What to Do When You Have Back Pain?

Back pain is one of the most common health issues, prompting patients to seek help from family doctors and emergency departments. It can lead to disability or decreased productivity. Back pain can severely impact daily activities, affecting physiological functions, altering routine tasks, and reducing quality of life as patients try to live with the pain. Sleep is disrupted, bending over, reaching for objects, or turning becomes difficult, and driving or going to work is a challenge. Lifting items and exercising become arduous, even making a trip to the bathroom a significant challenge. Back pain can dominate your thoughts, becoming a constant companion in daily life.

It’s essential to differentiate the causes of back pain: they can be either mechanical (linked to clear injuries, degenerative spine diseases, hernias) or non-specific. The latter is particularly challenging to diagnose and may require lengthy, complex treatment, encompassing multiple pain management methods. For non-specific pain, multidisciplinary treatment is crucial, involving comprehensive care from various specialists in one place.

Whom to Contact When You Have Back Pain?

In Lithuania, it’s still a common misconception that only neurologists or neurosurgeons can help with back pain. In reality, neurosurgeons recommend surgery to only about 10% of consulting patients. All other patients are typically advised to try conservative treatments first, such as physical therapy or various pain management methods. Changing the approach to the sequence of consultations could help many patients shorten their time in pain by starting with the appropriate specialist.

Inflammation, tumors, pregnancy, injuries, osteoporosis, nerve compression, radiculopathy, plexopathy, degenerative disc disease, herniated disc, spinal stenosis, joint dysfunction, joint injury, and infection are just some of the possible causes of back pain. When diagnosing back pain, it’s crucial to distinguish between neuropathic (radicular) pain and nociceptive (mechanical) pain symptoms. Once evaluated and differentiated, the most suitable treatment can be chosen, and surgery is rarely the primary option.

How is Back Pain Treated?

There are many different ways to treat back pain. Conservative treatment often includes medication and invasive pain management. Muscle relaxants, gabapentin, local anesthetics, and opioids play a significant role in managing back pain, but their doses and prescriptions are strictly monitored by pain specialistsSome types of back pain can be managed by limiting physical activity, resting, and applying cold and heat therapy, especially after an injury. Physical therapy and exercises to strengthen the muscles surrounding the spine are also essential during treatment. However, for chronic back pain lasting more than 12 weeks, 2-3 physical therapy sessions will not be sufficient. It’s recommended to start with at least five sessions under the supervision of a physical therapist. Subsequently, the patient should perform prescribed exercises almost daily and responsibly and return to the specialist periodically to assess progress, update exercises, and correct any errors.

What Are the Main Causes of Back Pain?

Back pain is widely studied and has many underlying causes, but the main ones include:

Mechanical: Mechanical pain is most often caused by damage to the spine, intervertebral discs, or soft tissues. Fractures, such as spondylolisthesis, can cause both acute and chronic pain. A herniated disc is a common result of injuries. Pregnancy is also a mechanical cause of back pain.

Degenerative: Spinal osteoarthritis includes spinal vertebral joint osteoarthritis, sacroiliac joint osteoarthritis, spinal stenosis, and degenerative disc diseases. In addition, osteoporotic compression fractures are also a degenerative cause of pain.

Inflammatory: This is most often caused by inflammatory spondyloarthropathy, such as ankylosing spondylitis—an inflammatory disease of unknown origin that affects the spine and joints connecting the pelvis to the spine and sometimes other joints. The nature and progression of back pain depend on the course of the disease and may be part of an acute inflammatory process.

Oncological: Back pain can be caused by spinal cord cancer or nerve compression due to tumors. Pathological fractures are often observed in these cases.

Infectious: Infections of the spine, discs, epidural abscesses, or infections in the muscles/soft tissues can also cause back pain.

Diagnosing back pain requires a thorough examination, including analyzing the patient’s history, physical tests, and assessing back pain using diagnostic tests such as MRI. Various treatments are applied, including medication, invasive, surgical, and alternative methods. To rule out degenerative diseases, disc herniation, or other conditions, an MRI is recommended before seeing a specialist, as it allows for immediate treatment planning.

What Worsens Back Pain?

Various studies have been conducted to determine factors that negatively affect the nature, intensity, and prognosis of back pain. Several key factors complicate the course and treatment of the disease: prolonged pain episodes, pain spreading to other areas, excess weight, smoking, and depression. Social factors also influence the onset and persistence of back pain. Poor education, a physically demanding job, low wages, and job dissatisfaction all have a negative impact on the disease’s course and treatment outcomes, primarily because such circumstances often lead to psychological stress.

Patients with chronic pain are advised to consult a pain specialist for medication and invasive procedures. In cases of severe symptoms like pain spreading to other areas, impaired urinary or bowel functions, or leg numbness, patients should urgently consult a neurosurgeon. Psychological support from cognitive-behavioral therapists and/or psychotherapists is also vital. They help patients with chronic back pain who may have coexisting mental health issues. Depression is, unfortunately, one of the most common causes of chronic pain.

Physical therapy sessions should begin early in the treatment process, with patients encouraged to exercise regularly.

Excess weight is also a common cause of back pain, so dietitian services may be included in the treatment plan to promote healthy eating and manage body weight.

Specialists and patients working together is the first step. A professional team and an appropriate treatment plan are only part of a successful outcome. The patient’s determination, inner strength, and desire to break free from the cycle of pain are the foundation of successful treatment.