If you have lower back pain, you are not alone. Nearly everyone
at some point has back pain that interferes with work, routine daily
activities, or recreation. Americans spend at least $50 billion each
year on low back pain, the most common cause of job-related
disability and a leading contributor to missed work. Back pain is
the second most common neurological ailment in the United States —
only headache is more common. Fortunately, most occurrences of low
back pain go away within a few days. Others take much longer to
resolve or lead to more serious conditions.
Acute or short-term low back pain generally lasts from a
few days to a few weeks. Most acute back pain is mechanical in
nature — the result of trauma to the lower back or a disorder such
as arthritis. Pain from trauma may be caused by a sports injury,
work around the house or in the garden, or a sudden jolt such as a
car accident or other stress on spinal bones and tissues. Symptoms
may range from muscle ache to shooting or stabbing pain, limited
flexibility and/or range of motion, or an inability to stand
straight. Occasionally, pain felt in one part of the body may
“radiate” from a disorder or injury elsewhere in the body. Some
acute pain syndromes can become more serious if left untreated.
Chronic back pain is measured by duration — pain that
persists for more than 3 months is considered chronic. It is often
progressive and the cause can be difficult to determine.
The back is an intricate structure of bones, muscles, and other
tissues that form the posterior part of the body’s trunk, from the
neck to the pelvis. The centerpiece is the spinal column, which not
only supports the upper body’s weight but houses and protects the
spinal cord — the delicate nervous system structure that carries
signals that control the body’s movements and convey its sensations.
Stacked on top of one another are more than 30 bones — the vertebrae
— that form the spinal column, also known as the spine. Each of
these bones contains a roundish hole that, when stacked in register
with all the others, creates a channel that surrounds the spinal
cord. The spinal cord descends from the base of the brain and
extends in the adult to just below the rib cage. Small nerves
(“roots”) enter and emerge from the spinal cord through spaces
between the vertebrae. Because the bones of the spinal column
continue growing long after the spinal cord reaches its full length
in early childhood, the nerve roots to the lower back and legs
extend many inches down the spinal column before exiting. This large
bundle of nerve roots was dubbed by early anatomists as the cauda
equina, or horse’s tail. The spaces between the vertebrae are
maintained by round, spongy pads of cartilage called intervertebral
discs that allow for flexibility in the lower back and act much like
shock absorbers throughout the spinal column to cushion the bones as
the body moves. Bands of tissue known as ligaments and tendons hold
the vertebrae in place and attach the muscles to the spinal
column.
Starting at the top, the spine has four regions:
- the seven cervical or neck vertebrae (labeled C1–C7),
- the 12 thoracic or upper back vertebrae (labeled T1–T12),
- the five lumbar vertebrae (labeled L1–L5), which we know as
the lower back, and
- the sacrum and coccyx, a group of bones fused together at the
base of the spine.
The lumbar region of the back, where most back pain is felt,
supports the weight of the upper body.
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As people age, bone strength and muscle elasticity and tone tend
to decrease. The discs begin to lose fluid and flexibility, which
decreases their ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts something too
heavy or overstretches, causing a sprain, strain, or spasm in one of
the muscles or ligaments in the back. If the spine becomes overly
strained or compressed, a disc may rupture or bulge outward. This
rupture may put pressure on one of the more than 50 nerves rooted to
the spinal cord that control body movements and transmit signals
from the body to the brain. When these nerve roots become compressed
or irritated, back pain results.
Low back pain may reflect nerve or muscle irritation or bone
lesions. Most low back pain follows injury or trauma to the back,
but pain may also be caused by degenerative conditions such as
arthritis or disc disease, osteoporosis or other bone diseases,
viral infections, irritation to joints and discs, or congenital
abnormalities in the spine. Obesity, smoking, weight gain during
pregnancy, stress, poor physical condition, posture inappropriate
for the activity being performed, and poor sleeping position also
may contribute to low back pain. Additionally, scar tissue created
when the injured back heals itself does not have the strength or
flexibility of normal tissue. Buildup of scar tissue from repeated
injuries eventually weakens the back and can lead to more serious
injury.
Occasionally, low back pain may indicate a more serious medical
problem. Pain accompanied by fever or loss of bowel or bladder
control, pain when coughing, and progressive weakness in the legs
may indicate a pinched nerve or other serious condition. People with
diabetes may have severe back pain or pain radiating down the leg
related to neuropathy. People with these symptoms should contact a
doctor immediately to help prevent permanent damage.
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Nearly everyone has low back pain sometime. Men and women are
equally affected. It occurs most often between ages 30 and 50, due
in part to the aging process but also as a result of sedentary life
styles with too little (sometimes punctuated by too much) exercise.
The risk of experiencing low back pain from disc disease or spinal
degeneration increases with age.
Low back pain unrelated to injury or other known cause is unusual
in pre-teen children. However, a backpack overloaded with
schoolbooks and supplies can quickly strain the back and cause
muscle fatigue. The U.S. Consumer Product Safety Commission
estimates that more than 13,260 injuries related to backpacks were
treated at doctors’ offices, clinics, and emergency rooms in the
year 2000. To avoid back strain, children carrying backpacks should
bend both knees when lifting heavy packs, visit their locker or desk
between classes to lighten loads or replace books, or purchase a
backpack or airline tote on wheels.
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Conditions that may cause low back pain and require treatment by
a physician or other health specialist include:
Bulging disc (also called protruding, herniated, or ruptured
disc). The intervertebral discs are under constant pressure. As
discs degenerate and weaken, cartilage can bulge or be pushed into
the space containing the spinal cord or a nerve root, causing pain.
Studies have shown that most herniated discs occur in the lower,
lumbar portion of the spinal column.
A much more serious complication of a ruptured disc is cauda
equina syndrome, which occurs when disc material is pushed into
the spinal canal and compresses the bundle of lumbar and sacral
nerve roots. Permanent neurological damage may result if this
syndrome is left untreated.
Sciatica is a condition in which a herniated or ruptured
disc presses on the sciatic nerve, the large nerve that extends down
the spinal column to its exit point in the pelvis and carries nerve
fibers to the leg. This compression causes shock-like or burning low
back pain combined with pain through the buttocks and down one leg
to below the knee, occasionally reaching the foot. In the most
extreme cases, when the nerve is pinched between the disc and an
adjacent bone, the symptoms involve not pain but numbness and some
loss of motor control over the leg due to interruption of nerve
signaling. The condition may also be caused by a tumor, cyst,
metastatic disease, or degeneration of the sciatic nerve root.
Spinal degeneration from disc wear and tear can lead to a
narrowing of the spinal canal. A person with spinal degeneration may
experience stiffness in the back upon awakening or may feel pain
after walking or standing for a long time.
Spinal stenosis related to congenital narrowing of the
bony canal predisposes some people to pain related to disc
disease.
Osteoporosis is a metabolic bone disease marked by
progressive decrease in bone density and strength. Fracture of
brittle, porous bones in the spine and hips results when the body
fails to produce new bone and/or absorbs too much existing bone.
Women are four times more likely than men to develop
osteoporosis. Caucasian women of northern European heritage
are at the highest risk of developing the condition.
Skeletal irregularities produce strain on the vertebrae
and supporting muscles, tendons, ligaments, and tissues supported by
spinal column. These irregularities include scoliosis, a
curving of the spine to the side; kyphosis, in which the
normal curve of the upper back is severely rounded; lordosis,
an abnormally accentuated arch in the lower back; back
extension, a bending backward of the spine; and back
flexion, in which the spine bends forward.
Fibromyalgia is a chronic disorder characterized by
widespread musculoskeletal pain, fatigue, and multiple “tender
points,” particularly in the neck, spine, shoulders, and hips.
Additional symptoms may include sleep disturbances, morning
stiffness, and anxiety.
Spondylitis refers to chronic back pain and stiffness
caused by a severe infection to or inflammation of the spinal
joints. Other painful inflammations in the lower back include
osteomyelitis (infection in the bones of the spine) and
sacroiliitis (inflammation in the sacroiliac joints).
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A thorough medical history and physical exam can usually identify
any dangerous conditions or family history that may be associated
with the pain. The patient describes the onset, site, and severity
of the pain; duration of symptoms and any limitations in movement;
and history of previous episodes or any health conditions that might
be related to the pain. The physician will examine the back and
conduct neurologic tests to determine the cause of pain and
appropriate treatment. Blood tests may also be ordered. Imaging
tests may be necessary to diagnose tumors or other possible sources
of the pain.
A variety of diagnostic methods are available to confirm the
cause of low back pain:
X-ray imaging includes conventional and enhanced methods
that can help diagnose the cause and site of back pain. A
conventional x-ray, often the first imaging technique used,
looks for broken bones or an injured vertebra. A technician passes a
concentrated beam of low-dose ionized radiation through the back and
takes pictures that, within minutes, clearly show the bony structure
and any vertebral misalignment or fractures. Tissue masses such as
injured muscles and ligaments or painful conditions such as a
bulging disc are not visible on conventional x-rays. This fast,
noninvasive, painless procedure is usually performed in a doctor’s
office or at a clinic.
Discography involves the injection of a special contrast
dye into a spinal disc thought to be causing low back pain. The dye
outlines the damaged areas on x-rays taken following the injection.
This procedure is often suggested for patients who are considering
lumbar surgery or whose pain has not responded to conventional
treatments. Myelograms also enhance the diagnostic imaging of
an x-ray. In this procedure, the contrast dye is injected into the
spinal canal, allowing spinal cord and nerve compression caused by
herniated discs or fractures to be seen on an x-ray.
Computerized tomography (CT) is a quick and painless
process used when disc rupture, spinal stenosis, or damage to
vertebrae is suspected as a cause of low back pain. X-rays are
passed through the body at various angles and are detected by a
computerized scanner to produce two-dimensional slices (1 mm each)
of internal structures of the back. This diagnostic exam is
generally conducted at an imaging center or hospital.
Magnetic resonance imaging (MRI) is used to evaluate the
lumbar region for bone degeneration or injury or disease in tissues
and nerves, muscles, ligaments, and blood vessels. MRI scanning
equipment creates a magnetic field around the body strong enough to
temporarily realign water molecules in the tissues. Radio waves are
then passed through the body to detect the “relaxation” of the
molecules back to a random alignment and trigger a resonance signal
at different angles within the body. A computer processes this
resonance into either a three-dimensional picture or a
two-dimensional “slice” of the tissue being scanned, and
differentiates between bone, soft tissues and fluid-filled spaces by
their water content and structural properties. This noninvasive
procedure is often used to identify a condition requiring prompt
surgical treatment.
Electrodiagnostic procedures include electromyography
(EMG), nerve conduction studies, and evoked potential (EP) studies.
EMG assesses the electrical activity in a nerve and can detect if
muscle weakness results from injury or a problem with the nerves
that control the muscles. Very fine needles are inserted in muscles
to measure electrical activity transmitted from the brain or spinal
cord to a particular area of the body. With nerve conduction studies
the doctor uses two sets of electrodes (similar to those used during
an electrocardiogram) that are placed on the skin over the muscles.
The first set gives the patient a mild shock to stimulate the nerve
that runs to a particular muscle. The second set of electrodes is
used to make a recording of the nerve’s electrical signals, and from
this information the doctor can determine if there is nerve damage.
EP tests also involve two sets of electrodes — one set to stimulate
a sensory nerve and the other set on the scalp to record the speed
of nerve signal transmissions to the brain.
Bone scans are used to diagnose and monitor infection,
fracture, or disorders in the bone. A small amount of radioactive
material is injected into the bloodstream and will collect in the
bones, particularly in areas with some abnormality.
Scanner-generated images are sent to a computer to identify specific
areas of irregular bone metabolism or abnormal blood flow, as well
as to measure levels of joint disease.
Thermography involves the use of infrared sensing devices to
measure small temperature changes between the two sides of the body
or the temperature of a specific organ. Thermography may be used to
detect the presence or absence of nerve root compression.
Ultrasound imaging, also called ultrasound scanning or
sonography, uses high-frequency sound waves to obtain images inside
the body. The sound wave echoes are recorded and displayed as a
real-time visual image. Ultrasound imaging can show tears in
ligaments, muscles, tendons, and other soft tissue masses in the
back.
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Most low back pain can be treated without surgery. Treatment
involves using analgesics, reducing inflammation, restoring proper
function and strength to the back, and preventing recurrence of the
injury. Most patients with back pain recover without residual
functional loss. Patients should contact a doctor if there is not a
noticeable reduction in pain and inflammation after 72 hours of
self-care.
Although ice and heat (the use of cold and hot compresses)
have never been scientifically proven to quickly resolve low back
injury, compresses may help reduce pain and inflammation and allow
greater mobility for some individuals. As soon as possible following
trauma, patients should apply a cold pack or a cold compress (such
as a bag of ice or bag of frozen vegetables wrapped in a towel) to
the tender spot several times a day for up to 20 minutes. After 2 to
3 days of cold treatment, they should then apply heat (such as a
heating lamp or hot pad) for brief periods to relax muscles and
increase blood flow. Warm baths may also help relax muscles.
Patients should avoid sleeping on a heating pad, which can cause
burns and lead to additional tissue damage.
Bed rest — 1–2 days at most. A 1996 Finnish study found
that persons who continued their activities without bed rest
following onset of low back pain appeared to have better back
flexibility than those who rested in bed for a week. Other studies
suggest that bed rest alone may make back pain worse and can lead to
secondary complications such as depression, decreased muscle tone,
and blood clots in the legs. Patients should resume activities as
soon as possible. At night or during rest, patients should lie on
one side, with a pillow between the knees (some doctors suggest
resting on the back and putting a pillow beneath the knees).
Exercise may be the most effective way to speed recovery
from low back pain and help strengthen back and abdominal muscles.
Maintaining and building muscle strength is particularly important
for persons with skeletal irregularities. Doctors and physical
therapists can provide a list of gentle exercises that help keep
muscles moving and speed the recovery process. A routine of
back-healthy activities may include stretching exercises, swimming,
walking, and movement therapy to improve coordination and develop
proper posture and muscle balance. Yoga is another way to gently
stretch muscles and ease pain. Any mild discomfort felt at the start
of these exercises should disappear as muscles become stronger. But
if pain is more than mild and lasts more than 15 minutes during
exercise, patients should stop exercising and contact a doctor.
Medications are often used to treat acute and chronic low
back pain. Effective pain relief may involve a combination of
prescription drugs and over-the-counter remedies. Patients should
always check with a doctor before taking drugs for pain relief.
Certain medicines, even those sold over the counter, are unsafe
during pregnancy, may conflict with other medications, may cause
side effects including drowsiness, or may lead to liver damage.
- Over-the-counter analgesics, including nonsteroidal
anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are
taken orally to reduce stiffness, swelling, and inflammation and
to ease mild to moderate low back pain. Counter-irritants
applied topically to the skin as a cream or spray stimulate the
nerve endings in the skin to provide feelings of warmth or cold
and dull the sense of pain. Topical analgesics can also reduce
inflammation and stimulate blood flow. Many of these compounds
contain salicylates, the same ingredient found in oral pain
medications containing aspirin.
- Anticonvulsants — drugs primarily used to treat
seizures — may be useful in treating certain types of nerve pain
and may also be prescribed with analgesics.
- Some antidepressants, particularly tricyclic
antidepressants such as amitriptyline and desipramine, have been
shown to relieve pain (independent of their effect on depression)
and assist with sleep. Antidepressants alter levels of brain
chemicals to elevate mood and dull pain signals. Many of the new
antidepressants, such as the selective serotonin reuptake
inhibitors, are being studied for their effectiveness in pain
relief.
- Opioids such as codeine, oxycodone, hydrocodone, and
morphine are often prescribed to manage severe acute and chronic
back pain but should be used only for a short period of time and
under a physician’s supervision. Side effects can include
drowsiness, decreased reaction time, impaired judgment, and
potential for addiction. Many specialists are convinced that
chronic use of these drugs is detrimental to the back pain
patient, adding to depression and even increasing pain.
Spinal manipulation is literally a “hands-on” approach in
which trained specialists (such as chiropractors, osteopaths, and
massage therapists) use leverage and a series of exercises to adjust
spinal structures and restore back mobility. These specialists do
not prescribe drugs or use surgery in their treatment of low back
pain.
When back pain does not respond to more conventional approaches,
patients may consider the following options:
Acupuncture involves the insertion of needles the width of
a human hair along precise points throughout the body. Practitioners
believe this process triggers the release of naturally occurring
painkilling molecules called peptides and keeps the body’s normal
flow of energy unblocked. Clinical studies are measuring the
effectiveness of acupuncture in comparison to more conventional
procedures in the treatment of acute low back pain.
Biofeedback is used to treat many acute pain problems,
most notably back pain and headache. Using a special electronic
machine, the patient is trained to become aware of, to follow, and
to gain control over certain bodily functions, including muscle
tension, heart rate, and skin temperature (by controlling local
blood flow patterns). The patient can then learn to effect a change
in his or her response to pain, for example, by using relaxation
techniques. Biofeedback is often used in combination with other
treatment methods, generally without side effects.
Interventional therapy can ease chronic pain by blocking
nerve conduction between specific areas of the body and the brain.
Approaches range from injections of local anesthetics, steroids, or
narcotics into affected soft tissues, joints, or nerve roots to more
complex nerve blocks and spinal cord stimulation. When extreme pain
is involved, low doses of drugs may be administered by catheter
directly into the spinal cord. Chronic use of steroid injections may
lead to increased functional impairment.
Traction involves the use of weights to apply constant or
intermittent force to gradually “pull” the skeletal structure into
better alignment. Traction is not recommended for treating acute low
back symptoms.
Transcutaneous electrical nerve stimulation (TENS) is
administered by a battery-powered device that sends mild electric
pulses along nerve fibers to block pain signals to the brain. Small
electrodes placed on the skin at or near the site of pain generate
nerve impulses that block incoming pain signals from the peripheral
nerves. TENS may also help stimulate the brain’s production of
endorphins (chemicals that have pain-relieving properties).
Ultrasound is a noninvasive therapy used to warm the
body’s internal tissues, which causes muscles to relax. Sound waves
pass through the skin and into the injured muscles and other soft
tissues.
Minimally invasive outpatient treatments to seal fractures of the
vertebrae caused by osteoporosis include vertebroplasty and
kyphoplasty. Vertebroplasty uses three-dimensional imaging to
help a doctor guide a fine needle into the vertebral body. A
glue-like epoxy is injected, which quickly hardens to stabilize and
strengthen the bone and provide immediate pain relief. In
kyphoplasty, prior to injecting the epoxy, a special balloon is
inserted and gently inflated to restore height to the bone and
reduce spinal deformity.
In the most serious cases, when the condition does not respond to
other therapies, surgery may relieve pain caused by back problems or
serious musculoskeletal injuries. Some surgical procedures may be
performed in a doctor’s office under local anesthesia, while others
require hospitalization. It may be months following surgery before
the patient is fully healed, and he or she may suffer permanent loss
of flexibility. Since invasive back surgery is not always
successful, it should be performed only in patients with progressive
neurologic disease or damage to the peripheral nerves.
- Discectomy is one of the more common ways to remove
pressure on a nerve root from a bulging disc or bone spur. During
the procedure the surgeon takes out a small piece of the lamina
(the arched bony roof of the spinal canal) to remove the
obstruction below.
- Foraminotomy is an operation that “cleans out” or
enlarges the bony hole (foramen) where a nerve root exits
the spinal canal. Bulging discs or joints thickened with age can
cause narrowing of the space through which the spinal nerve exits
and can press on the nerve, resulting in pain, numbness, and
weakness in an arm or leg. Small pieces of bone over the nerve are
removed through a small slit, allowing the surgeon to cut away the
blockage and relieve the pressure on the nerve.
- IntraDiscal Electrothermal Therapy (IDET) uses thermal
energy to treat pain resulting from a cracked or bulging spinal
disc. A special needle is inserted via a catheter into the disc
and heated to a high temperature for up to 20 minutes. The heat
thickens and seals the disc wall and reduces inner disc bulge and
irritation of the spinal nerve.
- Nucleoplasty uses radiofrequency energy to treat
patients with low back pain from contained, or mildly herniated,
discs. Guided by x-ray imaging, a wand-like instrument is inserted
through a needle into the disc to create a channel that allows
inner disc material to be removed. The wand then heats and shrinks
the tissue, sealing the disc wall. Several channels are made
depending on how much disc material needs to be removed.
- Radiofrequency lesioning is a procedure using
electrical impulses to interrupt nerve conduction (including the
conduction of pain signals) for 6 to12 months. Using x-ray
guidance, a special needle is inserted into nerve tissue in the
affected area. Tissue surrounding the needle tip is heated for
90-120 seconds, resulting in localized destruction of the nerves.
- Spinal fusion is used to strengthen the spine and
prevent painful movements. The spinal disc(s) between two or more
vertebrae is removed and the adjacent vertebrae are “fused” by
bone grafts and/or metal devices secured by screws. Spinal fusion
may result in some loss of flexibility in the spine and requires a
long recovery period to allow the bone grafts to grow and fuse the
vertebrae together.
- Spinal laminectomy (also known as spinal decompression)
involves the removal of the lamina (usually both sides) to
increase the size of the spinal canal and relieve pressure on the
spinal cord and nerve roots.
Other surgical procedures to relieve severe chronic pain include
rhizotomy, in which the nerve root close to where it enters
the spinal cord is cut to block nerve transmission and all senses
from the area of the body experiencing pain; cordotomy, where
bundles of nerve fibers on one or both sides of the spinal cord are
intentionally severed to stop the transmission of pain signals to
the brain; and dorsal root entry zone operation, or DREZ, in
which spinal neurons transmitting the patient’s pain are destroyed
surgically.
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Recurring back pain resulting from improper body mechanics or
other nontraumatic causes is often preventable. A combination of
exercises that don't jolt or strain the back, maintaining correct
posture, and lifting objects properly can help prevent injuries.
Many work-related injuries are caused or aggravated by stressors
such as heavy lifting, contact stress (repeated or constant contact
between soft body tissue and a hard or sharp object, such as resting
a wrist against the edge of a hard desk or repeated tasks using a
hammering motion), vibration, repetitive motion, and awkward
posture. Applying ergonomic principles — designing furniture and
tools to protect the body from injury — at home and in the workplace
can greatly reduce the risk of back injury and help maintain a
healthy back. More companies and homebuilders are promoting
ergonomically designed tools, products, workstations, and living
space to reduce the risk of musculoskeletal injury and pain.
The use of wide elastic belts that can be tightened to “pull in”
lumbar and abdominal muscles to prevent low back pain remains
controversial. A landmark study of the use of lumbar support or
abdominal support belts worn by persons who lift or move merchandise
found no evidence that the belts reduce back injury or back pain.
The 2-year study, reported by the National Institute for
Occupational Safety and Health (NIOSH) in December 2000, found no
statistically significant difference in either the incidence of
workers’ compensation claims for job-related back injuries or the
incidence of self-reported pain among workers who reported they wore
back belts daily compared to those workers who reported never using
back belts or reported using them only once or twice a month.
Although there have been anecdotal case reports of injury
reduction among workers using back belts, many companies that have
back belt programs also have training and ergonomic awareness
programs. The reported injury reduction may be related to a
combination of these or other factors.
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Following any period of prolonged inactivity, begin a program of
regular low-impact exercises. Speed walking, swimming, or stationary
bike riding 30 minutes a day can increase muscle strength and
flexibility. Yoga can also help stretch and strengthen muscles and
improve posture. Ask your physician or orthopedist for a list of
low-impact exercises appropriate for your age and designed to
strengthen lower back and abdominal muscles.
- Always stretch before exercise or other strenuous physical
activity.
- Don’t slouch when standing or sitting. When standing, keep
your weight balanced on your feet. Your back supports weight most
easily when curvature is reduced.
- At home or work, make sure your work surface is at a
comfortable height for you.
- Sit in a chair with good lumbar support and proper position
and height for the task. Keep your shoulders back. Switch sitting
positions often and periodically walk around the office or gently
stretch muscles to relieve tension. A pillow or rolled-up towel
placed behind the small of your back can provide some lumbar
support. If you must sit for a long period of time, rest your feet
on a low stool or a stack of books.
- Wear comfortable, low-heeled shoes.
- Sleep on your side to reduce any curve in your spine. Always
sleep on a firm surface.
- Ask for help when transferring an ill or injured family member
from a reclining to a sitting position or when moving the patient
from a chair to a bed.
- Don’t try to lift objects too heavy for you. Lift with your
knees, pull in your stomach muscles, and keep your head down and
in line with your straight back. Keep the object close to your
body. Do not twist when lifting.
- Maintain proper nutrition and diet to reduce and prevent
excessive weight, especially weight around the waistline that
taxes lower back muscles. A diet with sufficient daily intake of
calcium, phosphorus, and vitamin D helps to promote new bone
growth.
- If you smoke, quit. Smoking reduces blood flow to the lower
spine and causes the spinal discs to degenerate.
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The National Institute of Neurological Disorders and Stroke, a
component of the National Institutes of Health (NIH) within the U.S.
Department of Health and Human Services, is the nation’s leading
federal funder of research on disorders of the brain and nervous
system and one of the primary NIH components that supports research
on pain and pain mechanisms. Other institutes at NIH that support
pain research include the National Institute of Dental and
Craniofacial Research, the National Cancer Institute, the National
Institute on Drug Abuse, the National Institute of Mental Health,
the National Center for Complementary and Alternative Medicine, and
the National Institute of Arthritis and Musculoskeletal and Skin
Diseases. Additionally, other federal organizations, such as the
Department of Veterans Affairs and the Centers for Disease Control
and Prevention, conduct studies on low back pain.
Scientists are examining the use of different drugs to
effectively treat back pain, in particular daily pain that has
lasted at least 6 months. Other studies are comparing different
health care approaches to the management of acute low back pain
(standard care versus chiropractic, acupuncture, or massage
therapy). These studies are measuring symptom relief, restoration of
function, and patient satisfaction. Other research is comparing
standard surgical treatments to the most commonly used standard
nonsurgical treatments to measure changes in health-related quality
of life among patients suffering from spinal stenosis. NIH-funded
research at the Consortial Center for Chiropractic Research
encourages the development of high-quality chiropractic projects.
The Center also encourages collaboration between basic and clinical
scientists and between the conventional and chiropractic medical
communities.
Other researchers are studying whether low-dose radiation can decrease scarring
around the spinal cord and improve the results of surgery. Still others are
exploring why spinal cord injury and other neurological changes lead to an
increased sensitivity to pain or a decreased pain threshold (where normally
non-painful sensations are perceived as painful, a class of symptoms called
neuropathic pain), and how fractures of the spine and their repair
affect the spinal canal and intervertebral foramena (openings around the spinal
roots).
Also under study for patients with degenerative disc disease is
artificial spinal disc replacement surgery. The damaged disc is
removed and a metal and plastic disc about the size of a quarter is
inserted into the spine. Ideal candidates for disc replacement
surgery are persons between the ages of 20 and 60 who have only one
degenerating disc, do not have a systemic bone disease such as
osteoporosis, have not had previous back surgery, and have failed to
respond to other forms of nonsurgical treatment. Compared to other
forms of back surgery, recovery from this form of surgery appears to
be shorter and the procedure has fewer complications.
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The following organizations have information on lower back
pain:
American Academy of Neurological
and Orthopaedic Surgeons
American Association of Neurological
Surgeons
American Academy of Orthopaedic
Surgeons
American Academy of Physical
Medicine and Rehabilitation
American Academy of Family
Physicians
American Chiropractic
Association
American Chronic Pain Association
(ACPA)
American Pain Foundation
National Institute of Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse
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Anxiety Disorders
