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The type and severity of the back pain will depend on the condition that's causing the pain. Additionally, various causes of back pain may produce similar symptoms.
Lower Back
Low back pain may come on suddenly or gradually.
- When low back pain is intense or "acute," it usually lasts a brief period such as a few days to several weeks.
- Low back pain lasting longer than three months is termed "chronic."
- Low back pain may or may not radiate down into the leg.
Low back pain can be further divided into two main categories:
- Specific low back pain (SLBP) where there is a defined cause (etiology).
- Non-specific low back pain (NSLBP) or back pain of undetermined cause. (The latter does not mean that there is no specific cause of your pain—there may in fact be one or more causes that your physician cannot yet find due to the limitations of medical science.)
Specific Low Back Pain (SLBP)
The International Association for the Study of Pain (IASP) Back Pain in the Workplace taskforce describes known causes for SLBP as:
- Disc herniations (discogenic pain).
- Spondylolisthesis (a dislocation of the spine), usually in the young.
- Spinal stenosis, or narrowing of the canal through which the nerves or spinal cord pass.
- Vertebral fractures, tumors, infections and inflammatory diseases, such as arthritis.
Non-Specific Low Back Pain (NSLBP)
Fewer than 15 percent of people with back pain are diagnosed with a specific cause of pain. This suggests that the majority of people with back pain suffer from NSLBP where a definite cause cannot be determined. Many of those with NSLBP suffer from either myofascial (muscle) pain, or from facet joint disease. Others have intervertebral disc degeneration often caused by repetitive motion injuries. The IASP taskforce describes this type of pain as a disorder of “activity intolerance” and “work incapacity.” Most such pain responds well to the milder treatments.
Back and neck pain also is categorized as:
- Soft tissue and bone pain - In medical terms, soft tissue, including muscle, and bone pain are called nociceptive because receptors for these irritants are activated and send messages warning of tissue damage or impending tissue damage to the brain.
- Nerve pain. The technical term for pain due to nerve injury is neuropathic pain. It is not usually inflammatory or related to muscle and bone (nociceptive). . Nerve pain is sub-classified as peripheral nerve pain or central nerve pain. Some authorities add a third category known as sympathetically mediated nerve pain, or pain involving the autonomic nervous system.
- Discogenic pain. Pain in the lower back not associated with numbness or weakness could be related to a structural abnormality within the disc itself. this pain may be termed an annular tear or central disc herniation. Treatment for an annular tear generally falls in three options:
- Medication and physical therapy;
- Heating the disc with an internal probe for several minutes, a procedure known as intradiscal electro thermal therapy (IDET) and radiofrequency heating of the annulus;
- Fusing the spinal discs.
To this date, no studies show that one treatment approach is better than the others for treating disc-related pain. As in all treatments, patients and their doctors should weigh the relative risks against the potential benefits of each treatment they consider, and always be comfortable in seeking second opinions.
Sciatica
Pain from pressure on the sciatic nerve due to a herniated disc, or any condition that compresses the nerve, may be felt as:
- Mild pain in the hip or part of the leg, or tingling in these regions
- A sharp pain down part of the leg, with numbness in certain parts of the leg.
- Pain that gets worse with sneezing or coughing.
- Pain that is usually located on one side, but may radiate down both legs if the disc is pressing on the nerve roots to both legs.
- The pain may be worsened by sitting or standing for long periods
These symptoms may accompany back pain - or they may be felt without any accompanying back pain at all. These symptoms are commonly called "sciatica" - pain radiating into the hip or down the leg - due to the pressure on the nerve roots that make up the sciatic nerve, the great nerve of the leg.
Compression
Compression in the lower parts of the spinal canal by a disc can be serious. Emergency surgery may be required to decompress the nerves. Symptoms may include:
- Mild low back pain
- A feeling of numbness in the buttocks or thighs
- An inability to control urine or stools
Duration of Pain
Acute back pain typically gets better within a few days or weeks with little or no treatment and does not cause significant incapacity.
Chronic back pain typically persists longer than the expected healing time for the identified cause of the pain—such as low back surgery—or persists after the identified cause of the pain has been treated.
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