Most back pain is caused by muscle strain, trauma or spinal deformity. Only about 10 percent of back pain is caused by a systemic illness. Back pain can develop anywhere from the neck to the lower spine. The pain can be localized or spread across a wide area and radiate from a central point.
Back pain has many causes, including overuse, trauma, degeneration of vertebrae, infection, or tumor. The exact cause of pain may be difficult to identify, since it can come from soft tissue, bone, disc or nerves. Risk factors for low back pain include cigarette smoking, jobs that require repetitive or heavy lifting, and exposure to vibration produced by vehicles or industrial machinery. Certain sports, such as cross-country skiing, and prolonged vehicle driving are also associated with back pain. Diseases such as spinal osteoarthritis, spondylitis and compression fractures can also cause pain. Some of these diseases are more prevalent in the elderly, consequently older people are at higher risk for back pain.
Physicians should determine whether pain is musculoskeletal, neurological or from one of the organs. This diagnosis is based on a careful history and physical examination. Injection of a local anesthetic and/or steroid into soft tissue or joint spaces can be helpful in diagnosing and treating back pain. Imaging procedures that assist in identifying the pain source include the x-ray, bone scan, computerized tomography (CAT scan) and magnetic resonance imaging (MRI). Expensive imaging procedures are generally reserved for patients whose diagnosis is not apparent with more conventional diagnostic techniques.
Over-the-counter pain relievers, such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs, are often the only treatment necessary for back pain. Patients should avoid any activity that increases the pain. For persistent pain, assistance from a rheumatologist should be obtained. Treatment should be directed at the specific cause of pain. Management techniques include analgesics, anti-inflammatories, antidepressants, muscle relaxants and rehabilitation exercises. Mechanical back supports are usually recommended for limited periods of time in certain situations, such as post-operative patients. If these techniques fail within a reasonable time, injections with local anesthetics and steroids can be helpful. Surgery can be very helpful when comprehensive nonoperative therapy fails. Physical and occupational therapy are important forms of treatment.
Rheumatologists are the appropriate physicians to complete evaluation of patients with back pain and to plan a treatment program. Since surgery is indicated for only a small percentage of patients, it is likely that a rheumatologist can significantly reduce the cost of back pain by reducing hospitalization, expensive imaging procedures, excessive physical therapy visits and surgery.
