There are many types of arthritis & relative conditions which affect the muscles, joints and/or bones which can cause problems like swelling, stiffness & pain within the back region. Although, any portion of the back can get affected, lower back is the most common site of back pain relating to arthritis & most likely simply because it bears more body weight. The two main common types of back pain include the mechanical & the inflammatory. The largest group of mechanical back pain includes osteoarthritis, spinal stenosis, degenerative disc disease, injuries, disc lesions, strains, sprains & fractures of bones secondary to osteoporosis. After this, the second largest group is inflammatory back pain. This is generally caused by diseases like polymyalgia theumatica, enteropathic arthritis, psoriatic arthritis, ankylosing spondylitis & some other forms of arthritis. Moreover, some people also have back pain which arises from inflammation in soft tissues within the back & not within the spine. Several people also experience back pain because of the sciatic nerve, which runs through the buttocks & is sometimes inflamed in order to cause hip & back pain. Having scoliosis is another reason for people having back pain. Spine is found to twist to one side instead of running straight up the center of back in this condition. Moreover, a small number of people also develop infections or tumors within the spine so as to cause back pain. Back pain is one of the most common health problems in United States with more than 80 percent of the people reporting having had back pain at some time or the other within their life time. Back pain is also found to occur at any age for both, men & women.
Signs & Symptoms of Back Pain
When people have had a severe injury or fall or when their back pain is accompanied by any of the following symptoms, it is time that they seek an immediate appointment with the doctor.
- Pain which does not improve when they lie on their back
- Numbness, pain or weakness in one or both legs
- Unexplained fever
- Unintentional weight loss
- Having pain or difficulty while urinating
Causes of Back Pain
Most back pain is caused due to sprain, strain or an injury which affects muscles or ligaments of the spine. Only a relatively small percentage of back pain is caused due to one of the various other forms of arthritis like polymyalgia rheumatic, enteropathic arthritis, psoriatic arthritis, ankylosing spondylitis, osteoarthritis, spinal stenosis or degenerative disc disease.
- Sprains & Strains – When ligaments in the back region are torn or severely strained, most often due to sudden injury, results can be painful. Pain of sprains can be severe & localized to a single spot in the back or more generalized to all back region including areas nearby.
- Spasms – Many a times, overworked muscles in the back region go into spasms. Spasms are basically painful involuntary contractions. While they are painful, they are a natural way of the body which is designed to protect itself from the underlying problem. When muscles are in a state of spasm, they generally become rigid & painful. This in fact is a natural process which temporarily restricts the person from using or damaging them any further.
- Herniated or Ruptured Discs – Hard outer coverings can rupture when discs are weakened. This will eventually allow the squishy center to bulge out & cause irritation & pressure on nerves located close-by.
- Vertebral Fractures – These fractures of the vertebrae are sometimes caused by trauma. However, most often they result from osteoporosis which is general weakening of the vertebrae & which causes them to crumble. Medically, these are known as compression fractures.
- Other Causes of Pain – Quite often pain may occur following a period of strenuous activity, or even after a period of inactivity, like lying in bed for an extended period of time due to illness or other causes. Sometimes, being overweight can also add strain on the back region & stomach muscles so as to cause these muscles to stretch & weaken. Moreover, lack of support can also lead to poor posture & which can easily shift the body out of balance & eventually cause or worsen back pain. This pain may at times be a result of poor posture, regardless of how much weight a person is carrying. Stress may also be a factor in some cases due to the fact that people react to stress in different ways. Many people are found to tighten their back muscles whenever they are tense or worried & which can often make existing back pain problems go worse.
- Pain from Outside the Back Region – Quite often back pain is found to result from problems which are not located in the back region. Some of the possible causes of this kind of pain include the following.
- Kidney Infections or Kidney Stones – Since kidneys are located in the lower back region, any problems with the kidneys will generally be felt as back pain.
- Pregnancy – Weight gain resulting from pregnancy can stretch the back so as to cause stress & eventually weaken muscles which support the spine.
- Obesity – Being obese or overweight, especially when excessive weight is carried within the abdomen, would place additional stress on back muscles & eventually cause back pain.
- Endometriosis – This is basically a condition where tissue lining the uterus (endometrial tissue) migrates from uterus in order to deposit on other structures & organs. This pain resulting from endometriosis is quite often felt within the abdomen & back region.
- Aortic Aneurysms – This only happens in rare cases where the aorta, or the body’s main artery originating in the heart & running down the body just in front of spine, develops an aneurysm. Aneurysms are basically balloon-like swellings within the muscular wall of the arteries. In case of wall ruptures or when compression of blood vessels is caused which run off it, can result in pain which is felt within the chest, abdomen and/or lower back region. This will turn out to be a medical emergency requiring immediate treatment.
- Tumors – Although this happens in rare cases, tumors which are either cancerous (malignant) or noncancerous (benign) can affect tissue of nearby areas like spine & thereby cause pain.
Diagnosing Back Pain
Primary healthcare doctors can effectively evaluate & also be able to treat most cases of back pain. For this purpose, they will evaluate the health history of the patient, conduct a physical examination & possibly include diagnostic tests which will be utilized to make a proper diagnosis.
- Health History & Physical Examination – Doctors will collect information regarding the health history & symptoms of the patient alongside conducting a physical examination. Answers to questions mentioned below will eventually help the diagnostic process.
- When did pain first appear?
- What was the reason of origin of pain?
- Where is pain located?
- What, if anything, makes pain better or worse?
- How does it feel to lie on the back with knees bent?
- Which treatments, including over the counter drugs & nutritional supplements, have you been using?
- Are you having any other health problems?
Doctors will generally check the posture of patients during physical examination & also look for problems like the curvature of spine. They may also ask patients to stand & walk in order to determine if back pain is affecting in the manner which they walk (gait), or if the awkward gait is resulting from arthritis in knee or hip, or leg-length discrepancy which may eventually be contributing to back pain. Doctors may also ask patients to move, bend or change position in order to see if any particular position or activity is making pain worse. Doctors will also press on different parts of the body during physical examination, including parts where patients may not be aware of causing pain, so as to check for tender painful areas which are characteristic of fibromyalgia & trigger point areas of the body which when pressed cause pain elsewhere, in order to locate the basic source of pain.
- Diagnostic Tests – In case doctors need more information, patients may have to undergo one or more of the following tests. However, many of these tests are rarely required for most of the routine cases of back pain.
- Blood Tests – Finding a specific genetic marker known as HLA-B27 in blood for people with arthritis of spine can help doctors identify possible diagnosis of spondylarthropathy causing back pain. Reactive arthritis of ankylosing spondylitis are best examples of this disease. Although this genetic marker is more common among people with these diseases, it is also found among perfectly healthy people. It is for this reason that a positive HLA-B27 test is performed, but this does not anyway mean that the patient is having these diseases. Tests of fluid drawn from joints with help of a needle can also reveal crystals of uric acid which can confirm diagnosis of gout or a bacterium which suggests that joint inflammation is being caused by an infection.
- Lower Body Nerve Evaluation – For this purpose doctors run a device known as a pinwheel along the skin, from the feet to the hips, in order to check for any areas which are either abnormally sensitive or insensitive to stimulus & which would eventually suggest possible nerve involvement
- Muscle Strength Evaluation – This test enables doctors check the strength of different muscle groups within the lower body in order to detect possible nerve problems. Since different nerves supply different muscle groups, weakened muscle groups would suggest damage to nerves which supply specific group of muscles.
- Sciatic Nerve Stretch Test – Through this test doctors would be able to determine whether stretching the sciatic nerve is causing any pain. This could suggest any possible nerve-root involvement for back pain.
- X-Rays – Most cases of back pain which are occurring for short duration will not require patients to undergo X-ray imaging tests. However, these are most helpful when doctors suspect that back pain is resulting from inflammation, infection, arthritis, or from a tumor, or in cases where back pain symptoms are severe.
- CT scan – MRI & Bone Scans – Magnetic resonance imaging, computerized tomography or bone scans are usually unnecessary so as to diagnose acute lower back pain, but they are often very useful in determining the underlying cause of chronic back pain. Moreover, CT scans can help doctors visualize if there is any degenerated or ruptured disc, tumors, spinal stenosis or infections of spine. MRI images can also provide clear pictures of soft tissues & bone structures like tendons, ligaments, cartilage, muscles & blood vessels. In fact this is the best test for detecting whether there is any pressure on nerves or the spinal cord which is causing back pain. Lastly, bone scans are also often used for detecting infections or cases of bone inflammation.
- Myelogram – A special contrast dye is injected into the spinal canal & subsequently X-rays of the area are taken in a myelogram test. This test can effectively give more information about the cause of back pain which is better than a picture obtained through a MRI or CT scans.
- Electromyography – This is basically a nerve test which is utilized to determine whether electrical activity of nerves is disrupted as a result of problems occurring in the spinal region.
Treatment Options for Back Pain
Self-care & over the counter medications are all that is required for most instances of back pain. Moreover, treatment plan will follow for the specific type of arthritis in case back pain is caused for arthritis.
- Analgesics – Analgesics are primarily drugs which relieve pain, but not inflammation. Most common over-the-counter analgesic drug includes acetaminophen. Most of these drugs are available as pills or topical like sprays, rubs, patches, gels & creams. Topical analgesics are often are found to contain other ingredients apart from acetaminophen. These include at least one of the following.
- Salicylates – This includes aspirin which inhibits pain & inflanmmation by stimulating proper blood flow to tissues.
- Counterirritants – Common examples include eucalyptus oil, oil of wintergreen, menthol and/or camphor which cause feeling of cold or warmth, thereby distracting attention from actual pain.
- Capsaicin – This generally works by reducing amount of substance P. Substance P is a chemical which sends signals of pain to brain.
Topical analgesics should not however be used with heat therapy as they can also cause burns. However, whenever required, doctors can also prescribe a stronger analgesic.
- NSAIDs – Also called non-steroidal anti-inflammatory drugs, NSAIDs like aspirin, naproxen & ibuprofen can help reduce inflammation while reducing pain as well. Doctors may also prescribe a stronger NSAID when it is necessary. Selective COX-2 inhibitor celecoxib may prove to be safer for the stomach & less likely to cause ulcers when compared to other NSAIDs. However, there are concerns about increased risk of cardiovascular problems when patients are taking NSAIDs. It would be sensible to let the doctor know when a patient is having high blood pressure or heart disease before starting these medications. Patients must therefore also talk to the doctors about all risks which are associated with using any OTC medicine for back pain.
- Surgery – People with spinal stenosis, sciatica or tumors located within the spinal cord may require surgery in order to relieve pressure on nerves or spinal cord. Otherwise, surgery is not normally recommended to relieve pain. Spine specialists can help patients decide if an operation for back pain is necessary.
- Self-Care for Back Pain – Using natural & alternative therapies for maintaining good posture, losing weight by getting exercise & relieving stress are different ways which are basically designed to lose weight.
- Posture – Maintaining good posture can definitely help patients with back pain reduce stress & ease discomfort from the back region. Some techniques which they can try are listed below.
- When Sitting
- Keep stomach muscles pulled in while maintaining proper curve in lower back. Back pain patients can do this by tightening stomach & buttocks.
- Back pain patients can place a small cushion behind lower back region in order to help maintain natural curve of the back portion.
- Patients with back pain should keep their knees slightly higher than hips. They can for this purpose use a book or footstool under their feet if required.
- Back pain patients should not sit for long periods of time. They should periodically stand up & move around in order to stretch tightened muscles & give them a chance to relax.
- When Standing
- Patients with back pain should stand with their weight equally distributed on both feet.
- They should also place one foot on footstool in order to ease tension in the back region.
- Back pain patients should wear flat or low-heeled shoes when they are standing for long periods of time.
- They should also keep their backs straight by tightening the buttocks & stomach muscles while doing a pelvic tilt.
- When Lifting & Carrying Objects
- They should bend & lift objects using knees & legs instead of using the back muscles.
- Back pain patients should hold objects close to them.
- They must also straighten their legs in order to lift the object.
- Patients with back pain must seek help for lifting objects which are too heavy.
- When Sleeping
- It would be ideal for back pain patients to sleep on firm mattresses.
- They should place a pillow between knees while sleeping on the sides.
- People with back pain should not sleep on their stomach.
- Back pain patients who are not having any knee problems should try placing a pillow under knees when they are lying on their backs.
- Heat & Cold Therapy – Heat can quite often help relieve back pain by relaxing muscles & soothing painful areas within 48 hours after the pain has begun. Some of these safe & effective options include hydromassage, warm-water therapy, heating pads, heat wraps, hot water bottles, warm compresses & hot showers or baths. Moreover, warming the muscles at first may also make it easier for back pain patients to perform back exercises in case they are having arthritis. Quite often, healthcare professionals also recommend applying cold to back region, especially when pain is acute or severe, or after exercising.
- Exercise – There are a number of stretching & flexibility exercises which can help to alleviate pressure on back so as to loosen tightness in muscles. Tai chi & yoga are some good examples. However, back pain patients must make sure to talk to doctors before they begin any exercise program.
- Weight Loss – Doctors commonly recommend weight loss as one ideal way to reduce back pain & improving general health. However, best way to lose body weight is by eating a balanced diet & regular exercising. Patients must however be sensible to avoid fad diets & must not take recourse to quick weight-loss programs.
- Natural & Alternative Therapies – Acupuncture can also provide relief from back pain. Practice of acupuncture involves inserting fine metal needles into the patient’s skin at specific points, however not necessarily into areas which bother patients. Like stimulating acupuncture treatment points in feet can effectively relieve back pain. Patients must ensure that they are being treated by a certified acupuncturist. Massage is another great way for reducing back pain. This can be done under the guidance of a massage therapist or some physical therapists also providing this service. Licensed chiropractors can also provide spinal manipulation which can help patients with back pain. However, it is sensible to be aware that this procedure should not be provided to individuals suffering from inflammatory back pain like ankylosing spondylitis. Spinal manipulation of neck region is also potentially dangerous, especially among older patients who are having increased risk of stroke.
- Stress Relief – Here are some methods which can reduce daily stress which is causing tightening of shoulder & back muscles & worsening pain.
- Soaking in a hot tub, warm bath or spa.
- Getting involved in a pleasing hobby.
- Performing therapeutic exercises like tai chi or yoga after seeking permission from the doctor.
- Fun & relaxing activities with friends or family.
- Accepting what cannot be changed instead of constantly cribbing & feeling frustrated.
- Consider seeking professional help for problems which are difficult to handle.
- When Sitting
- Posture – Maintaining good posture can definitely help patients with back pain reduce stress & ease discomfort from the back region. Some techniques which they can try are listed below.
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