INTRODUCTION
Back pain is a common issue that can range from mild discomfort to severe, chronic pain. It often results from muscle strain, herniated discs, arthritis, or skeletal irregularities like scoliosis. Injuries, poor posture, and chronic conditions such as osteoporosis can also contribute. Symptoms include localized or radiating pain, stiffness, muscle spasms, and sometimes weakness or numbness if nerves are involved. Recognizing the causes and symptoms early is key to effective treatment and preventing complications.
• Age: Most common in individuals between 30-50 years old.
1. Risk Factors:
• Occupation: Jobs involving heavy lifting, bending, twisting, or prolonged sitting.
• Physical activity: Lack of exercise leads to weakened muscles, which can cause back pain.
• Obesity: Excess body weight increases stress on the spine.
• Smoking: Reduces blood flow to the spine and slows healing.
• Psychological factors: Stress, anxiety, and depression can contribute to back pain.
2. Pathophysiology:
• Mechanical causes: Muscle or ligament strain, herniated or degenerated discs, and skeletal abnormalities (e.g., scoliosis).
• Inflammatory causes: Conditions like ankylosing spondylitis cause chronic inflammation of the spine and joints.
• Neuropathic causes: Pinched or compressed nerves (e.g., sciatica).
• Degenerative causes: Osteoarthritis or degenerative disc disease that wears down the cartilage and discs between vertebrae.
• Infectious and neoplastic causes: Infections like osteomyelitis or tumors in the spine can also cause pain.
3. Signs and Symptoms:
• Pain location: Can be localized in the lower, middle, or upper back.
• Radiation of pain: Pain may radiate to the legs (sciatica) or arms, depending on nerve involvement.
• Limited mobility: Stiffness, inability to move, or muscle tightness in the back.
• Neurological signs: Numbness, tingling, or weakness in extremities due to nerve compression.
• Chronic pain: Pain lasting more than 3 months is considered chronic.
4. Lab Investigations and Findings:
• Blood tests: To rule out infections or inflammatory conditions (e.g., C-reactive protein, ESR for inflammation).
• Imaging:
• X-ray: To detect fractures, deformities, or osteoarthritis.
• MRI: Helps identify soft tissue problems, such as herniated discs, nerve impingement, and tumors.
• CT Scan: Used for detailed bone images, especially for complex fractures or spinal stenosis.
• Bone scan: Can detect bone infections or tumors.
• Electromyography (EMG): Measures electrical activity of muscles to evaluate nerve compression or injury.
5. Treatment:
• Non-pharmacological:
• Physical therapy: Strengthening and stretching exercises for the back and core muscles.
• Heat/ice application: Reduces inflammation and relieves pain.
• Chiropractic care: Spinal manipulation and adjustments.
• Massage therapy: Relaxes muscle tension.
• Pharmacological:
• NSAIDs (e.g., ibuprofen, naproxen): Reduces inflammation and pain.
• Muscle relaxants: For acute muscle spasms.
• Opioids: Short-term use for severe pain.
• Corticosteroids: May be used for nerve root pain (e.g., sciatica) via oral or epidural injections.
• Surgical options:
• Discectomy or laminectomy: Removes herniated or degenerative disc material causing nerve compression.
• Spinal fusion: Fuses vertebrae to stabilize the spine.
• Vertebroplasty or kyphoplasty: Used for compression fractures.
