Back Pain: Symptoms, Causes, and Management

Older people are not the only ones who suffer from backache and discomfort. Although most back pain-related issues are a result of aging and deterioration of some structures in the back, young people are not entirely exempt from this problem.

The spine consists of vertebrae (bones) stacked on top of each other, with discs between vertebrae and muscles and ligaments to support them. With several joints running down the length of the spine, the spinal cord itself passes through the vertebrae. The tailbone, at the end of the spine, is made of bones that have been fused together.

Back pain is a leading cause of limited activity and absence from work due to sickness across the world. It is estimated that about 84% of all individuals across the world have experienced backache at some time in their life. Based on the duration, it can be classified as acute, chronic, or sub-acute. 

• Acute back pain generally lasts for less than four weeks 
• Subacute back pain usually lasts between four to twelve weeks 
• Chronic back pain can last for twelve or more weeks

Treatment may differ based on the cause and type of pain.

Are you at risk?

The risk tends to get higher as you grow older. People who often push, pull, or lift heavy items without the right technique are also at risk of developing back pain. Other factors that can put you at a higher risk include:

• Physical inactivity
• Having a bad posture; not sitting and standing straight
• Being overweight
• Lifting weights by assuming the wrong posture
• If you are a smoker
• If you have been in an accident, such as falls, car crashes
• Health conditions like arthritis
• Pregnancy

What are the causes?

Most cases may not have an apparent cause and are referred to as mechanical pain or non-specific back pain. It may stem from any bones, joints, or soft tissues within or around the spine.  It can have a sudden or gradual onset. Depending on how you position yourself, pain may get better, or worsen; though it is the worst when you move.

1. Mechanical pain can arise while performing everyday activities like bending, improper posture while working at the desk, or lifting weights or slouching while watching TV. Lack of exercise can cause muscle weakness and stiffening of the spine leading to pain.  

2. Sports injuries, road traffic accidents, falls from a height, and direct trauma to the back can cause back pain of varying degrees. 

3. A herniated or slipped disc is a condition, where one or more discs present between the vertebrae of the spine push out. A slipped disc may also cause numbness, tingling, or weakness in other parts.

4. Sciatica is a disorder that is caused by irritation of the sciatic nerve, which extends from the lower back to the feet. It may cause pain, along with numbness, tingling and weakness in the lower back, legs, and feet.

5. Ankylosing spondylitis can cause stiffness and pain in the spine due to swelling of the joints of the spine. In this condition, pain tends to be worse in the morning and may feel better with movement.

6. Tuberculosis of the spine (Pott’s spine) and cancers like multiple myeloma are also common causes of backaches.

7. Use of steroid medications over a long period of time may weaken the vertebrae and lead to significant bone loss. It could make an individual prone to fractures, causing severe backaches.

How can you prevent it?

There are several ways to prevent back pain.

Stay active: It is important to stay physically active. Ensure that you exercise for at least 150 minutes every week. It is essential to include exercises and stretches to strengthen your back muscles. Yoga is another way to strengthen your muscles and improve your posture.

Maintain good posture: In some cases, backache can be prevented by maintaining good posture. Sit up and stand straight; avoid slouching. If you sit for long hours, make sure that you take occasional breaks.

Also read: Bad Posture: Tips and Exercises to Get It Right

Lift carefully: While lifting things, use your legs, not your back. Maintain your back in a straight position and bend either at the knees or hips. Avoid lifting items that are too heavy.

Vitamin D: In conditions like osteoporosis, weak bones can become fragile and prone to fractures, even with minor accidents. Adequate vitamin D levels can help maintain healthy bones. 

Healthy weight: Being overweight can put more strain on your back. So a healthy body weight can reduce the risk of back pain.

Supportive Mattress: A medium-firm mattress is considered to be a sound option for optimum back support.

What you can do to manage it

If you suffer from back pain despite all precautions, there are some steps that will help you.

1. Rest is essential or it might worsen the symptoms. So, try to remain active, perform your regular activities, but also rest adequately

2. Make a note of the activities that worsen the symptoms and avoid those as much as possible

3. You can apply cold or hot compression to the affected area

4. Some physical activities that can help include exercises and stretches targeted at the back muscles, walking, yoga, and Pilates

5. Sleeping on your back is recommended in upper and lower back pain as the weight gets distributed through the length of the spine. Keeping a pillow under the knees can help maintain the natural curve of the spine. If you prefer sleeping on your side, you can place a pillow between your knees; this will help keep your lower spine aligned with your hips and relieve any stress on your lower spine

6. Over-the-counter painkillers may help but it is advisable to consult a physician and avoid self-medication.

7. If you are a smoker, you need to quit. Nicotine is believed to heighten pain and delay healing. 

8. Chronic back pain can cause irritability, depression, and other emotional strains. Meditation and yoga can help you relax and calm your mind

Red flags: When should you see a doctor

Many times, the condition resolves on its own. However, it is advisable to seek medical attention in instances like:

• Persistent backache
• Pain that gets worse, especially at night, despite rest and self-care measures
• Pain that gets worse while sneezing, coughing, or while emptying the bowels
• If the symptoms are severe enough to interfere with your daily activities 
• If back pain is the result of a serious accident
• The pain arises from the region between your shoulders as opposed to your lower back
• Numbness or loss of function of fingers or any limb along with the pain, urinary, or fecal incontinence
• If back pain is a new symptom in any cancer patient
• If you feel reduced sensation in the anal region especially while wiping or washing the region — a sign called saddle anesthesia
• In rare instances, when back pain may be accompanied by other symptoms like chest pain, fever, unintentional weight loss, trouble sleeping, or change in sexual functions like the inability to get an erection

Treatment

In some cases, back pain may persist even after home care methods or it may occur with other symptoms, due to an underlying cause. In such cases, you must seek medical assistance. Treatments include:

1. Medications: Prescription and over-the-counter medications can help relieve pain and other associated symptoms. Painkillers in the form of cream, gel or salves, muscle relaxants may also be recommended. Other medicines like narcotics or antidepressants can also help in some cases.

2. Physical therapy: In physical therapy, exercises to strengthen your back and abdominal muscles and to improve your flexibility and posture may be suggested. These must be done under a licensed physiotherapist’s supervision because the exercise regimen will be designed according to the individual’s symptoms and fitness levels. These include stretching, flexibility exercises, routines to strengthen your core, correct your posture, and aerobic conditioning sets. 

3. Injections: Steroids and nerve blocks can provide relief. However, these are not preferred long-term solutions and are often used along with other treatment methods.

4. Other non-surgical treatments: These include massages, laser therapy, nerve ablation, biofeedback therapy etc, where devices are used to gain conscious control over body functions that are usually under the automatic control of the body. Electrical nerve stimulation, which involves low voltage electrical current is also used to relieve pain.

5. Surgery: In rare cases, when all other options have failed, or in cases of serious injuries, surgical intervention may be required.

Most cases can be prevented or managed through simple measures. These may not prevent the problem entirely but can help reduce frequency and aid recovery.

References
1. What Should I Know About Back Pain? Versus Arthritis. https://www.versusarthritis.org/about-arthritis/conditions/back-pain/ (accessed Feb 8, 2021).
2. Back Pain. NHS. https://www.nhs.uk/conditions/back-pain/causes/ (accessed Feb 8, 2021).
3. Barnsley L. Back Pain. In Sambrook P, Schrieber L, Taylor T, Ellis Am, eds. The Musculoskeletal System. Churchill Livingstone, 2010; 47–59.
4. Prevent Back Pain. Health.gov. https://health.gov/myhealthfinder/topics/everyday-healthy-living/safety/prevent-back-pain (accessed Feb 8, 2021).
5. Back Pain. NHS. https://www.nhs.uk/conditions/back-pain/treatment/ (accessed Feb 8, 2021).
6. Transcutaneous Electrical Nerve Stimulation (TENS). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens (accessed Feb 8, 2021).
7. 7 Ways to Treat Chronic Back Pain Without Surgery. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/7-ways-to-treat-chronic-back-pain-without-surgery (accessed Feb 8, 2021).
8. Likarish N. What Is the Best Sleeping Position for Restful Sleep? Sleep.org. https://www.sleep.org/best-sleep-position/  (accessed Mar 18, 2021).
9. Back pain – Treatment. https://www.nhs.uk/conditions/back-pain/treatment/ (accessed Mar 18, 2021).
10. George M. The Best Sleeping Position for Your Back Pain. Spine Health. 2019; published Dec 20. https://www.spine-health.com/blog/best-sleeping-position-your-back-pain#vh_footnotes (accessed Mar 18, 2021).
11. Back pain. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906 (accessed Mar 18, 2021).
12. Chou R. Subacute and chronic low back pain: Nonsurgical interventional treatment. UpToDate. https://www.uptodate.com/contents/subacute-and-chronic-low-back-pain-nonsurgical-interventional-treatment/print#:~:text=The%20long%2Dterm%20outcome%20of,for%2012%20or%20more%20weeks (accessed Mar 18, 2021).
13. Pillay S. The psychology of low back pain. Harvard Health Publishing. 2016; published online Apr 25. https://www.health.harvard.edu/blog/psychology-low-back-pain-201604259537 (accessed Mar 18, 2021).
14. Samanta J, Kendall J, Samanta A. Chronic low back pain. BMJ 2003; 326: 535.
15 Low back pain. WHO. https://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf (accessed Mar 18, 2021).