CHRONIC BACK PAIN: CAUSES AND EFFECTS

What are the causes of Back Pains?

Back pain is most commonly felt as soreness, tension or stiffness in the lower back (the area between the bottom of the ribs and the top of the legs) but it can also be felt in the neck, shoulders, buttocks and thighs.
The pain sometimes develops suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture.

Sometimes the pain develops for no apparent reason. Some people just wake up one day with a sore back. Typically, the pain eases when you lie down flat, whereas moving, coughing or sneezing makes it worse.



When to get medical help

Most cases of back pain usually improve without you having to get medical help, but if your condition does not get any better within three days see your GP. You should also see your GP if you suffer regular episodes of back pain for more than six weeks.

There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

• unexplained weight loss
• a fever of 38ºC (100.4ºF) or above
• swelling of the back
• constant back pain that does not ease after lying down
• pain in your chest or high up in your back
• pain down your legs and below the knees
• pain caused by a recent trauma or injury to your back
• loss of bladder control
• inability to pass urine
• loss of bowel control
• numbness around your genitals, buttocks or back passage
• pain that is worse at night

Other types of back pain

Pain in the upper back, legs, neck and shoulders can also be felt as back pain but it may be caused by another condition:

• pain in the lower back that moves down the buttocks into one or both of the legs may be a symptom of sciatica
• soreness in the lower back, muscle weakness, tight muscles and loss of bladder control may be the result of a slipped disc
• back pain, buttock pain, swollen joints and tendons and extreme tiredness are common symptoms of ankylosing spondylitis
• pain in the joints (including the back) when walking and stiffness first thing in the morning are symptoms of arthritis
• painful stiffness of the shoulder, which makes it very difficult to dress, drive or sleep, may be a sign of frozen shoulder
• neck pain and stiffness, headaches and lower back pain following an accident are common symptoms of whiplash

Almost everyone has back pain at some point in their lives. According to the National Institutes of Health, back pain is the second most common neurological disorder in the United States -- only headache is more common.

If you have back pain, the first step is to be properly assessed by your primary care provider. Back pain has many causes, from muscle strain to more serious conditions such as a herniated disc, spinal stenosis, spondylosisthesis, osteoporosis, or a tumor, so it's important to find out what is causing the back pain.

1) Acupuncture

A study conducted at Sheffield University in the United Kingdom looked at the long-term symptom reduction and economic benefits of acupuncture for persistent low back pain. An average of 8 acupuncture treatments were given to 159 people, while 80 people received usual care instead.

After one year, people receiving acupuncture had reduced pain and reported a significant reduction in worry about their pain compared to the usual care group. After two years, the acupuncture group was significantly more likely to report that the past year had been pain-free. They were less likely to use medication for pain relief.

How does acupuncture work? According to traditional Chinese medicine, pain results from blocked energy along energy pathways of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways.

A scientific explanation is that acupuncture releases natural pain-relieving opioids, sends signals that calm the sympathetic nervous system, and releases neurochemicals and hormones.

An acupuncture treatment generally costs between $60 and $120. Acupuncture is tax-deductible (it's considered a medical expense) and some insurance plans pay for acupuncture.

If you want to try acupuncture, plan on going one to three times a week for several weeks initially.

2) Capsaicin Cream

Although you may not have heard of capsaicin (pronounced cap-SAY-sin) before, if you've ever eaten a chili pepper and felt your mouth burn, you know exactly what capsaicin does. Capsaicin is the active ingredient in chili peppers.

When it is applied to the skin, capsaicin has been found to deplete substance P--a neurochemical that transmits pain--causing an analgesic effect.

In one double-blind study, 160 people were treated with capsaicin for 3 weeks, while another 160 people used a placebo. After 3 weeks, pain was reduced by 42% in the capsaicin group compared to 31% in the placebo group. Investigators rated capsaicin significantly more effective than placebo.

Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area.

If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.

3) Vitamin D

Chronic muscle pain can be a symptom of vitamin D deficiency. Vitamin D is found in fish with small bones, fortified milk and cereal, and exposure to sunlight.

Risk factors for vitamin D deficiency are:

darker pigmented skin (e.g. Hispanic, African American, Asian) does not convert UV rays efficiently to vitamin D digestive disorders, such as celiac disease use of glucocorticoid medications for conditions such as lung diseases and allergies minimal sun exposure (elderly, institutionalized, homebound, veiled or heavily-clothed individuals) latitude and season - for example, people in Boston do not produce vitamin D from sun exposure between November and February.  A study by the University of Minnesota looked at the prevalence of vitamin D deficiency in 150 people with chronic musculoskeletal pain. Researchers found that 93% of patients had vitamin D deficiency. All people with darker pigmented skin (African American, East African, Hispanic, and Native American origin) had vitamin D deficiency.

Another interesting finding was that the majority of people with severe vitamin D deficiency were under 30 years of age. Season was not a significant factor.

The researchers concluded that all people with persistent, non-specific musculoskeletal pain should be screened for vitamin D deficiency.

4) Music Therapy

Music therapy is a low-cost natural therapy that has been found to reduce the disability, anxiety, and depression associated with chronic pain.

A study evaluated the influence of music therapy in hospitalized patients with chronic back pain. Researchers randomized 65 patients to receive, on alternate months, physical therapy plus 4 music therapy sessions or physical therapy alone.

Music therapy significantly reduced disability, anxiety, and depression. Music had an immediate effect on reducing pain, although the results were not statistically significant.

5) Vitamin B12

Vitamin B12 has been found to relieve low back pain. A double-blind Italian study examined the safety and effectiveness of vitamin B12 for low back pain. People who received vitamin B12 showed a statistically significant reduction in pain and disability. They also used less pain medication than the placebo group.

Besides pain, other symptoms of vitamin B12 deficiency are numbness and tingling, irritability, mild memory impairment, and depression.

Risk factors for vitamin B12 deficiency are :

• pernicious anemia
• medications (stomach acid-blocking medications)
• inadequate intake of meat or dairy products
• infection (small intestine bacterial overgrowth, parasites)
• Digestive diseases (stomach removal surgery, celiac disease, Crohn's disease
• Vitamin B12 muscle injections are the standard treatment for vitamin B12 deficiency. Studies have found vitamin B12 sublingual tablets (placed under the tongue for absorption) and nasal gel are also effective.

6) Magnesium

Magnesium is the fourth most abundant mineral in the body. It's involved in over 300 biochemical reactions in the body.

Magnesium helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis.

Symptoms of magnesium deficiency include muscle spasms and pain, premenstrual syndrome, irritability, depression, insulin resistance, high blood pressure, irregular heart rhythms, and heart disease.

A German study found that mineral supplements increased intracellular magnesium levels by 11% and was associated with a reduction in pain symptoms in 76 out of 82 people with chronic low back pain.

7) Willow Bark

The bark of the white willow tree (Salix alba) has pain-relieving properties similar to aspirin. An ingredient in white willow bark, called salicin, is converted in the body to salicylic acid (aspirin is also converted to salicylic acid once in the body). Salicylic acid is believed to be the active compound that relieves pain and inflammtion.

A number of studies have compared white willow to medication or placebo:

A University of Sydney study compared the effects of willow bark extract to refecoxib, a Cox-2 inhibitor pain medication. In the study, 114 patients received a herbal extract containing 240 mg of salicin and 114 received 12.5 mg of refecoxib every day. After four weeks, both groups had a comparable reduction in pain.

A study in the American Journal of Medicine examined 191 patients with an exacerbation of chronic low back pain. They were randomly assigned to receive a willow bark extract with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo. In the fourth week of treatment, 39% of people receiving the high-dose extract were pain-free, 21% receiving the low-dose were pain-free, and 6% of people receiving the placebo were pain-free. People in the high-dose group improved after the first week. Significantly more people in the placebo group required pain medication.

8) Yoga for Back Pain

Yoga creates balance in the body through various poses that develop flexibility and strength. A study of people with chronic mild low back pain compared Iyengar yoga to back education. After 16 weeks, there was a significant reduction in pain intensity, disability, and reliance on pain medication in the yoga group. Benefits were also seen at three month follow up assessments.

Another study compared yoga, conventional exercise, and a self care book for people with chronic low back pain. Back function in the yoga group was superior to the book and exercise groups at 12 weeks. Although there was no difference in symptoms at 12 weeks, at 26 weeks, the yoga group was superior to the book group.

9) Bowen Therapy

Bowen therapy is a type of gentle bodywork that was developed in Australia by osteopath Tom Bowen (1916-1982). Bowen therapy is more widely used in Australia and Europe, but it has been growing in popularity in North America.

Bowen therapists use a series of specialized "moves" using their fingers and thumbs. The moves typically involve the therapist pulling the skin slack away from the muscle, applying pressure, and then quickly releasing the tension.

These moves are performed on precise areas of muscles where special receptors are located. Nerve impulses are sent to the brain, resulting in muscle relaxation and reduction of pain.

The moves are not continuous - the therapist allows the client to rest for a few minutes between each move. A typical treatment is between 30 to 40 minutes.

10) Breathing Techniques

Breathing techniques that make use of the mind-body connection have been found to reduce pain. These techniques integrate body awareness, breathing, movement, and meditation. What's great about breathing techniques is that you can do them yourself at home at no cost.

One study compared 6-8 weeks (12 sessions) of breath therapy to physical therapy. Patients improved significantly with breath therapy. Changes in standard low back pain measures of pain and disability were comparable to those resulting from high quality, extended physical therapy. Breath therapy was found to be safe. Other benefits of breath therapy were improved coping skills and new insight into the effect of stress on the body.

11) Massage Therapy

When many people have back aches and pain, the first thing they think of is massage. Studies have found that massage may be effective for subacute and chronic pain. It has also been found to reduce anxiety and depression associated with chronic pain. Massage therapy is the most popular therapy for low back pain during pregnancy.

12) Chiropractic

Back pain is one of most common reasons people see a chiropractor. Doctors of chiropractic use chiropractic spinal manipulation to restore joint mobility. They manually apply a controlled force to joints that have become restricted by muscle injury, strain, inflammation, and pain. Manipulation is believed to relieve pain and muscle tightness and encourage healing.

A study published in the Spine Journal examined manipulations compared to simulated manipulations in 102 people with back pain and/or radiating pain. The researchers found that active manipulations were more effective at reducing acute back pain and sciatica with disc protrusion.

13) Alexander Technique

Alexander technique teaches people to improve their posture and eliminate bad habits such as slouching, which can lead to pain, muscle tension, and decreased mobility. This technique was created by Frederick Matthias Alexander (1869-1955), an Australian actor who learned how to correct hoarseness in his voice by improving his posture.

You can learn Alexander technique in private sessions or group classes. A typical session lasts about 45 minutes. During that time, the instructor notes the way you carry yourself and coaches you with verbal instruction and gentle touch.

14) Prolotherapy

Prolotherapy addresses damaged ligaments (bands of connective tissue that help keep bones attached to each other) to relieve chronic musculoskeletal pain.

How does it work? Tendons and ligaments in the back often do not heal completely after injury. Bones of the spine become less stable, which can lead to chronic pain.

Prolotherapy involves the injection of a liquid solution into soft tissues such as ligaments and tendons. This triggers local inflammation and triggers the body's natural healing response which repairs the weakened soft tissues and relieves pain. Unlike drugs, prolotherapy is thought to address the underlying problem. 

After locating the areas that require treatment, the doctor inserts a thin needle with the solution into the area. There is often mild pain, but it can be reduced by using a local anaesthetic. A typical course of treatment is 10 to 25 sessions for back pain. Since it is believed to repair the joint, no other treatment is necessary. 

Preliminary studies have found that back pain, which often involves ligament injury, responds particularly well to prolotherapy. It is the position of the American Association of Orthopaedic Medicine that prolotherapy is a safe and effective therapy for the treatment of selected cases of low back pain and other chronic myofascial pain syndromes. Prolotherapy injections must be administered by a medical doctor (M.D.), osteopath (D.O.) or by a state-licensed naturopathic doctor (N.D.) in certain states.

15) Balneotherapy

Balneotherapy is one of the oldest therapies for pain relief. The term "balneo" comes from the Latin word, balneum, meaning bath. Balneotherapy is a form of hydrotherapy that involves bathing in mineral water or warm water.

A study compared bathing in mineral water to plain tap water in 60 people with low back pain. They found that mineral water containing sulphur was superior in reducing pain and improving mobility compared with tap water.

A systematic review and meta-analysis published in the journal Rheumatology assessed spa therapy and balneotherapy for low back pain. The researchers found that the data suggest beneficial effects compared to control groups. They concluded that the results were encouraging and that large-scale trials were warranted.

Dead Sea salts and other sulphur-containing bath salts can be found in spas, health food stores, and online.

People with heart conditions should not use balneotherapy unless under the supervision of their primary care provider.