diagnosing back pain. Your doctor will observe how you walk, bend, sit, and stand and then will ask you to lie down on an examination table, where he/she will do a hands-on examination of your back, while you lie on your stomach.

Then you will be asked to turn over and the doctor will check your reflexes. He/she may raise each of your legs and ask you to try to bring your knees to your chest, to find out which movements are painful for you. If your back pain is caused by muscle spasms or strain, your doctor will probably prescribe pain medication and anti-inflammatories.

But if your doctor suspects that your back pain is caused by something other than simple muscle spasming or strain, he/she may order diagnostic tests to try to find out the cause of your back pain, then refer you on to the relevant general medical practitioner or specialist for diagnosis and treatment.

Orthopedic surgeon and Neurosurgeon

Surgery can sometimes prevent paralysis and can often offer immediate relief from severe back pain. Orthopedic surgeons and neurosurgeons are Medical Doctors or Doctors of Osteopathy who are highly trained in the use of surgery to correct back problems.

While they generally perform the same types of spinal surgery, orthopedic surgeons and neurosurgeons do specialise in certain areas, e.g. orthopedic surgeons operate to correct spinal deformities and neurosurgeons operate on tumours close to the spinal cord. Recent improvements in surgical technique have led to higher success rate and less post-op pain and faster healing.

Anesthesiologist

An Anesthesiologist often treats patients suffering from chronic back pain, sometimes as part of a pain management clinic or spine care centre, but more familiarly as part of a surgical team, administering pain controlling drugs and maintain life support systems during surgery. Anesthesiologists also supervise care before surgery and in the recovery room.

Neurologist

Neurologists are Medical Doctors or Doctors of Osteopathy who are trained to diagnose and treat disorders of the brain, nervous system and related muscles, such as multiple sclerosis, Parkinson’s disease, epilepsy, Alzheimer’s as well as chronic pain such as back pain.

Neurologists use diagnostic test such CT scans and MRI scans, which cab provide detailed images of the brain, nerves and muscles, to diagnose problems causing back pain, as well as clinical examinations. They can also prescribe medications for neurological disorders and will refer patients for surgical evaluation, but they do not perform surgery.

They are also trained to perform spinal taps to obtain cerebrospinal fluid for analysis, and to perform EMG/NCV (electromyography/nerve conduction velocity tests, which helps to diagnose nerve and muscle disease.

Osteopathic physician

Osteopathic practitioners can prescribe drugs and tend to treat all types of lower back pain, however osteopathic physicians place great emphasis on preventative care. Heath problems are often treated with spinal manipulation osteopathic physicians, since the displacement of the spine is believed to be the source of all disease. Treatments for lower back pain can involve a wide range of therapies.

Physiatrist

Physiatrists are physical medicine and rehabilitation (PMR) specialists, who treat lower back pain with physical therapies such as exercise and stretching, epidural steroid injections, selective nerve block, IntraDiscal Electrothermal Therapy (IDET ) as well as other non-surgical options such as massage therapy, heat/ice therapy, TENS units, and prescription drugs.

They are also qualified to order diagnostic tests (CT myelogram, MRI, x-ray, and bone scans and can interpret the results. The physiatrist may specialize in many of the above treatments, and can be found practicing in hospitals, rehabilitation centers, and spine treatment centers, where they treat both acute and chronic lower back pain.

Rheumatologist

A Rheumatologist diagnoses and treats the many chronic musculoskeletal diseases that involve the joints, muscles and bones, such as rheumatoid arthritis, osteoarthritis, osteoporosis, fibromyalgia, autoimmune diseases, and tendonitis. The Rheumatologist must complete four years of medical school and two to three years in rheumatology training.

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