Understanding Back Pain and how to manage it

Back pain is a complicated, personal experience for most people. The intensity and manageability of pain is very different per person. For example, one person may have a large herniated disc and experience no pain at all, and another individual may have a simple muscle strain that can cause excruciating back pain and difficulty moving but will heal on its own in a few days. Also, with some conditions, the pain can flare up occasionally and then subside, only to flare up again after a few weeks or months and gradually increase over time. Because only you know your level of pain, your treatment will most likely be more successful if you proactively participate in making decisions about your medical care.

Many structures in your back can cause pain

While the anatomical structure of the spine is truly a marvel in terms of its form and function, many interconnected and overlapping structures in the spine can produce back pain. Moreover, the spine is highly prone to injury because it is subject to many strong forces: twisting, sudden jolts, and daily stresses (such as sitting too much, poor posture). Common anatomical causes of back pain include:

  • The large nerve roots that go to the legs and arms may be irritated
  • The smaller nerves in the discs may be irritated
  • The large paired back muscles that support the spine may be strained
  • Any of the bones, ligaments, or joints throughout the spine may be injured

The underlying cause of pain may be hard to identify

There is a lot of overlap of nerve supply to most of the anatomical structures in the spine (discs, muscles, ligaments, etc.), which often makes it impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury. For this reason, your physician will first take a thorough medical history and physical exam, discuss your symptoms and may conduct diagnostic tests (such as an X-ray or MRI scan) to try to distinguish the underlying condition causing your pain.

Description of your pain is important

The type way you describe your pain, the area of distribution of the pain, and any related symptoms are important to determine a back-pain diagnosis, and the treatments will usually be different depending on the diagnosis. Three common classifications of back pain include:

  • Axial pain: Also called mechanical pain, axial pain may be described in a number of ways, such as sharp or dull, constant or comes and goes, etc. A muscle strain is a common cause of axial pain.
  • Referred pain: Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example, in the lower back degenerative disc disease may cause referred pain to the hips and posterior thighs.
  • Radicular pain: Often described as deep and searing pain, radicular pain follows the path of the nerve into the arm or leg and may be accompanied by numbness or weakness. This type of pain is caused by compression, inflammation and/or injury to a spinal nerve root. Other terms for radicular pain are sciatica or radiculopathy, and can be caused by conditions such as a herniated disc or spinal stenosis, or spondylolisthesis.

If no anatomical reason is found, your pain is still real

Frequently, even after many tests and doctor visits, there may be no apparent anatomical cause for your back pain. If this is the case, the pain still needs to be treated and there are a variety of nonsurgical care option that can help alleviate or manage the pain. Also, for many people psychological factors, such as depression and sleeplessness, will often make the pain worse and need to be included as part of a comprehensive treatment program.

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