Back Pain

These include the following:

• Age: Increasing age raises your risk of developing back pain due to decreased bone strength and muscle tone. Discs can lose their flexibility and deteriorate with age causing less cushioning between the vertebrae.
  
• Physical Fitness: Inactive lifestyle and lack of exercise can lead to weight problems and obesity causing stress on the spine. When back and abdominal muscles are not strong enough to support the spine, back pain can occur.
  
• Smoking: Although smoking is not a direct cause of back pain, smoking affects circulation which can affect the delivery of nutrients to the discs. Chronic coughing from smoking can cause back pain. Also, smokers don’t heal as well as non-smokers which can prolong pain after back injury or surgery.
  
• Occupational Risks: If you are working in a job that involves heavy lifting, pushing, pulling, or frequent twisting of the body, you are at higher risk for developing back pain. If you work at a desk job and have poor posture or sit in an uncomfortable chair all day, back pain can develop.
  
• Genetics: Some painful back conditions may be hereditary such as disc disease and congenital scoliosis.
  
• Diet: An unhealthy diet high in fat and calories can lead to overweight or obesity increasing your risk of developing back pain.
  
• Medical Factors: Certain medical conditions such as osteoarthritis, rheumatoid arthritis, or cancer that has metastasised to the spine can cause back pain. It is important to know back pain is a symptom not a medical diagnosis. Some medical conditions that can cause back pain include:
  
  • Sprain, strain, or spasm to the back muscles or ligaments caused by heavy or improper lifting. This is the most common cause of low back pain and will usually resolve completely in a few weeks.
    
  • Injury or trauma to the back such as in car accidents, sports injuries or falls.
• Degenerative Disc Disease: A condition caused by wear and tear on the discs between the vertebrae causing them to lose their cushioning ability.
  
• Osteoporosis: Weak, porous bones caused by osteoporosis can lead to fractures of the spine.
  
• Arthritis: Degenerative changes from osteoarthritis and ankylosing Spondylitis are associated with back pain.
  
• Herniated Discs: A condition caused by a tear in a disc causing the disc contents to bulge outside of the disc. Symptoms related to herniated discs in the lumbar region include sharp, continuous back pain, weakness in the legs, and some loss of sensation to the leg and foot.
  
• Sciatica: Irritation of the sciatic nerve, one of the large nerves to the legs and thighs, is usually caused by a ruptured or herniated disc compressing the nerve. Sciatica causes pain to the leg and buttock often accompanied by tingling and numbness.
  
• Spondylitis: Infection or inflammation of the spinal joints causing chronic back pain.
  
• Spinal Stenosis: Narrowing of the spinal canal as we age, most commonly due to degenerative arthritis.
  
• Skeletal Conditions: Spine curvatures such as in Scoliosis and Kyphosis
  
• Cauda Equina Syndrome: A very serious compression disorder of the spine. The Cauda Equina is an area at the base of the spinal cord where the nerve roots of all spinal nerves are located. Compression in this area can cause pain and loss of all nerve function below the site of compression and loss of bowel and bladder control. This condition is a surgical emergency requiring immediate decompression of the spinal nerves.
  
• Fibromyalgia: A common condition characterised by chronic body wide pain with localised tender points in muscles, joints, and soft tissues.
  
• Referred Pain: Pain that occurs somewhere else in the body but is experienced in another location, such as in the back. Examples include kidney and bladder infections, ovarian cancer, ovarian cysts, endometriosis, etc.
  
• Psychological Factors: Stress and depression have been associated with increased complaints of back pain.
  
• Tumours: Although spinal tumours are rare, cancer can spread from other parts of the body to the spine causing pain.

Dr Hsu or Dr Singh will take a comprehensive medical history and perform a physical examination. Depending on what the history and exam show, your NSWSS spinal surgeon or your GP may order medical tests to determine the cause of your back pain.

Diagnostic studies may include:

• MRI: magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.
  
• CT scan: This test creates 3D images from multiple x-rays and reveals spinal structures not seen on regular x-ray.
  CT scan with myelogram: a type of medical imaging which is done by injecting contrast medium into the affected area of the spine followed by CT scan of the area that creates 3D images from multiple x-rays.
  
• X-rays: a form of electromagnetic radiation that is used to take pictures of bones.
  
• Electromyogram: a test involving the placement of small needles into the muscles to monitor electrical activity. This test is used to detect the level of nerve root damage related to chronic pain.

Acute back pain, the most common type of back pain, usually gets better on its own. Treatment guidelines for acute back pain include:

• Continue your normal daily activities as much as possible: bed rest is not recommended and in fact can make your pain worse
  
• NSAIDS (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, acetaminophen, can help ease the pain until it resolves
  
• Ice or heat packs, or both, applied to the back can help relieve stiffness and pain.
  
• Sleeping with a pillow between the knees while lying on your side or placing a pillow under your knees while sleeping on your back may help alleviate back pain.
  
• Exercise or surgery is not recommended for acute back pain

Chronic back pain is pain that lasts for several weeks or more. Treatment guidelines for chronic back pain include:

• Referral to a Physiotherapist or Sport Physician to instruct you on exercises to strengthen your trunk and back muscles.
  
• Medications: Dr Hsu, Dr Singh or your GP may prescribe over the counter anti-inflammatory medications such as ibuprofen, Tylenol, etc. For severe pain, you may be prescribed narcotic pain medications, muscle relaxants, anti-depressants, or injections into the back to decrease pain and inflammation. Prescription sleep aids are sometimes prescribed as most chronic pain patients also suffer with sleep disorders.
  
• Therapeutic Massage: Massage by a trained therapist can decrease muscle spasms
  
• Electrical Stimulation: Safe and painless, Transcutaneous electrical nerve stimulation, or TENS, sends a weak electrical current from the skin to the nerve pathways to interrupt pain signals being sent to the brain.
  
• Spine Care Education: your NSWSS spinal surgeon may recommend that you speak with one of our Practice Nurses to learn about posture, exercises, proper body mechanics, and back pain prevention.
  
• Behavioural Modification: Dr Hsu, Dr Singh or your GP may discuss ways for you to change current behaviours which may be affecting your back health. These include quitting smoking, eating healthier, losing weight, and getting regular sleep.

Surgical treatment is rarely the first choice for back pain unless Cauda equina syndrome, a medical emergency, has been diagnosed. Dr Hsu or Dr Singh will likely order conservative treatment methods first as previously described.

Some of the medical diagnoses that may need surgical intervention include:

• Herniated discs
  
• Spinal Stenosis
  
• Spondylolisthesis
  
• Degenerative Disc Disease
  
• Vertebral Fractures

Dr Hsu or Dr Singh will decide which options are best for you depending on your specific circumstances.