Definition:

Back pain (also known as dorsalgia) is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.

It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arm and hand), in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling.

The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

Classification:

Back pain can be divided anatomically:

• Neck pain.
• Upper back pain.
• Lower back pain or tailbone pain.

By its duration:

• Acute (less than 4 weeks).
• Subacute (4 – 12 weeks).
• Chronic (greater than 12 weeks).

By its cause:

• Musculoskeletal(MSK).
• Infectious.
• Cancer.

Back pain is classified according to etiology:

1.Mechanical or nonspecific back pain

Approximately 98% of back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology.

2.Secondary back pain

secondary back pain which is caused by an underlying condition accounts for nearly 2% of the cases. Underlying pathology in these cases may include metastatic cancer, spinal osteomyelitis and epidural abscess which account for 1% of the patients.

Also, herniated disc is the most common neurologic impairment which is associated with this condition, from which 95% of disc herniations occur at the lowest two lumbar intervertebral levels.

Causes:
Pain in back may arise from three causes:

1. Lesion or disorder of bony spine
2. Lesion of nerve root
3. Referred pain from deeper structures.

Lesion or disorder of the spine can be categorized in to 10. They are as follows:

1. Congenital abnormalities
A) Lumbar or sacral variation
B) Hemi vertebra
C) Spina bifida

2. Deformities
A) Kyphosis
B) Lordosis
C) Scoliosis
1
3. Infections of the bone
A) Tuberculosis of the thoracic or lumbar spine
B) Pyogenic infection of the thoracic or lumbar spine.

4. Arthritis of the spinal joints
A) Rheumatoid arthritis
B) Osteoarthritis
C) Ankylosing spondylitis

5. Mechanical derangements
A) Prolapsed lumbar disc
B) Acute lumbago
C) Spondylolysis
D) Spondylolisthesis
E) Spinal stenosis

6. Tumors
A) Tumors in relation to the spinal column (spinal cord)
B) Tumors in relation to the nerve root

7. Chronic strains
A) Coccydynia
B) Chronic lower lumbar ligamentous strain

8. Disorders of the sacro- iliac joints
A) Tuberculosis of the sacro-iliac joints
B) Sacro iliac ligamentous strain
C) Ankylosing spondylitis of sacroiliac joints
D) Other forms of arthritis of sacro iliac joints

9. Miscellaneous
A) Senile osteoporosis

10. Other local affections of bone
A) Scheurmann’s kyphosis
B) Calve’s vertebral compression
Congenital abnormalities

Minor variations of the bony anatomy are common in lumbar and sacral region.
They include

1. Deficient or rudimentary lowest ribs
2. Complete or incomplete incorporation of the fifth lumbar vertebral body in sacrum (Sacralisation of fifth lumbar vertebra)
3. Persistence of the first sacral segment as a separate vertebra
(Lumbarisation of the first sacral vertebra)
4. Over development of the fifth lumbar transverse process on one or both sides with a false joint between the hypertrophied process and ilium (false joint is the source of pain)

Diagnosis:
There are various types of tests that are conducted in the lab to detect the true cause of back pain. These tests are as follows:

• X-ray: This is the most common technique through which bone structures in the spine can be studied and the instabilities caused due to tumors, fractures or any infections can be detected.
• MRI scan: This scan is the most commonly used for surgical planning and in this case the patient as well as the doctor has some idea about the cause of the pain.
• CT scan: This scan is a detailed form of X-ray and takes a cross section image of the body. Usually if the cause is not detected via X-rays, this method is used as the second diagnosis option.

Management:

Pain:

• Heat therapy is useful for back spasms or other conditions. Some patients find that moist heat works best (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours).
• Cold compression therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases.
• Use of medications, such as muscle relaxants,[16] opioids, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs)[17] or paracetamol (acetaminophen).
• Massage therapy, especially from an experienced therapist, can provide short term relief.
• Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.
• Depending on the particular cause of the condition, posture training courses and physical exercises might help with relieving the pain.
• Exercises can be an effective approach to reducing pain, but should be done under supervision of a licensed health professional.However, one study found that exercise is also effective for chronic back pain, but not for acute pain
• Physical therapy consisting of manipulation and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine).
• Acupuncture has some proven benefit for back pain.
• Education, and attitude adjustment to focus on psychological or emotional causes- respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.

Surgery:

Surgery may sometimes be appropriate for patients with:

• Lumbar disc herniation or degenerative disc disease.
• Lumbar spinal stenosis from lumbar disc herniation.
• Degenerative joint disease.
• Spondylolisthesis.
• Scoliosis.
• Compression fracture.

Suggestion about homoeopathic Treatment:

Homeopathy can offer safe and effective pain relief for many kinds of backaches. Because homeopathic medicines need to be individually prescribed to the unique pattern of symptoms that sick people experience.