Dr. Nazmul Hasan BHMS

Back pain can be a symptom of many different illnesses and conditions. The main cause of the pain can be a problem with the back itself or by a problem in another part of the body. In many cases, doctors can’t find a cause for the pain. When a cause is found, common explanations include:

• Stress or injury involving the back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; and short term overload of back muscles caused by any unusual stress, such as lifting or pregnancy
• Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the bone-thinning disease osteoporosis
• Degenerative arthritis, a “wear and tear” process that may be related to age, injury and genetic predisposition.
• Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disk (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)
• Kidney stones or a kidney infection (pyelonephritis)

Rarer causes include:

• Inflammatory arthritis, including ankylosing spondylitis and related conditions
• A spinal tumor or a cancer that has spread (metastasized) to the spine from elsewhere in the body
• Infection, which may be in the disk space, bone (osteomyelitis), abdomen, pelvis or bloodstream

Symptoms

Back pain varies widely. Some symptoms may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer and neurological symptoms, such as numbness, weakness or incontinence (involuntary loss of urine). Back pain usually is accompanied by other symptoms that may help point to its cause. For example:

• Back sprain or strain – Back pain typically begins on the day after heavy exertion. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.
• Fibromyalgia – In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. People usually complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful to touch, called tender points.
• Degenerative arthritis of the spine – Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.
• Inflammatory arthritis, including ankylosing spondylitis and related conditions – In these disorders, there is pain in the lower back, together with morning stiffness in the back, hips or both. There also can be pain and stiffness in the neck or chest or an extremely tired feeling. Other features may include psoriasis, eye pain and redness, or diarrhea, depending on the specific disorder causing back pain. This group of diseases is a relatively rare cause of back pain.
• Osteoporosis – This common condition is characterized by thinned, weakened bones that fracture easily. It is most common in postmenopausal women. When vertebrae become compressed because of fracture, posture may become stooped over or hunched along with back pain. Osteoporosis is not painful unless a bone fractures.
• Cancer in the spinal bones or nearby structures – Back pain is consistent and may become worse when you are lying down. Numbness, weakness or tingling of the legs that continues to get worse. If cancer spreads to spinal nerves that control the bladder and bowel, there may be bowel or bladder incontinence (loss of control).
• Protruding disk – People with significant disk disease sometimes have severe pain in the lower back. If a disk compresses a nerve, the pain may spread down one leg. The pain gets worse during bending or twisting.
• Spinal stenosis – Pain, numbness and weakness affect the back and legs. Symptoms get worse when you are standing or walking, but are relieved by sitting or leaning forward.
• Pyelonephritis – People with a kidney infection typically develop sudden, intense pain just beneath the ribs in the back that may travel around the side toward the lower abdomen or sometimes down to the groin. There also can be a high fever, shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. There may be additional bladder related symptoms, such as the need to urinate more often than normal or pain or discomfort during urination.

When To Call a Professional

Contact your doctor if:

• Severe back pain makes it impossible for you to do your normal daily activities.
• Your back pain follows significant trauma.
• Mild back pain gets worse after a few days or persists more than a week or two.
• Back pain is accompanied by weight loss, fever, chills or urinary symptoms.
• You develop sudden weakness, numbness or tingling in a leg.
• You develop numbness in the groin or rectum or difficulty controlling bladder or bowel function.
• You have had cancer previously and you develop persistent back pain.

Diagnosis

Doctor will check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg (SLR test).

Your symptoms and the physical examination may give doctor enough information to diagnose the problem. However, with back pain, your doctor may ask one or more of the following tests:

• X-rays of your back
• Blood test (CBC, CRP, CPK, S.Electrolyte initially)
• Urine tests (R/M/E, BUN, S.Urea, S.Creatinine initially)
• Spinal magnetic resonance imaging (MRI) on complicated state and before surgery.
• Computed tomography (CT) scan
• Nerve conduction studies and electromyography to determine whether nerves, muscles or both may be injured (Special cases)
• Bone scan, especially if you have a previous history of cancer or fracture or degenerative diseases.

Expected Duration of Healing

How long back pain lasts depends on its cause. For example, if your pain is caused by strain from overexertion, symptoms usually subside over days or weeks and you may be able to return gradually to your normal activities. However, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back gets better.

Prevention

You can help prevent some forms of back pain by strengthening your back with exercises and by avoiding activities that lead to back injury. This means:

• Practice good posture.
• Sleep on your side or on your back with a pillow under your knees if you can.
• Exercise regularly, but stretch before and after.
• Practice abdominal crunches to strengthen abdominal muscles, which support your lower back. Also, walk or swim regularly to strengthen your lower back.
• Always lift objects from a squatting position, using your hips and your legs to do the heavy work. Avoid lifting, twisting and bending at the same time.
• Avoid sitting or standing for extended periods of time.
• Wear soft soled shoes with heels that are less than 1 and one-half inches high.
• To help prevent osteoporosis, make sure you get enough calcium and vitamin D daily to meet the dietary requirements for your age group.
• Follow a routine program of weight-bearing exercise.
• Avoid smoking and limit the amount of alcohol you drink.
• If you are a woman who has entered menopause, speak with your doctor about testing for osteoporosis and medications that can help to prevent or reverse it.

Treatment

The role of homeopathy lies in the fact that it can bring back the lost balance in the human body when it is in a diseased state. Homeopathic remedies act at the Psycho Neuro Endocrinal axis. In other words it stimulates the human body which in turn will take care of the imbalance. If no pathology found then it may take around 2-3 weeks to 6-7 months to heal a case of ‘Back Pain’.
Homeopathic medicines given on the basis of symptoms similarity  in various potencies. Acupuncture is also a good treatment for any kind of back pain.
In my practice, I have seen homeopathic medicine and Acupuncture could give a better result if applied together.

Prognosis

More than 90% of people with back pain get better after conservative treatment within 12-20 weeks. Only 5-10% of people with back pain will have symptoms for more than 20 weeks.