Musculoskeletal diseases: Back pain

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Back pain

Back pain can occur at any point of the spine, and is characterized by a range of symptoms including pain, muscle tension or stiffness, weakness in the legs or feet, and a possible tingling or burning sensation, often traveling down the legs (sciatica). It is often caused by stresses on the muscles and ligaments that support the spine. Thus, the most common site affected is the lower back because it bears the most weight and physical stress.

Back problems are among the most common chronic conditions in Canada.⁹ Four out of five adults will experience at least one episode of back pain at some time in their lives,^10-13 although occurrence is most often between the ages of 30 and 50.¹⁴ Back problems appear with equal frequency in men and women. Back pain is generally mechanical in nature, or a result of a trauma or another underlying medical condition. For example, a herniated (bulging, slipped) disc occurs when the cushion between two vertebrae of the spine pops out of place and bulges into the spinal canal, putting pressure on the nerves. If pressure is applied to the sciatic nerve (the main nerve to the leg), severe pain radiates down the buttocks and the leg to below the knee; a condition known as sciatica. Another example is degenerative disc disease (ICD-9 code: 722.6), a disorder associated with aging; specifically, wear and tear over time result in a loss of disc height, thereby reducing the disc’s ability to act as a cushion for the vertebrae. Back pain may also be due to inflammation in the spine. Ankylosing spondylitis (ICD-9 code: 720.0), for example, is a progressive, inflammatory disease that affects the joints between the vertebrae of the spine. Over time, the disease spreads along the spine, and eventually causes the affected vertebrae to fuse together, resulting in progressive loss of mobility and loss of function.

The cause of back pain, however, is not always apparent;¹¹ in fact, in approximately 85% to 90% of individuals with back pain, no specific cause can be identified.^12,15 Contributing factors include poor muscle tone, especially in the back and abdominal muscles; sedentary lifestyle; obesity; smoking; poor posture; and in particular, improper or heavy lifting. There is also evidence suggesting that psychosocial factors (e.g., chronic stress and depression) are determinants of back pain.^16,17

Both low back pain (pain in the lumbar region of the spine) and neck pain (pain in the cervical region) will be described in this section. Symptoms may be acute, lasting six weeks or less, or chronic, lasting longer than three months. Generally, symptoms of neck and back pain include pain that varies in intensity, at times described as “unbearable.”¹⁰ This pain interferes with social roles and activities because of concern that the activity will increase the pain or cause further injury. Stiffness and tension are also commonly experienced. While there can be considerable variation in the underlying causes of both back and neck pain (i.e., biomechanical, ankylosing spondylitis, degenerative disk disease, etc.), the ultimate consequences for functional health are similar; therefore, the health states presented in this section are considered to summarize the impact of the pain on daily living, regardless of its actual cause.

Treatment is aimed at alleviating pain and restoring proper function and strength to the back. Bed rest for the first one or two days will reduce the symptoms, and applying heat or ice to the affected area will improve blood flow, reducing inflammation. Resuming normal activities as soon as possible is regarded as the best way to cope with the pain as it will prevent stiffness and keep the back flexible and strong. Pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Pain killers (analgesics) are also a key part of a typical treatment regimen, for example, acetaminophen in addition to NSAIDs. Efforts for prevention include losing weight if obese, regular exercise, strengthening the back and abdominal muscles, maintaining correct posture, lifting by bending at the knees rather than at the waist, avoiding standing or working in any one position for too long, and quitting smoking.

Acute low back pain
ICD-9 code: 724.2

Description

Acute low back pain is usually defined as pain experienced for six weeks or less, and is more common than chronic pain. Acute low back pain is commonly described as a very sharp pain or dull ache, usually felt deep in the back, and can be more severe in one area than another. Symptoms also include limited flexibility and/or range of motion, or an inability to stand straight, especially if sciatica is present. Most cases have no known cause; they can result from an injury or trauma to the lower back or a disorder such as ankylosing spondylitis or a herniated disc. Treatment of the acute episode is primarily aimed at relieving muscle spasms and pain.

Acute low back pain is generally severe; often activities are reduced or avoided because of concern the activity will increase the pain or cause further injury. Furthermore, performing normal daily tasks can be difficult due to the limited range of spinal movement or due to the pain itself. People with acute back pain are often unable to work, and even if they can work, they may be less productive. The pain may be so severe that it can interfere with sleep, resulting in periods of fatigue. Pain may also interfere with social roles and functioning; some activities may need to be avoided altogether.

Classification

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Chronic low back pain
ICD-9 code: 724.2

Description

Chronic low back pain is usually described as deep, aching, dull or burning pain in the area of the low back or traveling down the legs, and lasts longer than three months. Pain is worse while sitting too long in one position, driving, spending long periods bending over, lifting, bending or pulling (or doing physically demanding work), and when not exercising regularly. Treatment is mainly directed toward alleviating the causes of the pain, muscle strengthening, and preventing actions that can aggravate pain.

The functional limitations associated with chronic low back pain are similar to those linked to acute low back pain. For example, moderate pain or discomfort and some fatigue are experienced, as well as difficulties lifting objects and moving about. The emotional state is often affected, in part due to the frustration that results from living with constant pain. Depression is also common in individuals with chronic pain.¹³ In addition, the pain may affect the capacity to sustain social relationships due to avoidance of certain activities.

Classification

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Acute neck pain
ICD-9 code: 723.1

Description

Cervical neck pain is generally acute, lasting six weeks or less. The severity of symptoms and limitations are similar to acute low back pain: moderate levels of pain and discomfort, moderate limitations in physical functioning and occasional periods of fatigue. Pain and stiffness can cause limited range of motion in the neck; therefore driving, working, or even sleeping may be difficult. Pain may affect social relationships as well.

Classification

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Health State Descriptions for Canadians 82-619-MIE