Rapid Orthopedic Care

Back Pain

Back pain is among the most common reasons for visits to urgent care, doctors offices, and emergency rooms. It is the leading cause of disability, and is a major cause of missed work days.

Most episodes of back pain can be treated with excellent results. It is important to learn how to prevent back pain problems from getting worse, and avoid activities that increase stress on the back, while engaging in activities that strengthen the back and lower the risk of re-injury. This is an important balancing act for many who suffer chronic back pain. Surgery for back pain is usually not necessary unless the symptoms become very severe and lead to loss of normal function.

Symptoms of Back Pain

Back pain symptoms can vary depending upon the location in the back that is hurting. Lower back pain, the most common type of back pain, is often described as a shooting, burning or stabbing sensation. In some cases, lower back pain may radiate into one or both legs. Depending upon the source of back pain, it can worsen with bending, twisting, lifting, standing or walking. Some forms of back pain are even worse in the sitting position.

Causes of Back Pain

Back pain, especially lower back pain, often happens without a specific injury. It is very common for lower back pain to occur during activities that are not particularly strenuous. It is also possible for back pain to follow excessive lifting, twisting or bending. Upper back pain (thoracic pain), usually occurs for a more specific reason.

Back pain can result from muscle strains, bulging  or “herniated” discs, flare-ups of spinal arthritis, or from more specific conditions associated with inflammatory or bone problems. Examples of specific problems include a fractured vertebra (bone in the back) from osteoporosis, and inflammation of the sacroiliac joints (the part of the lower back connected to the pelvis) due to connective tissue disease (inflammatory back pain).

Risk factors for Back Pain

Anyone can develop back pain, even children and teens. The more common risk factors include:

• Back pain is more common over age 30.
• Lack of exercise.Deconditioning, or weakness of the muscles that support the trunk and back.
• Obesity is a possible risk factor for back pain, but the relationship is not quite as clear as it is for lower extremity arthritis (hip, knee).
• Medical conditions.Some medical conditions and cancers are frequently associated with chronic pain in the back. Examples include Ankylosis Spondylitis, Chronic Renal Disease, and Multiple Myeloma.
• Activity-related.Posture changes, and lifting techniques are linked to some types of back pain problems.
• Psychological conditions.Anxiety, depression, and other psychological problems can significantly enhance the experience of back pain. This is due to the brain’s interconnections between pain and emotional processing.
• Chronic smoking affects inflammation, oxygen delivery, and bone metabolism in manners which increase the risk of having more difficulties with back pain  .

Prevention of Back Pain

Exercise and learning how to use your back properly in daily activities are believed to be the most important ways to prevent back pain.

To keep your back healthy and strong:

• Cardiovascular exercise.Exercises that do not result in rapid changes in your back’s position and impact on the discs in the back are believed to be better than high impact exercises for those with back pain. For example, swimming and walking are better choices than running and jumping if you have trouble with back pain.
• Core Strengthening exercise.The muscles in the upper back, lower back, and abdomen help to protect the discs in the back from excessive pressures that can happen even with normal activities. It is believed that strengthening these muscles helps to prevent episodes of back pain from occurring by strengthening the connective tissues that support the discs.
• Achieving and maintaining an ideal body weight is believed to reduce stress on the back, as well as systemic inflammation that may lead to more difficulties with back pain.
• Tobacco cessation.Smoking is likely to increase systemic inflammation and lead to problems with bone health that increases the risk of disc problems and fractures in the back due to osteoporosis. Limiting or stopping smoking is an important part of a back pain prevention program.
• Biomechanical Techniques.Prolong standing can create stress on the back, so frequent weight shifts, sitting breaks, and walking can help relieve the stress on the back. Prolonged sitting also creates stress on the back, by building up pressure in the discs between the vertebrae. Lumbar supports, arm rests, frequent breaks from sitting, and proper leg alignment during long periods of sitting are believed to decrease stress on the back. Lifting with the hips and legs, when possible, while keeping the curvature in the back can reduce the stress caused by heavy lifting.

When should I to go to ROC for back pain?

Most episodes of back pain get better in a few days. If your pain is severe or persistent, then a visit to ROC can help you determine the next steps in diagnosis and treatment. If the pain is going into the hips, buttocks or legs, an evaluation for a pinched or inflamed nerve in the back will be necessary to determine the next best steps for appropriate treatment.

Will ROC be able to perform a back pain diagnosis?

Providers at ROC will examine your back and review your medical history to determine the next best steps for determining the potential cause or causes for you back pain.

What tests may be ordered by ROC to help determine the cause of back pain?

If your history and physical examination results suggest that a specific cause for your back pain can be determined by diagnostic testing, ROC providers can assist in ordering the most appropriate test or tests for your specific situation. These tests include:

• Digital X-ray.These radiology tests can be performed on-site at ROC. X-rays are able to assess the alignment of the spine, the stability of the bones, and whether fractures or the changes of arthritis are present.
• MRI scans.  This is an advanced imaging procedure that is necessary for the diagnosis of conditions that involve the discs in the back, as well as problems with connective tissue and muscle. MRI examinations are also excellent tests to detect rare causes of back pain, such as tumors or infections.
• CT scans.The computed tomography (CT) scan is and advanced X-ray system that can be used to see more details of the bones of the spine, and can also be used to detect rare causes of back pain such as tumors or infections.
• Blood tests.Blood tests are not commonly used for the diagnosis of back pain, but can be used to assess for rare causes of back pain such as infections, and autoimmune diseases.
• Bone scan.In rare cases, a bone scan may be used to look for bone tumors or compression fractures caused by osteoporosis.
• Nerve studies.Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Does ROC provide back pain treatment?

Back pain gets better within a short period of time with minimal treatment. Some people develop more persistent problems with back pain, and a more advanced treatment plan will be required as recommended by a spine specialist. Many people have episodic back pain, which means that have days or weeks when the pain is

Medications

Providers at ROC might recommend the following:

• Over-the-counter (OTC) pain relievers.

• • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), may help relieve back pain by reducing inflammation in the back. Some medical conditions are worsened with these medications, and your ROC provider will discuss your individual recommendations prior to prescribing.
  • Acetaminophen is also available over-the-counter. It can be used in conjunction with NSAIDs or alone, particularly if NSAIDs are well-tolerated or advisable for your situation.

• Muscle relaxants.If the OTC medications do not provide much relief, and muscle spasms are present, your ROC provider might also prescribe a muscle relaxant. Muscle relaxants can cause sedation and increase the risks of falls, so they need to be used very carefully.
• Topical pain relievers.Several pain relieving substances can be administered as creams, salves, ointments or patches. These include local anesthetics (such as lidocaine), menthol, and NSAIDs.
• Drugs such as codeine, hydrocodone, or tramadol may be utilized for more severe pain, depending upon the specific back pain condition. ROC providers due not treat chronic pain, so your prescription will usually provide less than a week’s worth of pills..

Does ROC provide physical therapy?

ROC has access to physical therapy care that can aid in the relief of a back pain episode. ROC physical therapy may include physical therapy modalities (such as transcutaneous nerve stimulation, alpha stimulation, heat, ultrasound) as well as the instruction of exercises to improve flexibility, strength (back and core musculature), and improve posture. Regular use of these techniques can help keep pain from returning. ROC physical therapists can also assess and make recommendations for your regular activities, so that modifications may be made to assist with maintaining your functional status while you recover from back pain.

Does ROC provide surgical and interventional pain management services?

ROC providers can provide direct access the spinal surgical and interventional pain specialists if your back pain does not respond to initial treatments. Our team of experienced physician consulting specialists have extensive experience in the proper diagnostic and treatment of back pain that has become persistent and severe.

When should I go to the Emergency Room instead of ROC for Back Pain?

• If you back pain is also causing weakness, numbness or tingling in one or both legs that is getting worse, an emergency neurological condition could be developing.
• If your back pain is accompanied by unexplained weight loss, fever, chills, or other general symptoms, it could be caused by a malignancy or an infection.
• If your back pain resulted from a fall or direct trauma, and you are unable to bear weight, walk, or turnover in bed, your back could be due to a spinal fracture requiring emergency attention.