|
|
| (93 intermediate revisions by 18 users not shown) |
| Line 1: |
Line 1: |
| {{Infobox_Disease |
| |
| Name = {{PAGENAME}} |
| |
| Image = Spinal column curvature.png |
| |
| Caption = Different regions (curvatures) of the vertebral column |
| |
| DiseasesDB = 15544 |
| |
| ICD10 = {{ICD10|M|54||m|50}} |
| |
| ICD9 = {{ICD9|724.5}} |
| |
| ICDO = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = |
| |
| eMedicineTopic = |
| |
| MeshID = D001416 |
| |
| }}
| |
| {{SI}}
| |
| {{CMG}}
| |
| __NOTOC__ | | __NOTOC__ |
| '''Associate Editor-In-Chief:''' {{CZ}} | | {| class="infobox" style="float:right;" |
| | |- |
| | |[[File:Siren.gif|30px|link={{PAGENAME}} resident survival guide]]||<br>||<br> |
| | |[[{{PAGENAME}} resident survival guide|Resident<br>Survival<br>Guide]] |
| | |} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Back pain}} |
|
| |
|
| {{Editor Join}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{HM}}, {{CZ}}, {{MUT}} {{ZMalik}} |
|
| |
|
| ==Overview==
| | {{SK}} Backache; backache; notalgia; dorsalgia |
|
| |
|
| '''Back pain''' (also known "dorsalgia") is [[Pain and nociception|pain]] felt in the [[Human back|back]] that may originate from the [[muscle]]s, [[nerve]]s, [[bone]]s, [[joint]]s or other structures in the [[Vertebral column|spine]].
| | ==[[Back pain overview|Overview]]== |
|
| |
|
| The pain may be have a sudden onset or it can be a [[chronic pain]], it can be felt constantly or intermittently, stay in one place or refer or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be felt in the [[neck]] (and might radiate into the [[arm]] and [[hand]]), in the upper back, or in the low back, (and might radiate into the [[leg]] or [[foot]]), and may include symptoms other than pain, such as weakness, numbness or tingling.
| | ==[[Back pain historical perspective|Historical Perspective]]== |
|
| |
|
| Back pain is one of humanity's most frequent complaints. In the U.S., acute [[low back pain]] (also called [[lumbago]]) is the fifth most common reason for all physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year.<ref name=AAFP>A.T. Patel, A.A. Ogle. "[http://www.aafp.org/afp/20000315/1779.html Diagnosis and Management of Acute Low Back Pain]". [[American Academy of Family Physicians]]. Retrieved March 12, 2007.</ref>
| | ==[[Back pain classification|Classification]]== |
|
| |
|
| The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.
| | ==[[Back pain pathophysiology|Pathophysiology]]== |
| | ==[[Back pain causes|Causes]]== |
|
| |
|
| ==Associated conditions== | | ==[[Back pain differential diagnosis|Differentiating Back Pain from other Diseases]]== |
| Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause: | |
| * Typical warning signs of a potentially life-threatening problem are [[Intestine|bowel]] and/or [[Urinary bladder|bladder]] [[incontinence]] or progressive weakness in the legs. Patients with these symptoms should seek immediate medical care.
| |
| * Severe back pain (such as pain that is bad enough to interrupt [[sleep]]) that occurs with other signs of severe illness (''e.g.'' [[fever]], unexplained [[weight loss]]) may also indicate a serious underlying medical condition, such as [[cancer]].
| |
| * Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a [[fracture]] or other injury.
| |
| * Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as [[osteoporosis]] or [[multiple myeloma]], also warrants prompt medical attention.
| |
|
| |
|
| In general, however, back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to [[inflammation]], especially in the acute phase, which typically lasts for two weeks to three months.
| | ==[[Back pain epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| A few observational studies suggest that two common diagnoses of back pain, lumbar disc herniation or [[degenerative disc disease]] may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.<ref>{{cite journal |author=Borenstein DG, O'Mara JW, Boden SD, ''et al'' |title=The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study |journal=The Journal of bone and joint surgery. American volume |volume=83-A |issue=9 |pages=1306-11 |year=2001 |pmid=11568190 |doi=}}</ref><ref>{{cite journal |author=Savage RA, Whitehouse GH, Roberts N |title=The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males |journal=European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society |volume=6 |issue=2 |pages=106-14 |year=1997 |pmid=9209878 |doi=}}</ref><ref>{{cite journal |author=Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS |title=Magnetic resonance imaging of the lumbar spine in people without back pain |journal=N. Engl. J. Med. |volume=331 |issue=2 |pages=69-73 |year=1994 |pmid=8208267 |url = http://content.nejm.org/cgi/content/abstract/331/2/69}}</ref><ref>{{cite journal |author=Kleinstück F, Dvorak J, Mannion AF |title=Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? |journal=Spine |volume=31 |issue=19 |pages=2250-7 |year=2006 |pmid=16946663 |doi=10.1097/01.brs.0000232802.95773.89}}</ref> Other studies suggest that for as many as 85% of cases, no physiological cause for the pain has been able to be specifically identified.<ref>{{cite journal |author=White AA, Gordon SL |title=Synopsis: workshop on idiopathic low-back pain |journal=Spine |volume=7 |issue=2 |pages=141-9 |year=1982 |pmid=6211779 |doi=}}</ref><ref>{{cite journal |author=van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK |title=Evidence against the use of lumbar spine radiography for low back pain |journal=Clinical radiology |volume=59 |issue=1 |pages=69-76 |year=2004 |pmid=14697378 |doi=}}</ref>
| | ==[[Back pain risk factors|Risk Factors]]== |
|
| |
|
| A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.<ref>{{cite journal |author=Burton AK, Tillotson KM, Main CJ, Hollis S |title=Psychosocial predictors of outcome in acute and subchronic low back trouble |journal=Spine |volume=20 |issue=6 |pages=722-8 |year=1995 |pmid=7604349 |doi=}}</ref><ref>{{cite journal |author=Carragee EJ, Alamin TF, Miller JL, Carragee JM |title=Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain |journal=The spine journal : official journal of the North American Spine Society |volume=5 |issue=1 |pages=24-35 |year=2005 |pmid=15653082 |doi=10.1016/j.spinee.2004.05.250}}</ref><ref>{{cite journal |author=Hurwitz EL, Morgenstern H, Yu F |title=Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study |journal=Journal of clinical epidemiology |volume=56 |issue=5 |pages=463-71 |year=2003 |pmid=12812821 |doi=}}</ref><ref>{{cite journal |author=Dionne CE |title=Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings |journal=Journal of clinical epidemiology |volume=58 |issue=7 |pages=714-8 |year=2005 |pmid=15939223 |doi=10.1016/j.jclinepi.2004.12.005}}</ref>
| | ==[[Back pain screening|Screening]]== |
|
| |
|
| ==Underlying causes== | | ==[[Back pain natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Transient back pain is likely one of the first symptoms of [[influenza]].
| |
|
| |
|
| Muscle strains (pulled muscles) are commonly identified as the cause of back pain, as are muscle imbalances. Pain from such an injury often remains as long as the muscle imbalances persist. The muscle imbalances cause a mechanical problem with the skeleton, building up pressure at points along the spine, which causes the pain.
| | ==Diagnosis== |
|
| |
|
| Another cause of acute low back pain is a Meniscoid Occlusion. The more mobile regions of the spine have invaginations of the synovial membrane that act as a cushion to help the bones move over each other smoothly. The synovial membrane is well supplied with blood and nerves. When it becomes pinched or trapped it can cause sudden severe pain. The pinching causes the membrane to become inflamed, causing greater pressure and ongoing pain. Symptoms include severe low back pain that may be accompanied by muscle spasm, pain with walking, concentration of pain to one side, and no [[radiculopathy]] (radiating pain down buttock and leg). Relief should be felt with flexion (bending forward),and exacerbated with extension (bending backward).
| | [[Back pain diagnostic study of choice|Diagnostic study of choice]] | [[Back pain history and symptoms|History and Symptoms]] | [[Back pain physical examination|Physical Examination]] | [[Back pain laboratory findings|Laboratory Findings]] | [[Back pain electrocardiogram|Electrocardiogram]]| [[Back pain x ray|X Ray]] | [[Back pain echocardiography and ultrasound|Echocardiography and ultrasound]] | [[Back pain CT|CT]] | [[Back pain MRI|MRI]] | [[Back pain ultrasound|Ultrasound]] | [[Back pain other imaging findings|Other Imaging Findings]] | [[Back pain other diagnostic studies|Other diagnostic studies]] | [[Back pain other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| When back pain lasts more than three months, or if there is more radicular pain ([[sciatica]]) than back pain, a more specific [[diagnosis]] can usually be made. There are several common causes of back pain: for adults under age 50, these include [[spinal disc herniation]] and [[degenerative disc disease]] or isthmic spondylolisthesis; in adults over age 50, common causes also include [[Osteoarthritis|osteoarthritis (degenerative joint disease)]] and [[spinal stenosis]] [http://www.spine-health.com/topics/cd/tlbp/type01.html],trauma, cancer, infection, fractures, and inflammatory disease [http://www.ninds.nih.gov/disorders/backpain/backpain.htm]. Non-anatomical factors can also contribute to or cause back pain, such as [[Stress (medicine)|stress]], repressed anger,[http://www.prevention.com/article/0,5778,s1-1-77-24-928-1,00.html] or [[depression (mood)|depression]]. Even if there is an anatomical cause for the pain, if depression is present it should also be treated concurrently.
| | ==Treatment== |
|
| |
|
| New attention has been focused on ''non-discogenic back pain'', where patients have normal or near-normal MRI and CT scans. One of the newer investigations looks into the role of the [[dorsal ramus]] in patient's pain that have normal radiographic evidence. See [[Posterior Rami Syndrome]].
| | [[Back pain medical therapy|Medical Therapy]] | [[Back pain surgery|Surgery]] | [[Back pain primary prevention|Primary Prevention]] | [[Back pain secondary prevention|Secondary Prevention]] | [[Back pain cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Back pain future or investigational therapies|Future or Investigational Therapies]] | [[Back pain monitoring response to therapy| Monitoring Response to Therapy]] |
|
| |
|
| == Differential Diagnosis == | | ==Lecture== |
|
| |
|
| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | [[Media:Back Pain.ppt|Back Pain]] |
|
| |
|
| === Common Causes === | | ==Case Studies== |
| | [[Back pain case study one|Case #1]] |
|
| |
|
| * [[Discopathy]]
| |
| * Idiopathic lumbago
| |
| * [[Trauma]] due to lifting
| |
|
| |
|
| ===Complete Differential Diagnosis of the Causes of Back pain=== | | ==References== |
| (In alphabetical order)
| | <references /> |
|
| |
|
| *[[Abatacept ]]
| | ==Related Chapters== |
| *[[Abdominal Aortic Aneurysm]]
| | |
| *[[Abnormal posturing]]
| | *[[Failed back syndrome]] |
| * Abnormally flexible ribs
| | *[[Low back pain]] |
| *[[Achalasia]]
| |
| *[[Acitretin ]]
| |
| *[[Acute prostatitis]]
| |
| *[[Addison's disease]]
| |
| *[[Albuterol ]]
| |
| *[[Aldesleukin ]]
| |
| *[[Alexithymia]] | |
| *[[Alprazolam]]
| |
| *[[Amitriptyline ]]
| |
| *[[Anagrelide ]]
| |
| *[[Angina pectoris]]
| |
| *[[Angiotensin II receptor antagonist]]
| |
| *[[Ankylosing Spondylitis]]
| |
| *[[Aortic Dissection]]
| |
| *[[Arachnoiditis]]
| |
| *[[Bearberry]]
| |
| *[[Bechterew's Disease]]
| |
| *[[Borreliosis]]
| |
| *[[Bortezomib ]]
| |
| *[[Bright's disease]]
| |
| *[[Budesonide Inhalation Powder ]]
| |
| *[[Cadmium poisoning]]
| |
| *[[Calcitonin Salmon Nasal Spray ]]
| |
| *[[Candesartan ]]
| |
| *[[Carbamazepine ]]
| |
| *[[Carboplatin ]]
| |
| *[[Cat scratch fever]]
| |
| *[[Cervical cancer]]
| |
| *[[Cervical fracture]]
| |
| *[[Cetuximab Injection ]]
| |
| *[[Childbirth]]
| |
| *[[Cholelithiasis]]
| |
| *[[Chronic fatigue syndrome]]
| |
| *[[Chronic inflammatory demyelinating polyneuropathy]] | |
| *Chronic uteral obstruction
| |
| *[[Clofarabine Injection ]]
| |
| *[[Conversion syndrome]]
| |
| *[[Coxarthrosis]]
| |
| *[[Cramp]]
| |
| *[[Cushing's Disease]]
| |
| *[[Cyanocobalamin Injection ]]
| |
| *[[Darbepoetin Alfa Injection ]]
| |
| *[[Daunorubicin ]]
| |
| *[[Degenerative disc disease]]
| |
| *[[Desloratadine ]]
| |
| *[[Desmoplastic small round cell tumor]]
| |
| *[[Didanosine ]]
| |
| *[[Diflunisal ]]
| |
| *Disc space infection
| |
| *[[Dofetilide ]]
| |
| *[[Donepezil ]]
| |
| *[[Dorsopathy]]
| |
| *[[Drotrecogin alfa]]
| |
| *[[Dural ectasia]]
| |
| *Dysraphia
| |
| *[[Ectopic pregnancy]]
| |
| *[[Efalizumab Injection ]]
| |
| *[[Endometriosis]]
| |
| *[[Epidural abscess]]
| |
| *[[Epoetin Alfa Injection ]]
| |
| *[[Eszopiclone ]]
| |
| *[[Etodolac ]]
| |
| *[[Facet Syndrome]]
| |
| *[[Fenoprofen ]]
| |
| *[[Fexofenadine ]]
| |
| *[[Fibromyalgia]]
| |
| *[[Formoterol ]]
| |
| *[[Fulvestrant Injection ]]
| |
| *[[Glatiramer Injection ]]
| |
| *[[Gonarthrosis]]
| |
| *[[Hantavirus Pulmonary Syndrome]]
| |
| *[[Hemangioma]]
| |
| *[[Herpes Zoster]]
| |
| *[[Hyperparathyroidism (primary/secondary)]]
| |
| *[[Ibandronate ]]
| |
| *[[Idiopathic]]
| |
| *[[Indinavir ]]
| |
| *[[Infliximab Injection ]]
| |
| *Injury of disci and ligaments
| |
| *[[Leflunomide ]]
| |
| *[[Leg length discrepancy]]
| |
| *[[Leriche's Syndrome]]
| |
| *[[Lumbago Syndrome]]
| |
| *[[Lumbar disc disease]]
| |
| *Lumbar strain
| |
| *[[Lung cancer]]
| |
| *Malignant processes of vertebral body
| |
| *[[Marfan syndrome]]
| |
| *[[Meclofenamate ]]
| |
| *[[Mediastinitis]]
| |
| *[[Medroxyprogesterone Injection ]]
| |
| *[[Mefenamic Acid ]]
| |
| *[[Meningioma]]
| |
| *[[Menopause]]
| |
| *[[Mesalamine ]]
| |
| *[[Metastases]]
| |
| *[[Modafinil ]]
| |
| *[[Multiple Myeloma]]
| |
| *[[Mycophenolate ]]
| |
| *[[Myelofibrosis]]
| |
| *[[Myocardial infarction]]
| |
| *[[Myositis]]
| |
| *[[Myotendinosis]]
| |
| *[[Nabumetone ]]
| |
| *[[Nateglinide oral ]]
| |
| *[[Nephrolithiasis]]
| |
| *[[Olanzapine ]]
| |
| *[[Osteoarthritis]]
| |
| *[[Osteochondroma]]
| |
| *[[Osteochondrosis]]
| |
| *[[Osteogenesis imperfecta]]
| |
| *[[Osteogenic Sarcoma]]
| |
| *[[Osteomalacia]]
| |
| *[[Osteomyelitis]]
| |
| *[[Osteoporosis]]
| |
| *[[Ovarian cancer]]
| |
| *[[Oxaliplatin injection ]]
| |
| *[[Oxcarbazepine ]]
| |
| *[[Oxybutynin ]]
| |
| *[[Paget's Disease]]
| |
| *[[Pancreatitis]]
| |
| *[[Peptic ulcer disease]]
| |
| *[[Pergolide ]]
| |
| *[[Pilonidal cyst]]
| |
| *[[Piriformis syndrome]]
| |
| *[[Piroxicam ]]
| |
| *[[Pleuritis]]
| |
| *[[Pneumonia]]
| |
| *[[Poliomyelitis]]
| |
| *[[Polycystic kidney disease]]
| |
| *[[Polymyalgia Rheumatica]]
| |
| *[[Posaconazole ]]
| |
| *[[Posterior Rami Syndrome]] | | *[[Posterior Rami Syndrome]] |
| *Postlaminectomy Syndrome
| |
| *Posttraumatic spinal stenosis
| |
| *[[Pott's disease]]
| |
| *[[Praziquantel]]
| |
| *[[Prednisolone]]
| |
| *[[Pregabalin ]]
| |
| *[[Pregnancy]]
| |
| *[[Prostatitis]]
| |
| *[[Psoriatic Arthritis]]
| |
| *[[Psychosomatic]]
| |
| *[[Pulmonary embolism]]
| |
| *[[Pyelonephritis]]
| |
| *[[Ranibizumab injection ]]
| |
| *[[Reiter's Syndrome]]
| |
| *[[Renal osteodystrophy]]
| |
| *[[Renal vein thrombosis]]
| |
| *[[Repaglinide ]]
| |
| *[[Retroperitoneal fibrosis]]
| |
| *[[Retroperitoneal hematoma]]
| |
| *[[Rheumatoid Arthritis]]
| |
| *[[Ribavirin ]]
| |
| *[[Rift Valley fever]]
| |
| *[[Risedronate ]]
| |
| *[[Rituximab injection ]]
| |
| *[[Rosiglitazone ]]
| |
| *[[Sacroiliitis]]
| |
| *[[Salpingitis]]
| |
| *[[Salsalate ]]
| |
| *[[Saquinavir ]]
| |
| *[[Sargramostim injection ]]
| |
| *[[Scheuermann's Disease]]
| |
| *[[Sciatica]]
| |
| *[[Scoliosis]]
| |
| *[[Selegiline ]]
| |
| *[[Sibutramine ]]
| |
| *[[Sickle Cell Disease]]
| |
| *[[Sirolimus ]]
| |
| *[[Sodium oxybate ]]
| |
| *[[Solifenacin ]]
| |
| *[[Spina Bifida]]
| |
| *[[Spinal cord compression]]
| |
| *[[Spinal disc herniation]]
| |
| *[[Spinal fusion]]
| |
| *[[Spinal stenosis]]
| |
| *[[Spinal tumor]]
| |
| *[[Spondylolisthesis]]
| |
| *[[Spondylolysis]]
| |
| *[[Spondylosis]]
| |
| *[[Subarachnoid hemorrhage]]
| |
| *[[Sulfinpyrazone ]]
| |
| *[[Sulindac ]]
| |
| *[[Sunitinib ]]
| |
| *[[Syringomyelia]]
| |
| *[[Tabes dorsalis]]
| |
| *[[Tacrolimus topical ]]
| |
| *[[Tadalafil]]
| |
| *[[Tamsulosin]]
| |
| *[[Tegaserod ]]
| |
| *[[Telbivudine ]]
| |
| *[[Telmisartan ]]
| |
| *[[Temozolomide ]]
| |
| *[[Tension myositis syndrome]] | | *[[Tension myositis syndrome]] |
| *[[Terazosin ]]
| | *[[Upper back pain]] |
| *[[Transverse myelitis]]
| | *[[Pelvic girdle pain | Pregnancy related pelvic girdle pain]] |
| *[[Traumatic aortic rupture]]
| |
| *[[Triamterene]]
| |
| *[[Urinary tract infection]]
| |
| *[[Valganciclovir ]]
| |
| *[[Valproic Acid ]]
| |
| *[[Valsartan ]]
| |
| *[[Vancomycin Hydrochloride ]]
| |
| *[[Vardenafil]]
| |
| *Vertebral Fractures
| |
| *[[Vertebral subluxation]]
| |
| *[[Zolpidem ]]
| |
| *[[Zonisamide ]]
| |
|
| |
| ==Back Pain During Pregnancy==
| |
| | |
| About 50% of women experience low back pain during pregnancy.<ref>Ostgaard HC, Andersson GBJ, Karlsson K. Prevalence of back pain in pregnancy. Spine 1991;16:549-52.</ref>
| |
| | |
| Back pain in pregnancy may be severe enough to cause significant pain and disability and pre-dispose patients to back pain in a following pregnancy. No significant increased risk of back pain with pregnancy has been found with respect to maternal weight gain, exercise, work satisfaction, or pregnancy outcome factors such as birth weight, birth length, and Apgar scores.
| |
| | |
| Biomechanical factors of pregnancy that are shown to be associated with low back pain of pregnancy include abdominal sagittal and transverse diameter and the depth of lumbar lordosis. Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.
| |
| | |
| The avoidance of high impact, weight-bearing activities and especially those that asymmetrically load the involved structures such as: extensive twisting with lifting, single-leg stance postures, stair climbing, and repetitive motions at or near the end-ranges of back or hip motion can easen the pain.
| |
| | |
| Direct bending to the ground without bending the knee causes severe impact on the lower back in pregnancy and in normal individuals, which leads to strain, especially in the lumbo-saccral region that in turn strains the multifidus.
| |
| | |
| ==Treatment==
| |
| | |
| The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual's ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better.
| |
| | |
| Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition ([[acute (medical)|acute]] or [[chronic (medicine)|chronic]]) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery.
| |
| | |
| ===Conservative treatment===
| |
| * [[Heat therapy]] is useful for back spasms or other conditions. A [[meta-analysis]] of studies by the [[Cochrane Collaboration]] concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.<ref name=pmid16641776>{{cite journal | author = French S, Cameron M, Walker B, Reggars J, Esterman A | title = A Cochrane review of superficial heat or cold for low back pain. | journal = Spine | volume = 31 | issue = 9 | pages = 998-1006 | year = 2006 | id = PMID 16641776}}</ref> Some patients find that moist heat works best (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours). Cold therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases.
| |
| | |
| * [[Medications]], such as muscle relaxants,<ref name=pmid12804507>{{cite journal | author = van Tulder M, Touray T, Furlan A, Solway S, Bouter L | title = Muscle relaxants for non-specific low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD004252 | year = | id = PMID 12804507}}</ref> [[narcotics]], [[Non-steroidal anti-inflammatory drugs|non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs)]]<ref name=pmid10796356>{{cite journal | author = van Tulder M, Scholten R, Koes B, Deyo R | title = Non-steroidal anti-inflammatory drugs for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000396 | year = | id = PMID 10796356}}</ref> or [[paracetamol|paracetamol (acetaminophen)]]. A [[meta-analysis]] of [[randomized controlled trials]] by the [[Cochrane Collaboration]] found that injection therapy, usually with corticosteroids, does not appear to help regardless of whether the injection is facet joint, epidural or a local injection.<ref name="pmid10796449">{{cite journal |author=Nelemans P, de Bie R, de Vet H, Sturmans F |title=Injection therapy for subacute and chronic benign low back pain |journal=Cochrane Database Syst Rev |volume= |issue= |pages=CD001824 |year= |id=PMID 10796449}}</ref> Accordingly, a study of intramuscular [[corticosteroids]] found no benefit.<ref name="pmid17046475">{{cite journal |author=Friedman B, Holden L, Esses D, Bijur P, Choi H, Solorzano C, Paternoster J, Gallagher E |title=Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain |journal=J Emerg Med |volume=31 |issue=4 |pages=365-70 |year=2006 |id=PMID 17046475}}</ref> [[Herbalism|Herbal]] [[analgesic]]s may also be effective.
| |
| | |
| * [[Exercise]]s can be an effective approach, particularly when done under supervision of a professional such as a physical therapist. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is also effective for chronic back pain, but not for acute pain.<ref name=pmid16034851>{{cite journal | author = Hayden J, van Tulder M, Malmivaara A, Koes B | title = Exercise therapy for treatment of non-specific low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000335 | year = | id = PMID 16034851}}</ref> Another study found that back-mobilizing exercises in acute settings are ''less effective'' than continuation of ordinary activities as tolerated.<ref name=pmid7823996>{{cite journal | author = Malmivaara A, Häkkinen U, Aro T, Heinrichs M, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V | title = The treatment of acute low back pain--bed rest, exercises, or ordinary activity? | journal = N Engl J Med | volume = 332 | issue = 6 | pages = 351-5 | year = 1995 | id = PMID 7823996}}</ref>
| |
| | |
| * [[Physical therapy]] and [[exercise]], including stretching and strengthening (with specific focus on the [[muscle]]s which support the spine), often learned with the help of a health professional, such as a physical therapist. Physical therapy, when part of a 'back school', can improve back pain.<ref name=pmid15494995>{{cite journal | author = Heymans M, van Tulder M, Esmail R, Bombardier C, Koes B | title = Back schools for non-specific low-back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000261 | year = | id = PMID 15494995}}</ref>
| |
| | |
| * [[Massage]] therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.<ref name=pmid12076429>{{cite journal | author = Furlan A, Brosseau L, Imamura M, Irvin E | title = Massage for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001929 | year = | id = PMID 12076429}}</ref>
| |
| | |
| * Body Awareness Therapy such as the Feldenkrais Method has been studied in relation to [[Fibromyalgia]] and chronic pain and studies have indicated positive effects.<ref name=pmid16012065>{{cite journal | author = Gard G | title = Body awareness therapy for patients with fibromyalgia and chronic pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = | year = 2005 | id = PMID 16012065}}</ref>. Organized exercise programs using these therapies have been developed.
| |
| | |
| * [[Joint manipulation|Manipulation]], as provided by an appropriately trained and qualified chiropractor, [[osteopath]], physical therapist, or a physiatrist. Studies of the effect of manipulation suggest that this approach has a small benefit similar to other therapies and superior to sham.<ref name=pmid14973958>{{cite journal | author = Assendelft W, Morton S, Yu E, Suttorp M, Shekelle P | title = Spinal manipulative therapy for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000447 | year = | id = PMID 14973958}}</ref><ref name=pmid12779300>{{cite journal | author = Cherkin D, Sherman K, Deyo R, Shekelle P | title = A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. | journal = Ann Intern Med | volume = 138 | issue = 11 | pages = 898-906 | year = 2003 | id = PMID 12779300}}</ref>
| |
| | |
| * [[Acupuncture]] has a small benefit for chronic back pain. The [[Cochrane Collaboration]] concluded that "for chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and alternative treatments."<ref name=pmid15674876>{{cite journal | author = Furlan A, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B | title = Acupuncture and dry-needling for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001351 | year = | id = PMID 15674876}}</ref>. More recently, a [[randomized controlled trial]] found a small benefit after 1 to 2 years.<ref name=pmid16980316>{{cite journal | author = Thomas K, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M, Roman M, Walters S, Nicholl J | title = Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. | journal = BMJ | volume = 333 | issue = 7569 | pages = 623 | year = 2006 | id = PMID 16980316}}</ref>
| |
| | |
| * Education, and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.<ref name=pmid15674889>{{cite journal | author = Ostelo R, van Tulder M, Vlaeyen J, Linton S, Morley S, Assendelft W | title = Behavioural treatment for chronic low-back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD002014 | year = | id = PMID 15674889}}</ref>
| |
| | |
| * Most people will benefit from assessing any [[ergonomic]] or postural factors that may contribute to their back pain, such as improper lifting technique, poor posture, or poor support from their mattress or office chair, etc. Although this recommendation has not been tested, this intervention is a part of many 'back schools' which do help.<ref name=pmid15494995>15494995</ref>
| |
| | |
| ===Surgery===
| |
| Surgery may sometimes be appropriate for patients with:
| |
| * Lumbar disc herniation or [[degenerative disc disease]]
| |
| * [[Spinal stenosis]] from lumbar disc herniation, degenerative joint disease, or [[spondylolisthesis]]
| |
| * [[Scoliosis]]
| |
| * [[Compression fracture]]
| |
| | |
| ===Emerging Treatments===
| |
| * [[Vertebroplasty]] involves the percutaneous injection of surgical cement into vertebral bodies which have collapsed due to compression fractures. This new procedure is far less invasive than surgery, but may be complicated by the entry of cement into Batson's plexus with subsequent spread to the lungs or into the spinal canal. Ideally this procedure can result in rapid pain relief.
| |
| * The use of specific biologic inhibitors of the inflammatory cytokine [[tumor necrosis factor-alpha]] may result in rapid relief of disc-related back pain. <ref>Uceyler N, Sommer C. Cytokine-induced Pain: Basic Science and Clinical Implications. Reviews in Analgesia 2007;9(2):87-103.</ref>
| |
| | |
| ===Treatments with uncertain or doubtful benefit===
| |
| * [[injection (medicine)|Injections]], such as [[epidural]] steroid injections, facet joint injections, or prolotherapy have limited, if any, benefit.<ref name=pmid10796449>{{cite journal | author = Nelemans P, de Bie R, de Vet H, Sturmans F | title = Injection therapy for subacute and chronic benign low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001824 | year = | id = PMID 10796449}}</ref><ref name=pmid15106234>{{cite journal | author = Yelland M, Mar C, Pirozzo S, Schoene M, Vercoe P | title = Prolotherapy injections for chronic low-back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD004059 | year = | id = PMID 15106234}}</ref>
| |
| | |
| * [[Cold compression therapy]] is advocated for a strained back or chronic back pain and is postulated to reduce pain and inflammation, especially after strenuous exercise such as golf, gardening, or lifting. However, a [[meta-analysis]] of [[randomized controlled trials]] by the [[Cochrane Collaboration]] concluded "The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain"<ref name=pmid16641776>{{cite journal | author = French S, Cameron M, Walker B, Reggars J, Esterman A | title = A Cochrane review of superficial heat or cold for low back pain. | journal = Spine | volume = 31 | issue = 9 | pages = 998-1006 | year = 2006 | id = PMID 16641776}}</ref>
| |
| | |
| * Bed rest is rarely recommended as it can exacerbate symptoms,<ref name=pmid15495012>{{cite journal | author = Hagen K, Hilde G, Jamtvedt G, Winnem M | title = Bed rest for acute low-back pain and sciatica. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001254 | year = | id = PMID 15495012}}</ref> and when necessary is usually limited to one or two days. Prolonged bed rest or inactivity is actually counterproductive, as the resulting stiffness leads to more pain.
| |
| | |
| * [[Electrotherapy]], such as a [[Transcutaneous Electrical Nerve Stimulator]] (TENS) has been proposed. Two [[randomized controlled trials]] found conflicting results.<ref name="pmid10084439">{{cite journal |author=Cheing GL, Hui-Chan CW |title=Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain |journal=Archives of physical medicine and rehabilitation |volume=80 |issue=3 |pages=305-12 |year=1999 |pmid=10084439 |doi=}}</ref><ref name="pmid2140432">{{cite journal |author=Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S |title=A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain |journal=N. Engl. J. Med. |volume=322 |issue=23 |pages=1627-34 |year=1990 |pmid=2140432 |doi=}}</ref> This has led the [[Cochrane Collaboration]] to conclude that there is inconsistent evidence to support use of TENS.<ref name="pmid16034883">{{cite journal |author=Khadilkar A, Milne S, Brosseau L, ''et al'' |title=Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD003008 |year=2005 |pmid=16034883 |doi=10.1002/14651858.CD003008.pub2}}</ref> In addition, spinal cord stimulation, where an electrical device is used to interrupt the pain signals being sent to the brain and has been studied for various underlying causes of back pain.
| |
| | |
| * [[Inversion therapy]] is useful for temporary back relief due to the traction method or spreading of the back vertebra's through (in this case) gravity. The patient hangs in an upside down position for a period of time from ankles or knees until this separation occurs. The effect can be achieved without a complete vertical hang (90 degree) and noticeable benefits can be observed at angles as low as 10 to 45 degrees.
| |
| | |
| ==Prognosis==
| |
| | |
| Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.
| |
| | |
| ==See also==
| |
| * [[Failed back syndrome]]
| |
| * [[Low back pain]]
| |
| * [[Posterior Rami Syndrome]]
| |
| * [[Tension myositis syndrome]]
| |
| * [[Upper back pain]] | |
| * [[Pelvic girdle pain | Pregnancy related pelvic girdle pain]] | |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| ==External links==
| |
|
| |
|
| * [http://www.ascent-oxford.kramesonline.com/HealthSheets/AlphaList.pg?Letter=b Back Pain - Information for Patients]
| |
| * [http://search.dmoz.org/cgi-bin/search?search=back+pain Back pain] at the [[Open Directory Project]]
| |
| * {{NINDS|backpain}}
| |
| * [http://www.niams.nih.gov/hi/topics/pain/backpain.htm Handout on Health: Back Pain] at [[National Institute of Arthritis and Musculoskeletal and Skin Diseases]]
| |
| * [http://www.spine-health.com Back Pain Information for Patients: Spine-health.com]
| |
| * [http://www.backpainguide.com Patient's guide to back pain]
| |
| * [http://www.nlm.nih.gov/medlineplus/backpain.html Back pain, on Medline plus, a service of the National Library of Medicine]
| |
|
| |
|
| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
| {{SIB}}
| |
|
| |
|
|
| |
|
| [[de:Rückenschmerzen]]
| |
| [[es:Espalda#Dolor de espalda]] | | [[es:Espalda#Dolor de espalda]] |
| [[fr:mal de dos]] | | [[fr:mal de dos]] |
| [[it:Dorsopatia]]
| |
| [[nl:Rugpijn]]
| |
| [[pt:Dor nas costas]] | | [[pt:Dor nas costas]] |
| [[simple:back pain]]
| | {{WikiDoc Help Menu}} |
| | {{WikiDoc Sources}} |
|
| |
|
| [[Category:Pain]] | | [[Category:Pain]] |
| [[Category:Orthopedics]] | | [[Category:Orthopedics]] |
| [[Category:Rheumatology]] | | [[Category:Rheumatology]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Primary care]]
| |
| [[Category:Neurosurgery]] | | [[Category:Neurosurgery]] |
| | | [[Category:Disease]] |
| {{WikiDoc Help Menu}}
| |
| {{WikiDoc Sources}}
| |
