Back Pain

Back pain is a very common condition and can affect adults of all ages. Chronic back pain is less common than acute back pain, but it is still widespread.

Back (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.

There are several potential sources and causes of back pain. However, the diagnosis of specific tissues of the spine as the cause of pain presents problems. This is because symptoms arising from different spinal tissues can feel very similar and is difficult to differentiate without the use of invasive diagnostic intervention procedures, such as local anaesthetic blocks.

Common potential sources of back pain are skeletal muscle, facet joints, vertebral disc and nerve roots. Pain arising from muscle tissue is due to muscle strains, spasm and imbalance. Facet joints have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash. Pain arising from disc is mainly due to disc herniation or degenerative disc disease. Nerve roots that are inflamed, irritated or compressed due to disc herniation gives pain going down the leg often called sciatica.

Sometimes the pain is not due to any specific or underlying disease that can be found; in which case it is grouped has non-specific pain. It is thought that the cause may be a sprain (an over-stretch) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small ‘facet’ joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain.

Occasionally pain could be due to more sinister causes like malignancy, fracture, abscess or ankylosing spondylitis and other inflammatory disorders.

Management of back pain is multimodal approach and includes medications, physiotherapy, accupuncture and Injections. Special investigations like blood tests, X-ray, MRI and nerve studies need to be done in few patients to diagnose the problem. Some patients might need procedures like radiofrequency denervation, spinal cord stimulators and thermocoagulation of disc. Surgery is indicated in few patients.