What causes back pain?

Acute and chronic backache are both caused by inflammation, a biological process that the body activates in order to heal injured tissues. Acute backache usually settles within a few weeks when the inflammatory process naturally abates. Chronic inflammation, however, results in continuous and unabating discomfort in the spine. Besides causing pain, chronic inflammation also progressively damages the spine if left to continue. In the latest Global Burden of Disease study (GDB 2013), lower back pain is ranked the single biggest cause for chronic disability in the world.

Where does the pain originate from?

The body experiences the perception of pain through specialised nerve cells called nociceptors. These are situated throughout the entire body and respond to potentially damaging stimuli by sending signals to the spinal cord and brain, usually causing the perception of pain. This process, called nociception, is biochemically triggered by certain molecules which are released or become activated during inflammation. The spine consists of several different tissue types which all contain nociceptors, as listed below:

  • Vertebrae – segments of bone stacked upon each other, providing strength and structure
  • Intervertebral discs – circular pads of pliable soft issue situated between the vertebrae. These allow flexibility and shock absorption in the spine
  • Ligaments – fibrous bands which keep the vertebra in place.
  • Nerves – run along the spinal column throughout the body and branches off in a segmental manner between each vertebra, passing information from the body to the brain.
  • Muscles – vertical columns running down, and anchored to, the spine.
  • Facet joints – small joints covered by cartilage that allow the vertebra to rotate upon each other.

Of importance is that each tissue type can be a source of pain, either individually or collectively. In a more chronic situation, pain often originates from several different disease processes, activating pain signals in several different tissue types at the same time.

What are the most common mechanisms that causes back pain?

  • Muscle inflammation
    Painful muscle inflammation can be caused by several mechanisms including sprain, strain, poor posture, lifting heavy objects, or whiplash injury. Several different groups of muscles associated with the spine can be involved.
  • Intervertebral disc prolapse or spondylosis
    Spondylosis is the medical term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the intervertebral discs situated between the vertebrae and then spreads to surrounding tissues such as ligaments, joints, and bones. Besides causing local pain, an inflamed intervertebral disc may progressively become weakened through continual enzymatic activity caused by inflammation. This corrosive activity makes the disk increasingly more prone to future damage and even collapse. A collapsed disc may cause direct pressure on the nerve roots as they exit the spinal cord between each vertebra, causing a referred pain syndrome during which pain radiates down the shoulder or arm. Tingling or pins and needles are also common symptoms, whilst in a more advanced state, weakness and loss of sensation may occur within the hands or arms.
  • Osteoarthritis
    This is a common condition that mainly affects the integrity of the cartilage, especially as one becomes older. Osteoarthritis mostly affects the small facet joints between the vertebrae, as they are the only cartilage containing structures in the neck. Importantly, the presence of osteoarthritis in the neck is commonly associated with the presence of several other inflammatory conditions, such as spondylosis, where protein containing structures contained in the spine are simultaneously degraded. Since the neck is predominantly protein based, these cumulative effects can cause severe impairment and chronic disability over time.
  • Other diseases
    Less common conditions may cause or contribute to back pain in certain circumstances. These include osteoporosis (reasonably common) as well as rheumatoid arthritis and certain forms of cancers (quite rare).

What are the risk factors for chronic back pain?

The following factors increase your risk:

  • Age – lower back pain typically occurs as a first symptom between the ages of 30 and 40 and increases with age.
  • Fitness level – back ache is more common among people who are physically unfit. Weak back and abdominal muscles offer poor support to the spine.
  • Diet/weight – excess body fat increases mechanical stress on the back.
  • Genetics – conditions such as ankylosing spondylitis, a rare form of arthritis that affects the spine, are genetically inheritable. Genetics may also contribute to poor bone structure, muscle development, and numerous other factors. These conditions are therefore often passed down among families.
  • Occupational risk factors – having a physical job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job, on the other hand, may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.

How is back ache treated?

  • Step 1 – alleviation of acute pain in order to improve your quality of life and help you remain as functional as possible.
  • Step 2 –implementation of self-help strategies to help prevent recurrent or chronic bouts of back ache and help to protect your spine from the permanent structural damage that chronic inflammation often causes.

Acute pain management for back ache:

  • Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long term, since as a class, these drugs pose a significant side-effect risk relating to cardio-vascular, gastro-intestinal and kidney disease. (Ask your doctor or pharmacist for advice).
  • Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
  • Hot or cold packs – applying a heat pack to your neck can help to ease pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the blood takes to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
  • Rehabilitation therapies – physiotherapy, biokinetics, or chiropractic therapy may prove helpful. A good massage may also assist. Therapy may reduce inflammation, correct posture, muscle tension, or other contributors to neck pain.

Preventative self-help strategies:

By preserving the integrity and mobility of your back you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from a chronic backache, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

  • Stretch your back
    Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain.
  • Strengthen your back muscles with exercise
    Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue play as an endocrine (hormone producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects will assist you locally with inflammation in your spine, as well as systemically in the rest of your body. Regular exercise can help reduce your risk of developing a herniated disc by slowing down their age-related deterioration as a result of chronic inflammation. It can also help keep your supporting back muscles strong and supple. Always stretch properly in order to warm up and cool down properly before and after any workout or sports activity.
  • Use supplements that naturally reduce inflammation
    Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical (plant based) compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation, and are also the three predominant causes of most cases of chronic back and neck pain.
  • Manage stress better
    Any form and stress can increase the tension in the muscles of your spine and should therefore be managed.
  • Sleeping posture
    Your mattress should be firm enough to support your body and the weight of your shoulders and buttocks, keeping your spine straight. If your mattress is too soft, place a firm board under the mattress. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle. Ideally the pillow should fill in the natural hollow between the neck and shoulders, and a soft or moulded pillow may be useful.
  • Weight-control
    Excess weight contributes to back pain as it increases the mechanical stress on the spine, hips and knees, Controlling weight may therefor prove helpful/beneficial. Although weight-loss can be very difficult to achieve, there are certain strategies that you can follow that will significantly increase your chance of success.

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