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Back Pain
Back Pain
Back pain can occur in the neck, thoracic (mid-back), and lower back regions. According to a WHO study, over 619 million people suffer from lower back pain globally, and that number is projected to rise to 813 million by 2025. Lower back pain originates from the lumbar region of the spine. While back pain often has mild causes, prolonged discomfort may signal a risk of more serious conditions. Therefore, it is important to seek medical attention if symptoms persist.


Symptoms
Lower Back Pain (3 types)
- Acute Back Pain: Occurs suddenly and typically lasts from a few days to a few weeks.
- Chronic Back Pain: It can develop either gradually or suddenly and persist for more than 3 months. It often occurs daily.
- Recurrent Back Pain: Patients suffer from pain flares for at least 24 hours, followed by a pain free episode of at least 1 month.
Nerve Root Pain
Additionally, back pain may come with Nerve Root Pain. This refers to pain that travels down the back, also known as Sciatica, with or without weakness in the lower limbs.
In addition to back pain, you may also experience pain radiating down your thighs and legs. This often indicates nerve root irritation and a more serious condition. The radiating pain can extend to the knee, calf, or even down to the foot and may be accompanied by tingling sensations, pins and needles, or sharp, shooting pain.
Causes
Back pain can result from various factors, including:
- Lifestyle Factors: Poor posture, lack of exercise, or prolonged sitting.
- Sports Activities: Intense physical activities that strain the back.
- Posture: Poor posture, especially while sitting or standing for extended periods.
- Recent Falls or Trauma: Injuries or accidents that affect the spine or muscles.
- Straining the Back: From improper handling of heavy items or overexertion.
- Slipped Discs: When the soft tissue between the vertebrae bulges out or ruptures.
- Spinal Canal Narrowing: Known as spinal stenosis, leading to pressure on the spinal cord or nerves.
- Osteoporosis Fractures: Fragile bones in elderly individuals, causing fractures.
- Infections or Tumours: More severe but less common causes of back pain.
Risk Factors
Back Strain: Commonly due to posture issues, bad posture, not careful in lifting heavy items and excessive movement.
Spinal Canal Narrowing: Degenerative conditions.
Osteoporosis: Related to age-related loss of bone density.
Infections: Commonly due to poor immunity.
Tumours: Commonly arise due to cancer found in other parts of the body that may spread to the spine (these are more serious conditions).
Diagnosis
Accurate diagnosis is essential for effective treatment and recovery. Steps include:
- Medical History: A thorough review of symptoms and any previous back issues.
- Physical Examination: To check for pain, range of motion, and reflexes.
- X-rays: Used to evaluate the structure of the spine and detect abnormalities.
- MRI or CT Scans: For detailed imaging of soft tissues, such as discs and nerves, to identify herniations or other conditions.
- Additional Tests: Based on severity, tests like nerve conduction studies may be required to assess nerve function.
Treatments Provided By Us
Surgical
Surgery is only recommended by our doctors when clearly necessary, such as in cases of severe nerve root pain causing dysfunction, like loss of motion or control in the lower limbs. Conditions that may require surgery include prolapsed disc with severe pain or weakness, nerve root compression, severe spinal infections, and spinal cord narrowing.
- Open Surgery: Open surgery is considered when there are clear indications that surgery is required. These include severe nerve root pain causing dysfunction, especially loss of motion or control of the lower limbs. Procedures include spinal canal stenosis surgery, severe slipped disc discectomy, decompressions, and fusions.
- Minimally Invasive Methods: Minimally invasive surgery is an option for certain conditions where smaller incisions can reduce recovery time and minimise tissue damage.
- Fusion Surgery: Fusion surgery is used to stabilise the spine by permanently connecting two or more vertebrae, eliminating motion between them.
- Motion Preservation Surgery: Motion preservation surgery aims to maintain as much natural movement in the spine as possible, even after intervention.
Treatment 1: Open Surgery
Open surgery is considered when there are clear indications that surgery is required, such as severe nerve root pain causing dysfunction, especially loss of motion or control of the lower limbs. Procedures include spinal canal stenosis surgery, severe slipped disc discectomy, decompressions, and fusions.
Treatment 2: Minimally Invasive Methods
Minimally invasive surgery is an option for certain conditions where smaller incisions can reduce recovery time and minimize tissue damage.
Treatment 3: Fusion Surgery
Fusion surgery is used to stabilize the spine by permanently connecting two or more vertebrae, eliminating motion between them.
Treatment 4: Motion Preservation Surgery
Motion preservation surgery aims to maintain as much natural movement in the spine as possible, even after intervention.
Non-Surgical
Most patients suffering from back pain are treated conservatively with:
- Medication: Medication such as pain relievers, anti-inflammatory drugs, and muscle relaxants to manage symptoms.
- Physiotherapy: Physiotherapy is often prescribed to strengthen the muscles supporting the spine, improve posture, and enhance flexibility.
- Epidural Steroid Injections: Epidural steroid injections are used to reduce inflammation and pain in the affected areas.
- Nerve Root Block: Nerve root block injections target specific nerves to relieve pain.
- Radio Frequency Ablation: Radio Frequency Ablation is commonly performed for neck and back pain conditions, using heat to reduce or stop nerve pain.
Treatment 1: Medication
Medications include pain relievers, anti-inflammatory drugs, and muscle relaxants to manage symptoms.
Treatment 2: Physiotherapy
Physiotherapy is often prescribed to strengthen the muscles supporting the spine, improve posture, and enhance flexibility.
Treatment 3: Epidural Steroid Injections
Epidural steroid injections are used to reduce inflammation and pain in the affected areas.
Treatment 4: Nerve Root Block
Nerve root block injections target specific nerves to relieve pain.
Treatment 5: Radio Frequency Ablation
Radio Frequency Ablation is commonly performed for neck and back pain conditions, using heat to reduce or stop nerve pain.
Rehabilitation
Post-treatment rehabilitation is essential for recovery and preventing future episodes of back pain.
- Physical Therapy or Physiotherapy: Strengthens the core muscles and improves flexibility to support the spine.
- Posture Training: Learning proper body mechanics to avoid future strain.
- Gradual Activity: Returning to normal activities with a structured exercise program that emphasises gradual progress.
- Pain Management: Working with pain specialists to manage chronic pain through medication, injections, or alternative therapies.
Complications
Most patients with mild back pain recover with conservative treatment and experience few complications. However, more severe cases can lead to:
- Nerve Root Compression: Causing chronic leg pain and potential weakness.
- Loss of Strength: Particularly in the legs, which may impair mobility.
- Impaired Urinary or Bowel Functions: Severe cases may result in difficulty controlling bladder or bowel movements.
- Chronic Pain: Long-term, unresolved pain can significantly affect quality of life.
Prevention Methods
There are various types of back pain and related conditions. Here are general prevention methods for common issues like back strain and slipped discs.
- Good posture
- Regular strengthening of the back muscles, consult physiotherapy on the exercises focused on strengthening these muscles
- Avoid excessive weight lifting with bad posture
- Avoid high impact, high risk activities
Early detection is important for more severe conditions. Some red flags that could indicate these conditions include:
- Increasingly worsening pain especially with weakness of lower limbs and bowel, bladder dysfunctions
- Fevers
- Poor immunity & health
It is best to come in early and get diagnosed to ensure you minimise the impact on your daily life and start treatment as soon as possible.
When To See A Doctor
You should consult a doctor if your symptoms are extremely severe, acute, or have persisted for longer than one or two weeks. If you experience other symptoms such as fever, urinary symptoms, or pain radiating down your legs, it is important to book an appointment with a specialist. Early diagnosis is crucial to ensure that your condition is properly identified and treated, setting you on the road to recovery without further delays.
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