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Your aching back

What it means and what to do

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April 23rd, 2013
Back pain
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According to the National Institutes of Health, back pain is one of the most common medical problems in the U.S. In any three-month period, up to 25% of adults experience some form of back pain lasting at least one day. In older adults, the prevalence of back pain is about 70%.

Common types of back pain

“Back pain can be acute, which means lasting four weeks or less, or chronic, which lasts greater than 12 weeks,” says Cheryl Ziemba, M.D., medical director at Cedar Crest, an Erickson Living community in Pompton Plains, N.J. “Anything in-between is called subacute back pain.”

Back pain can occur in the neck or in the upper, middle, or lower back. It can feel sharp, dull, throbbing, aching, or cramping. “Lumbago, or acute lower back pain, is the fifth most common reason that people see a doctor,” Ziemba says. “It’s usually related to muscle strain—lifting or moving something heavy or some other strenuous activity. Exertion may also lead to vertebral compression fractures, especially in people with osteoporosis.”

“Displaced or herniated discs also cause acute pain,” Ziemba continues. “This can cause pain that moves down the leg—what some people call sciatica.”

“Chronic pain can come from spinal stenosis, which is when the spinal column narrows and puts pressure on the nerves,” she adds.

Other diseases and conditions can contribute to back pain. “About 95% of older adults have osteoarthritis in their back but that doesn’t necessarily mean it’s what’s causing pain,” says Judith Kahn, M.D., a physiatrist and consultant with Workmen’s Circle MultiCare Center, in Bronx, N.Y. “But osteoarthritis may worsen because deteriorated discs cause joints to rub together. That can lead to displacement of the vertebrae themselves, which is called spondylolisthesis.”

Osteoarthritis in other parts of the body can lead to back problems. “Arthritis in your legs may cause one leg to become shorter than the other. This can lead to scoliosis, or curvature of the spine,” Kahn explains. Back pain can also be caused by conditions that have nothing to do with bones. “Fibromyalgia is widespread tissue pain that can affect back muscles,” Kahn says.

Warning signs

Back pain can be a symptom of something very serious, such as a vertebral bone infection (osteomyelitis) or, more rarely, a tumor. “Pain can be referred from other regions of the body by traveling along the nerves,” Ziemba says. “Conditions that may cause this include kidney stones, a blood clot in the lung, pneumonia, or even a heart attack.”

“It’s a red flag if you have a fever, weakness, weight loss, a cough, difficulty urinating, or pain that radiates from your back,” Ziemba advises. “Pain after a fall or other injury should also be evaluated right away.”

Prevention and treatment

Prevention is always best. Although some causes of pain may be inevitable, you may be able to lessen it if it occurs by exercising regularly. Good nutrition, including foods that contain calcium and vitamin D, can keep your bones and muscles strong.

Practice good posture and body mechanics. Keep your back straight when lifting and let your legs do the work. But avoid back braces. “Back braces weaken your muscles,” Kahn says. “They shouldn’t be used unless ordered by a doctor.”

Back pain treatment depends on the cause. “For most back pain, over-the-counter pain relievers such as ibuprofen and acetaminophen are sufficient,” Kahn says. “Some people may also need prescription medications.”

Older adults should consult their doctors if they use ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs. “These drugs can affect the kidneys or cause bleeding,” Ziemba says. “Take the lowest recommended dose and follow your doctor’s guidance.”

“Some prescription drugs can cause drowsiness, so you have to be especially careful with balance and take measures to avoid falls,” Kahn says. Reducing clutter, removing loose rugs, having good lighting, wearing sturdy shoes, and using grab bars can help.

Topical treatments such as hot or cold packs, creams, or ointments are options. “Some of these are available as prescriptions and are quite safe,” Kahn says. “The most frequent side effect is skin irritation.”

Get out of bed

“Bed rest used to be prescribed for back pain, but now we know that activity is best. Rest can lead to muscle weakness, which makes the healing period longer,” Ziemba says.

“To get your muscle strength back, it takes two days to make up for every day you stay in bed,” Kahn adds.

A recent study showed that a simple walking program relieved chronic lower back pain as well as formal muscle-strengthening programs. “Pilates, yoga, tai chi, and even chair classes are also good ways to treat pain,” Kahn says. “Any activity should be started only with your doctor’s guidance.”

Physical therapy can often help. “A therapist can teach you how to strengthen your muscles and improve flexibility,” Kahn says.

Surgery and alternative treatments

Several types of injections to areas of the back are available to relieve pain, although some of these techniques have been found to have little long-term value. Surgery may also be an option for some people. “If conservative treatments don’t work, age alone shouldn’t determine your eligibility for back surgery,” Kahn says. “Recovery may be more difficult, however, depending on your health.”

“Surgery can relieve pain quickly, especially for sciatica, spinal stenosis, and spondylolisthesis,” Kahn says. “There is no evidence, however, that the long-term outcome is any better than if surgery wasn’t performed in the first place.”

Some people find chiropractic services, acupuncture, acupressure, massage, or transcutaneous electrical nerve stimulation to be effective. Although these treatments don’t necessarily cure the underlying reason for pain, they may help relieve muscle tension and stress.

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