Back pain is one of the most common reasons people visit their doctor. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 8 out of 10 people have some type of backache.
Back pain can be acute, subacute, or chronic.
- Acute back pain develops suddenly and lasts up to several weeks. Acute pain is the most common type of back pain.
- Subacute back pain is pain that lasts up to 3 months.
- Chronic back pain can begin abruptly or gradually, but it lasts longer than 3 months.
Back pain can occur in any area of the back, but it is more common in the lower back, which supports most of the body’s weight.
The back is highly complex, and pain may result from damage or injury to any of its various bones, nerves, muscles, ligaments, and other structures. Still, despite sophisticated techniques, which provide detailed anatomical images of the spine and other tissues, the cause of most cases of back pain remains unknown.
Vertebrae. The spine is a column of small bones, or vertebrae, that support the entire upper body. The column is grouped into three sections:
- The cervical (C) vertebrae are the seven spinal bones that support the neck.
- The thoracic (T) vertebrae are the twelve spinal bones that connect to the rib cage.
- The lumbar (L) vertebrae are the five lowest and largest bones of the spinal column. Most of the body’s weight and stress falls on the lumbar vertebrae.
Below the lumbar region is the sacrum, a shield-shaped bony structure that connects with the pelvis at the sacroiliac joints.
At the end of the sacrum are two to four tiny, partially fused vertebrae known as the coccyx, or “tail bone.”
Each vertebra is designated by using a letter and number, allowing the doctor to determine where it is in the spine.
The letter reflects the spinal region where the vertebra is located:
- C=cervical (neck region)
- T= thoracic (chest, or middle back, region)
- L=lumbar (lower back)
The number signifies the vertebra’s place within that spinal region. The numbers start with 1 at the top of a region and count up as the vertebrae descend within the region. For example, C4 is the fourth bone down in the cervical region, and T8 is the eighth thoracic vertebrae.
The Discs. Vertebrae in the spinal column are separated from each other by small cushions of cartilage known as intervertebral discs. The discs have no blood supply of their own. They rely on nearby blood vessels to keep them nourished.
Each disc is 80% water and contains two structures.
- Inside each disc is a jelly-like substance called the nucleus pulposus.
- The nucleus pulposus is surrounded by a tough, fibrous ring called the annulus.
Processes. Each vertebra in the spine has a number of bony projections called processes. The spinous and transverse processes attach to the muscles in the back and act like little levers, allowing the spine to twist or bend. The particular processes form the joints between the vertebrae themselves, meeting together and interlocking at the zygapophysial joints (more commonly known as facet, or z-joints).
Spinal Canal. Each vertebra and its processes surround and protect an arch-shaped central opening. These arches, aligned to run down the spine, form the spinal canal, which encloses the spinal cord.
Spinal Cord. The spinal cord is the central trunk of nerves that connects the brain with the rest of the body. Each nerve root passes from the spinal column to other parts of the body through small openings, bounded on one side by the disc and on the other by the facets. When the spinal cord reaches the lumbar region, it splits into four bundled strands of nerve roots called the cauda equina (meaning horsetail in Latin).
Symptoms and Causes
The origin of the pain is often unknown, and imaging studies may fail to determine its cause. Disc disease, spinal arthritis, and muscle spasms are the most common diagnoses.
Psychological and Social Factors for a Speedy Recovery
Psychological factors are known to play a strong influential role in three phases of low back pain:
Some evidence suggests preexisting depression and the inability to cope may be more likely to predict the onset of pain than physical problems. A “passive” coping style (not wanting to confront problems) was strongly associated with the risk of developing disabling neck or low back pain.
Social and psychological factors, as well as job satisfaction, all play a role in the severity of a person’s perception of back pain. For example, one study compared truck drivers and bus drivers. Nearly all the truck drivers liked their work. Half of them reported low back pain but only 24% lost time at work. Bus drivers, on the other hand, reported much lower job satisfaction than truck drivers, and these workers with back pain had a significantly higher absentee rate than truck drivers in spite of less stress on their backs. Similarly, another study found that pilots, who generally reported “loving their jobs,” reported far fewer back problems than their flight crews. And yet another study reported that low rank, low social support, and high stress in soldiers was associated with a higher risk for disabling back pain.
Depression and a tendency to develop physical complaints in response to stress also increase the likelihood that acute back pain will become a chronic condition. The way a patient perceives and copes with pain at the beginning of an acute attack may actually condition the patient to either recover or develop a chronic condition. Those who over-respond to pain and fear for their long-term outlook tend to feel out of control and become discouraged, increasing their risk for long-term problems.
Studies also suggest that patients who reported prolonged emotional distress have less favorable outcomes after back surgeries. It should be strongly noted that the presence of psychological factors in no way diminishes the reality of the pain and its disabling effects. Recognising this presence as a strong player in many cases of low back pain, however, can help determine the full range of treatment options.
Find out more…
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