Back pain Classification and external resources
Different regions (curvatures) of the vertebral column
ICD-10	M54.
ICD-9	724.5
DiseasesDB	15544
MeSH	D001416

Back pain (also known "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm "Back" redirects here For other uses please see Back (disambiguation. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the A nerve is an enclosed cable-like bundle of peripheral Axons (the long slender projections of Neurons. Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce A joint is the location at which two or more Bones make contact In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral

The pain may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process 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. The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk In Anatomy, an arm is one of the Upper limbs of an animal The term arm can also be used for analogous structures such as one of the paired upper limbs The hands ( med / lat: manus pl manūs are the two intricate prehensile multi- Fingered body parts normally located at the end of each arm of a A leg is a limb on an Animal 's Body that supports the rest of the animal above the ground between the Ankle and the Hip and is used for The foot is an Anatomical structure found in many Animals It is the terminal portion of a limb which bears weight and allows Locomotion.

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 physician visits. The United States of America —commonly referred to as the Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the Lumbar vertebrae. Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the Lumbar vertebrae. 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. ^[1]

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.

Contents 1 Associated conditions 2 Underlying causes 3 Treatment 3.1 Conservative treatment 3.2 Surgery 3.3 Emerging treatments 3.4 Treatments with uncertain or doubtful benefit 4 See also 5 References 6 External links

Associated conditions

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 bowel and/or bladder incontinence or progressive weakness in the legs. In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the
• Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e. Sleep is a Natural state of bodily rest observed throughout the animal kingdom g. fever, unexplained weight loss) may also indicate a serious underlying medical condition. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid
• Back pain that occurs after a trauma, such as a car accident or fall may indicate a bone fracture or other injury. A bone fracture (sometimes abbreviated # or Fx or Fx) is a medical condition in which a Bone is cracked or broken
• 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. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of

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. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens

A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and 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. Degeneration of the Intervertebral disc, which is often called " degenerative disc disease " (DDD of the spine, is a condition that can be painful and can ^[2][3][4][5] Other studies suggest that for as many as 85% of cases, no physiological cause can be shown. ^[6][7]

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. The term psychosocial refers to one in Psychological development in and interaction with a Social environment. A dysfunctional family is a Family in which Conflict, misbehavior and even Abuse on the part of individual members of the family occur continually leading ^{[8][9][10][11]}

Underlying causes

Muscle strains (pulled muscles) are commonly identified as the cause of back pain, as are muscle imbalances. A strain is an Injury to a Muscle in which the Muscle fibers tear as a result of overstretching. 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.

Another cause of acute low back pain is a meniscoid occlusion. The more mobile regions of the spine, such as the facet joints, have invaginations of their synovial membranes that act as a cushion to help the bones move over each other smoothly. A zygapophysial joint ( zygapophyseal, or facet joint) is a Synovial joint between the superior articular process of one Vertebra and The synovial membrane is well supplied with blood and nerves. When these become pinched or trapped sudden severe pain may result. 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, but no radiculopathy (radiating pain down buttock and leg). Radiculopathy is not a specific condition but rather a description of a problem in which one or more nerves are affected and do not work properly (a Neuropathy) Relief should be felt with flexion (bending forward),and exacerbated with extension (bending backward).

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. Sciatica is a set of symptoms including Pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the Sciatic nerve Diagnosis is the identification by Process of elimination, of the nature of anything 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 (degenerative joint disease) and spinal stenosis,trauma, cancer, infection, fractures, and inflammatory disease[1]. Degeneration of the Intervertebral disc, which is often called " degenerative disc disease " (DDD of the spine, is a condition that can be painful and can Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves Non-anatomical factors can also contribute to or cause back pain, such as stress,^[12] repressed anger,^[13] or depression. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe Even if there is an anatomical cause for the pain, if depression is present it should also be treated concurrently.

New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI and CT scans. Computed tomography (CT is a Medical imaging method employing Tomography. One of the newer investigations looks into the role of the dorsal ramus in patients that have no radiographic abnormalities. The posterior (or dorsal branches (or divisions of the Spinal nerves are as a rule smaller than the anterior divisions See Posterior Rami Syndrome. Posterior Ramus Syndrome, also referred to as Thoracolumbar Junction Syndrome, Maigne Syndrome and Dorsal Ramus Syndrome is caused by the unexplained activation

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 or chronic) is also a determining factor in the choice of treatment. In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course In Medicine, a chronic disease is a Disease that is long-lasting or recurrent 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. Heat therapy is the application of heat to the body for Pain relief and health A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical ^[14] 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 compression therapy (e. Cold Compression Therapy combines two of the principles of RI g. ice or cold pack application) may be effective at relieving back pain in some cases.

• Use of medications, such as muscle relaxants,^[15] narcotics, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs)^[16] or paracetamol (acetaminophen). Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease This article refers to skeletal muscle relaxants For information on Smooth muscle relaxants see Antispasmodic. The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication 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. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical ^[17] Accordingly, a study of intramuscular corticosteroids found no benefit. Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. ^[18]

• Exercises can be an effective approach, particularly when done under supervision of a licensed health professional. 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. ^[19] Another study found that back-mobilizing exercises in acute settings are less effective than continuation of ordinary activities as tolerated. ^[20]

• Physical therapy and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine), often learned with the help of a health professional, such as a physical therapist. The term can also refer to the stretching of Canvas on a frame. Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the Physical therapy may be especially effective when part of a 'work hardening' program, or 'back school'. ^[21]

• Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage. ^[22]

• Body Awareness Therapy such as the Feldenkrais Method has been studied in relation to Fibromyalgia and chronic pain and studies have indicated positive effects. The Feldenkrais Method is an educational system centered on movement aiming to expand and refine the use of the self through awareness Fibromyalgia (FM is a disorder classified by the presence of chronic widespread Pain and tactile Allodynia. ^[23]. Organized exercise programs using these therapies have been developed.

• Manipulation, as provided by an appropriately trained and qualified chiropractor, osteopath, physical therapist, or a physiatrist. Joint manipulation is a type of passive movement of a skeletal Joint. Chiropractic is a Health care profession that focuses on diagnosis treatment and prevention of mechanical disorders of the Musculoskeletal system, with special emphasis Physical medicine and rehabilitation (PM&R or physiatry, is a branch of Medicine dealing with functional restoration of a person affected by physical disability Studies of the effect of manipulation suggest that this approach has a benefit similar to other therapies and superior to placebo. Placebo is a substance or procedure a patient accepts as medicine or therapy but which has no specific therapeutic activity ^[24][25]

• Acupuncture has some proven benefit for back pain. History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as [2]

• Education, and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain. ^[26]

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 that have collapsed due to compression fractures. Degeneration of the Intervertebral disc, which is often called " degenerative disc disease " (DDD of the spine, is a condition that can be painful and can Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves Spondylolisthesis describes the anterior displacement of a Vertebra or the vertebral column in relation to the vertebrae below Scoliosis is a medical condition in which a person's spine is curved from side to side and may also be rotated A compression fracture is a collapse of a Vertebra. It may be due to trauma or due to a weakened vertebra in a patient with Osteoporosis or Osteogenesis Imperfecta Vertebroplasty is a medical procedure where bone cement is percutaneously injected into a fractured Vertebra in order to stabilize it 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. Tumor necrosis factor ( TNF, cachexin or cachectin and formally known as Tumor necrosis factor-alpha) is a Cytokine involved in systemic ^[27]

Treatments with uncertain or doubtful benefit

• Injections, such as epidural steroid injections and facet joint injections, may be effective when the cause of the pain is accurately localized to particular sites. An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through The term epidural is often short for epidural anesthesia, a form of Regional anesthesia involving injection of drugs through a Catheter placed into the The benefit of prolotherapy has not been well-documented. Prolotherapy ("Proliferative Injection Therapy" involves injecting an otherwise non- pharmacological and non- active irritant solution into the body ^[17][28]

• 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. Cold Compression Therapy combines two of the principles of RI 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. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical No conclusions can be drawn about the use of cold for low-back pain"^[14]

• Bed rest is rarely recommended as it can exacerbate symptoms,^[29] 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. Electrotherapy is the use of Electrical energy in the treatment of impairments of health and a conditions of abnormal functioning. Two randomized controlled trials found conflicting results. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare ^[30][31] This has led the Cochrane Collaboration to conclude that there is inconsistent evidence to support use of TENS. The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical ^[32] 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. Spinal Cord Stimulator (SCS or Dorsal Column Stimulator (DCS is an implantable Medical device used to treat chronic pain of neurologic origin

• Inversion therapy is useful for temporary back relief due to the traction method or spreading of the back vertebres through (in this case) gravity. Inversion therapy involves hanging upside down or at an inverted angle with the intention of therapeutic benefits 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.

See also

• Failed back syndrome
• Low back pain
• Posterior Rami Syndrome
• Tension myositis syndrome
• Upper back pain

References

External links

• Back and spine at the Open Directory Project
• Handout on Health: Back Pain at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Back pain, on Medline plus, a service of the National Library of Medicine

The Open Directory Project ( ODP) also known as dmoz (from directory The National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, is an institute of the National Institutes of Health, an agency of the United

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