Brunilda Nazario, MD
It's hard to find any part of Elin Laird's life that hasn't been touched by pain. "I can't stand for too long. I can't sit for too long. Pretty much if I'm at home, I'm lying in bed," says the 39-year-old single mother. "I can't be as active in my son's life. I can't travel as much. I've lost so much of my life."
Laird describes the pain of her herniated disc as similar to having "an ice pick shoved in the base of my spine." It's a pain that no therapy – from steroids to painkillers to surgery – has managed to budge. And she is far from alone in her discomfort.
"Eighty percent of the population of the United States, at some point in their life, is going to have back pain," says Ronald J. Wisneski, MD, an orthopedic surgeon, specialist in spinal disorders and spine surgery, and associate in the Department of Orthopedic Surgery at Geisinger Medical Center in Danville, Pa. Most of the time, that pain is centered in the lower back and non-specific, meaning there is no primary cause found. About 2% to 10% of people who experience low back pain develop chronic low back pain, which affects daily living for at least 3 months.
What could be triggering your back pain? To get an idea, WebMD talked to two orthopaedic surgeons about the most common causes of chronic lower back pain -- and what you can do about it.
Why is the lower back a target area for pain? "Generally speaking, the lower back is subject to a lot of mechanical stress and strain,” says Gunnar Andersson, MD, PhD, professor and chairman emeritus of the Department of Orthopedic Surgery at Rush University Medical Center in Chicago. “The reason is the weight of the upper body, which always puts loads on the lower back."
Supporting all that upper body weight is the spine, which is made up of more than 30 small bones called vertebrae stacked one on top of the other. A spongy piece of cartilage, called a disc, sits between each vertebra. It acts as a shock absorber, preventing the bony vertebrae from grinding against one another.
With age, these cushioning discs gradually wear away and shrink, a condition known as degenerative disc disease. Discs can also tear or become injured. Sometimes the weakening of a disc can put pressure on its jelly-like center. Wisneski describes this process as similar to a bubble forming on your car's tire.
"You hit a bump in the road, then all of a sudden that tire goes pop," he says. In the case of your back, that pressure can lead to a herniated disc (also called a "slipped disc" or "ruptured disc"), in which the center of the disc bulges.
Sometimes that bulging causes the material from inside the disc to press on the sensitive nerves that carry messages to the brain. The result can be the kind of excruciating pain Laird has experienced. "If I move wrong, I get what I call a 'sonic boom’ -- this jolt of electricity through my pelvic area," she says.
A herniated disc in the lower back can put pressure on the nerve that extends down the spinal column. This commonly causes pain to radiate to the buttocks and all the way down the leg. This condition is called sciatica.
There are many causes of back pain. Overuse injuries are a very common source of lower back pain and stiffness. However this usually goes away after a few days. Others causes of chronic pain include:
Less commonly, low back pain can be a sign of a serious medical condition, such as diabetes or a pinched nerve. In the case of a pinched nerve, the pain may be accompanied by symptoms like fever, chills, night sweats, or loss of bladder control.
Even with the more sophisticated techniques available to diagnose what's causing low back pain, many times doctors don’t know what caused the problem. "It's very hard for us to identify the reason for a patient's pain," Andersson says.
Although too much strain may be part of the equation, it isn't always entirely to blame for lower back pain.
Tests used to help confirm the causes of back pain include X-rays, magnetic resonance imaging (MRI), computerized axial tomography (CAT) scan, bone scan, and bone density test.
One of the main reasons a person develops low back pain and another doesn't may lie in their genes. With disc degeneration, Andersson says, “If you take twins -- one who is doing heavy physical work and one who is doing desk work -- and you compare their MRI exams, they are essentially identical. This tells you that genetic factors are very important.”
If you have chronic low back pain, you've likely inherited the tendency, and you're probably hardwired for it. The lower back contains sensitive receptors called nociceptive fibers, which send pain signals to the brain. "Some people have a lot of nociceptive fibers -- for example, in their discs -- while others have relatively few," Wisneski tells WebMD. That may be why one person can lift heavy weights many times and never experience low back pain, while another who barely lifts anything is in constant agony.
Just because it's possible to inherit low back pain doesn't mean the matter is completely out of your control. "It's how we're born and how we take care of ourselves," Wisneski says.
If you sit in an uncomfortable chair all day, work a jackhammer, or regularly twist your body into uncomfortable positions, your lower back will suffer for it. Smoking -- the bad habit that increases the risk of dozens of diseases -- can also lead to backaches. One study found that smokers are nearly a third more likely to have low back pain compared to nonsmokers.
Try these five tips to prevent or ease lower back pain:
SOURCES:Gunnar Andersson, MD, PhD, professor and chairman emeritus, Department of Orthopedic Surgery, Rush University Medical Center, Chicago.National Institute of Neurological Disorders and Stroke: "Low Back Pain Fact Sheet."American Academy of Orthopedic Surgeons: "Low Back Pain."Ronald J. Wisneski, MD, board-certified orthopedic surgeon; specialist in spinal disorders and spine surgery; associate in the Department of Orthopedic Surgery, Geisinger Medical Center, Danville, Pa.Battié MC. Spine Journal, January-February 2009; vol 9: pp 47-59.Shiri R. American Journal of Medicine, January 2010; vol 123: pp 87.e7-87.e35.
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