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It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation.
There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle.
Back pain symptoms - signs a lower back condition could be serious | ldi.mx
For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. Back pain can also be due to referred pain from another source.
Referred pain occurs when pain is felt at a location different from the source of the pain. An abdominal aortic aneurysm and ureteral colic can both result in pain felt in the back.
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Another possible cause of chronic back pain in people with otherwise normal scans is central sensitization , where an initial injury or infection causes a longer-lasting state of heightened sensitivity to pain. This persistent state maintains pain even after the initial injury has healed. Obesity, sedentary lifestyle, and lack of exercise can increase a person's risk of back pain.
In general, fatigue can worsen pain.
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A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in X-rays and other medical imaging scans. In most cases of low back pain, medical consensus advises not seeking an exact diagnosis but instead beginning to treat the pain.
Imaging is not typically needed in the initial diagnosis or treatment of back pain. However, if there are certain "red flag" symptoms present plain radiographs x-ray , CT scan , or magnetic resonance imaging MRI may be recommended. These red flags include: There is moderate quality evidence that suggests the combination of education and exercise may reduce an individual's risk of developing an episode of low back pain.
The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual's ability to function in everyday activities, to help the patient cope with residual pain, to assess for side-effects of therapy, and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery.
For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long-term pain relief.
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Also, for some people the goal is to use non-surgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better. Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition acute or chronic is also a determining factor in the choice of treatment.
Back pain is generally treated with non-pharmacological therapy first, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture, and spinal manipulation therapy may be recommended. Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident. Surgery may sometimes be appropriate for people with severe myelopathy or cauda equina syndrome. When a herniated disc is compressing the nerve roots, hemi- or partial- laminectomy or discectomy may be performed, in which the material compressing on the nerve is removed.
A foraminotomy or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression. It involves removing the protruding disc, either a portion of it or all of it, that is placing pressure on the nerve root. Spinal fusion is a procedure in which bone grafts and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots. If infection, such as a spinal epidural abscess , is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective.
Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of the lower back, or lumbar lordosis , to support the added weight on the abdomen.
This softening and increased flexibility of the ligaments and joints in the lower back can result in pain. Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.
Local heat, acetaminophen paracetamol , and massage can be used to help relieve the pain. Avoiding standing for prolonged periods of time is also suggested. Although back pain does not typically cause permanent disability, it is a significant contributor to physician visits and missed work days in the United States, and is the single leading cause of disability worldwide.
Lower Back Pain Symptoms, Diagnosis, and Treatment
The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain. There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle — both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
Low back pain can incorporate a wide variety of symptoms.
It can be mild and merely annoying or it can be severe and debilitating. Low back pain may start suddenly, or it could start slowly—possibly coming and going—and gradually get worse over time. Depending on the underlying cause of the pain, symptoms can be experienced in a variety of ways. See Types of Back Pain: