| name: | Backache |
| also known as: | Low Back Pain; Lower Back Pain; Back Ache; Back Stiffness; Lumbar Strain; Lumbar Sprain; Lumbago; Herniated Nucleus Pulposis; HNP; ICD 724.5 |
| also see: | Sciatica; Laminectomy; Lower Back Strain; Mid Back Strain; Back Sprain; Sacroiliac Back Sprain; Ruptured Disk Disease; Acute Kidney Infection; Urinary Tract Infection; Upper Back Pain; Cauda Equina Syndrome; Spinal Stenosis |
| description: | Most causes of backache are from muscle sprain and strain such as injury or overuse and is also called mechanical low back pain. Mechanical low back pain is caused by muscle sprain, ligamentous strain, and normal aging process. The pain and injury is often the result of mechanical stresses and mechanical demands. Causes include injury, lifting too heavy of objects or lifting with the back, not with the knees, as well as improper movement such as twisting, sleeping on a hard bed, or sleeping in an awkward position. Risk is increased with obesity, poor conditioning, previous back injury. Mechanical low back pain is a diagnosis of exclusion and should be distinguished from other causes of backache, such as swollen, slipped, or ruptured disk disease, pinched nerve or sciatica, arthritis, urinary tract infection, acute kidney infection, bone degeneration, osteoporosis, menstrual cramps, PMS. Factors or modulators that can make back pain worse include stress, anxiety, depression. |
| signs & symptoms: | Intermittent or continuous back pain and stiffness, made worse with movement, relieved with rest. There is radicular pain down the leg, bowel and bladder function preserved, and no leg numbness. With sciatica which is a different problem, pain can radiate into and down the leg. Nerve impingement can lead to numbness, tingling, weakness, and bowel and bladder problems. |
| diagnosis: | Based on signs, symptoms, history, exam and x-rays. In severe or chronic cases, a CT Scan or MRI Scan is indicated. Occasionally, a myelogram is obtained. Other studies might include blood count, rheumatoid factor, ANA profile, sedimentation rate, EMG. |
| treatment: | In uncomplicated lower back aches, treatment consists mostly of rest, cold packs, hot packs, massage, and pain relief medicines, such as naproxen or ibuprofen, or other NSAID. Complicated lower back pain usually requires prescribed medical treatment, such as physical therapy, narcotics, muscle relaxants and possibly surgery, depending upon the cause of the back pain. A bulging disc or nerve impingement sciatica might need an operation called a laminectomy. Injection of trigger points, such as with a local anesthetic, or with steroids can afford some relief. Referral to a physical therapist should not be performed until routine x-rays and possibly a CT scan or MRI scan is done in order to exclude significant bone or disc disease that can be made worse with physical therapy. Chronic back pain, greater than 6 weeks, is sometimes treated with tricyclic antidepressants or some of the antiseizure drugs such as carbamazepine or gabapentin Self care measures might include learning yoga, performing back exercises as can be taught by a physical therapist, walking and low impact exercise, heating pad or warm compresses, correct posture, reevaluating the state of the mattress (not too soft, not too hard), and losing weight. Willow bark is an herb that contains natural salicylate (aspirin) and can help back pain sufferers. |
| prevention: | Bend at the knees when lifting rather than bending at the waist, lift with the legs, not the back, don't twist when lifting, don't lift too heavy of objects, and don't lift over the head. |
| outcome: | Although treatment will greatly improve the symptoms, back pain and problems tend to recur. |
skynetMD suggests the following:
| if: | If the person has lower back pain that came on suddenly, radiates across the entire back, was not preceded by an injury, of, if the pain began in the chest and moved to the back, of, if there is weakness and numbness of the legs, feet, toes immediately after an injury, or, if there is loss of bowel and/or bladder function |
| go to: | Go to the hospital for emergency care |
| if: | If the pain came on all of the sudden and the person is over 60, or, if the pain is severe and not the result of an injury, and has lasted more than 5 days, or, if there is weakness and numbness of the legs, feet and toes, or, does the pain travel down the back of the leg (sciatica), does it hurt with movement or straining, or has the person loss control of their bladder, or, is the pain associated with fever, chills, nausea, vomiting and pain and frequency of urination and blood in the urine, or, is the back pain associated with joint pain, swelling and cracking |
| go to: | Go to the doctor |
| if: | If the person has a lower backache, and is under the care of a doctor, and does not have symptoms as outlined above, they should rest flat of their back on a hard mattress for 3-5 days, use ice packs 20-30 minutes out of each hour for the first 3 days, followed by, warm packs (hot compresses) after the first 3-5 days in order to promote blood flow and healing, and |
| go to: | Go to the pharmacy an ice bag, heating pad, a back support (unisex girdle) and aspirin (if older than 19 years), ibuprofen or naproxen. Acetaminophen is good for pain and fever, but not swelling. |
| if: | If the person would like a back pain Internet Resource |
| go to: | Go to American college of Rheumatology www.rheumatology.org/patients/factsheets.html |
Last updated 7/18/2009