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Back pain (also known "dorsalgia") is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine. Image File history File links Merge-arrows. ... It has been suggested that this article or section be merged with Back pain. ... Image File history File links Broom_icon. ... Image File history File links Download high resolution version (400x622, 96 KB) Labelled by Vsion, using another Public Domain image [1], from Grays Anatomy File links The following pages link to this file: Vertebra Vertebral column User:Vsion/Gallery ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... “Hurting” redirects here. ... Illustration of a human back from Grays Anatomy. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Nerves (yellow) Nerves redirects here. ... This article is about the skeletal organs. ... For other uses, see Joint (disambiguation). ... The vertebral column seen from the side Different regions (curvatures) of the vertebral column The vertebral column (backbone or spine) is a column of vertebrae situated in the dorsal aspect of the abdomen. ...

The pain may be have a sudden onset or it can be a chronic pain, it can be felt constantly or intermittently, stay in one place or refer or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may be felt in the neck (and might 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. Chronic pain was originally defined as pain that has lasted 6 months or longer. ... A human neck. ... Look up ARM in Wiktionary, the free dictionary. ... For other uses, see Hand (disambiguation). ... Diagram of an insect leg A leg is the part of an animals body that supports the rest of the animal above the ground and is used for locomotion. ... For other uses, see Foot (disambiguation). ...

Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for all physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year.^[1] It has been suggested that this article or section be merged with Back pain. ... Lumbago is a term used to refer to low back pain. ...

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.

Associated conditions

Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:

• Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs. Patients with these symptoms should seek immediate medical care.
• Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition, such as cancer.
• Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a fracture or other injury.
• Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention.

In general, however, back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months. In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... In anatomy, the urinary bladder is a hollow, muscular, and distensible (or elastic) organ that sits on the pelvic floor in mammals. ... Look up incontinence in Wiktionary, the free dictionary. ... For other uses, see Sleep (disambiguation). ... This article needs additional references or sources for verification. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... For other uses, see Fracture (disambiguation). ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahlers disease after Otto Kahler) is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...

A few observational studies suggest that two common diagnoses of back pain, lumbar disc herniation or degenerative disc disease may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.^[2][3][4][5] Other studies suggest that for as many as 85% of cases, no physiological cause for the pain has been able to be specifically identified.^[6][7] // Lumbar disc herniation As a disc in the back, degenerates, the inner portion of the disc can herniate or extrude back into the spinal canal and irritate a nerve root. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ...

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.^{[8][9][10][11]} Psychosocial refers to ones psychological development in the context of a social environment. ... A dysfunctional family is a family in which conflict, misbehavior and even abuse on the part of individual members of the family occur continually, leading other members to accommodate such actions. ...

Underlying causes

Transient back pain is likely one of the first symptoms of influenza. Influenza, commonly known as flu, is an infectious disease of birds and mammals caused by an RNA virus of the family Orthomyxoviridae (the influenza viruses). ...

Muscle strains (pulled muscles) are commonly identified as the cause of back pain, as are muscle imbalances. Pain from such an injury often remains as long as the muscle imbalances persist. The muscle imbalances cause a mechanical problem with the skeleton, building up pressure at points along the spine, which causes the pain. A strain is an injury to a muscle in which the muscle fibers tear as a result of overstretching. ...

Another cause of acute low back pain is a Meniscoid Occlusion. The more mobile regions of the spine have invaginations of the synovial membrane that act as a cushion to help the bones move over each other smoothly. The synovial membrane is well supplied with blood and nerves. When it becomes pinched or trapped it can cause sudden severe pain. The pinching causes the membrane to become inflamed, causing greater pressure and ongoing pain. Symptoms include severe low back pain that may be accompanied by muscle spasm, pain with walking, concentration of pain to one side, and no radiculopathy (radiating pain down buttock and leg). Relief should be felt with flexion (bending forward),and exacerbated with extension (bending backward). Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly. ...

When back pain lasts more than three months, or if there is more radicular pain (sciatica) than back pain, a more specific diagnosis can usually be made. There are several common causes of back pain: for adults under age 50, these include spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis; in adults over age 50, common causes also include osteoarthritis (degenerative joint disease) and spinal stenosis[1],trauma, cancer, infection, fractures, and inflammatory disease[2]. Non-anatomical factors can also contribute to or cause back pain, such as stress, repressed anger,[3] or depression. Even if there is an anatomical cause for the pain, if depression is present it should also be treated concurrently. Sciatica is pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve. ... In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ... A spinal disc herniation, incorrectly called a slipped disc, is a medical condition affecting the spine, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... Osteoarthritis / Osteoarthrosis (OA, also known as degenerative arthritis, degenerative joint disease, arthrosis or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. ... This article does not cite any references or sources. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... In everyday language depression refers to any downturn in mood, which may be relatively transitory and perhaps due to something trivial. ...

New attention has been focused on non-discogenic back pain, where patients have normal or near-normal MRI and CT scans. One of the newer investigations looks into the role of the dorsal ramus in patient's pain that have normal radiographic evidence. See Posterior Rami Syndrome. The posterior (or dorsal) branches (or divisions) of the spinal nerves are as a rule smaller than the anterior divisions. ... Posterior Ramus Syndrome, also referred to as Thoracolumbar Junction Syndrome, Maigne Syndrome and Dorsal Ramus Sundrome is caused by the unexplained activation of the primary division of a posterior ramus of a spinal nerve (Dorsal ramus of spinal nerve). ...

Treatment

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. 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. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery. In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... In medicine, a chronic disease is a disease that is long-lasting or recurrent. ...

Conservative treatment

• Heat therapy is useful for back spasms or other conditions. A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.^[12] 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 therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases.

• Medications, such as muscle relaxants,^[13] narcotics, non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs)^[14] or paracetamol (acetaminophen). A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that injection therapy, usually with corticosteroids, does not appear to help regardless of whether the injection is facet joint, epidural or a local injection.^[15] Accordingly, a study of intramuscular corticosteroids found no benefit.^[16] Herbal analgesics may also be effective.^{[citation needed]}

• Exercises can be an effective approach, particularly when done under supervision of a professional such as a physical therapist. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is also effective for chronic back pain, but not for acute pain.^[17] Another study found that back-mobilizing exercises in acute settings are less effective than continuation of ordinary activities as tolerated.^[18]

• Physical therapy and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine), often learned with the help of a health professional, such as a physical therapist. Physical therapy, when part of a 'back school', can improve back pain.^[19]

• Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.^[20]

• Body Awareness Therapy such as the Feldenkrais Method has been studied in relation to Fibromyalgia and chronic pain and studies have indicated positive effects.^[21]. Organized exercise programs using these therapies have been developed.

• Manipulation, as provided by an appropriately trained and qualified chiropractor, osteopath, physical therapist, or a physiatrist. Studies of the effect of manipulation suggest that this approach has a small benefit similar to other therapies and superior to sham.^[22][23]

• Acupuncture has a small benefit for chronic back pain. The Cochrane Collaboration concluded that "for chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and alternative treatments."^[24]. More recently, a randomized controlled trial found a small benefit after 1 to 2 years.^[25]

• Education, and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.^[26]

• Most people will benefit from assessing any ergonomic or postural factors that may contribute to their back pain, such as improper lifting technique, poor posture, or poor support from their mattress or office chair, etc. Although this recommendation has not been tested, this intervention is a part of many 'back schools' which do help.^[19]

heat/massage therapy ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... A medication is a drug or substance taken to reduce symptoms or cure an illness or medical condition. ... In medicine, a muscle relaxant is a drug that causes skeletal muscle contraction to cease. ... The term narcotic, derived from the Greek word for stupor, originally referred to a variety of substances that induced sleep (such state is narcosis). ... Wikipedia does not yet have an article with this exact name. ... Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Dioscorides’ Materia Medica, c. ... An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... Physical therapy can help restore lost functionality in many people. ... Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... The term Exercise can refer to: Physical exercise such as running or strength training Exercise (options), the financial term for enacting and terminating a contract Category: ... This article is about stretching as a form of physical exercise. ... A top-down view of skeletal muscle Muscle (from Latin musculus little mouse [1]) is contractile tissue of the body and is derived from the mesodermal layer of embryonic germ cells. ... Physical therapy can help restore lost functionality in many people. ... This article does not cite any references or sources. ... The Feldenkrais Method is an educational system intended to give a greater functional awareness of the self. ... Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. ... Joint manipulation is a type of passive movement of a skeletal joint. ... Chiropractic treatment uses manipulative therapy to correct subluxation, which has been shown to have some efficacy in treating back and neck pain, headache, and other symptoms of spinal-related conditions. ... An osteopath is a practitioner of osteopathy the approach to healthcare named, which emphasises the importance of the musculoskeletal system on general health. ... Physical therapy can help restore lost functionality in many people. ... A physiatrist is a doctor with specialty training in Physical Medicine and Rehabilitation. ... Acupuncture chart from Hua Shou (fl. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Ergonomics (from Greek ergon work and nomoi natural laws) is the study of designing objects to be better adapted to the shape of the human body and/or to correct the users posture. ... While not moving, a human can be in one of the following main positions. ...

Surgery

Surgery may sometimes be appropriate for patients with:

• Lumbar disc herniation or degenerative disc disease
• Spinal stenosis from lumbar disc herniation, degenerative joint disease, or spondylolisthesis
• Scoliosis
• Compression fracture

// Lumbar disc herniation As a disc in the back, degenerates, the inner portion of the disc can herniate or extrude back into the spinal canal and irritate a nerve root. ... Degeneration of the intervertebral disc, which is often called degenerative disc disease (DDD) of the spine, is a common disorder of the lower spine. ... This article does not cite any references or sources. ... // Lumbar disc herniation As a disc in the back, degenerates, the inner portion of the disc can herniate or extrude back into the spinal canal and irritate a nerve root. ... Spondylolisthesis (not to be confused with spondylosis or spondylolysis), also known as hangmans fracture, is an anteroposterior translatory movement (displacement) of two spinal vertebrae in relationship to each other caused by instability between the two involved vertebrae. ... A compression fracture is a collapse of a vertebra. ...

Emerging Treatments

• Vertebroplasty involves the percutaneous injection of surgical cement into vertebral bodies which have collapsed due to compression fractures. This new procedure is far less invasive than surgery, but may be complicated by the entry of cement into Batson's plexus with subsequent spread to the lungs or into the spinal canal. Ideally this procedure can result in rapid pain relief.
• The use of specific biologic inhibitors of the inflammatory cytokine tumor necrosis factor-alpha may result in rapid relief of disc-related back pain. ^[27]

Vertebroplasty is a medical procedure where bone cement is percutaneously injected into a fractured vertebra in order to stabilize it. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ...

Treatments with uncertain or doubtful benefit

• Injections, such as epidural steroid injections, facet joint injections, or prolotherapy have limited, if any, benefit.^[15][28]

• Cold compression therapy is advocated for a strained back or chronic back pain and is postulated to reduce pain and inflammation, especially after strenuous exercise such as golf, gardening, or lifting. However, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded "The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain"^[12]

• Bed rest is rarely recommended as it can exacerbate symptoms,^[29] and when necessary is usually limited to one or two days. Prolonged bed rest or inactivity is actually counterproductive, as the resulting stiffness leads to more pain.

• Electrotherapy, such as a Transcutaneous Electrical Nerve Stimulator (TENS) has been proposed. Two randomized controlled trials found conflicting results.^[30][31] This has led the Cochrane Collaboration to conclude that there is inconsistent evidence to support use of TENS.^[32] In addition, spinal cord stimulation, where an electrical device is used to interrupt the pain signals being sent to the brain and has been studied for various underlying causes of back pain.

• Inversion therapy is useful for temporary back relief due to the traction method or spreading of the back vertebres through (in this case) gravity. The patient hangs in an upside down position for a period of time from ankles or knees until this separation occurs. The effect can be achieved without a complete vertical hang ( 90 degree) and noticeable benefits can be observed at angles as low as 10 to 45 degrees.^{[citation needed]}

An injection is a method of putting liquid into the body with a hollow needle and a syringe which is pierced through the skin long enough for the material to be forced into the body. ... An epidural catheter after insertion. ... It has been suggested that this article or section be merged with Sclerotherapy. ... There are very few or no other articles that link to this one. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... Electrotherapy is the use of electrical energy in the treatment of impairments of health and a conditions of abnormal functioning. ... “TENS” redirects here. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicine, used because of its record of reliability. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ... Spinal Cord Stimulator (SCS) or Dorsal Column Stimulator (DCS) is an implantable medical device used to treat chronic pain of neurologic origin. ... Inversion therapy involves hanging upside down to apply gentle traction to the spine. ...

See also

• Failed back surgery
• Low back pain
• Posterior Rami Syndrome
• Tension myositis syndrome
• Upper back pain

Failed Back Syndrome or Post-laminectomy Syndrome is a condition characterized by persistent pain following back surgeries. ... It has been suggested that this article or section be merged with Back pain. ... Posterior Ramus Syndrome, also referred to as Thoracolumbar Junction Syndrome, Maigne Syndrome and Dorsal Ramus Sundrome is caused by the unexplained activation of the primary division of a posterior ramus of a spinal nerve (Dorsal ramus of spinal nerve). ... Tension myositis syndrome (TMS) is a condition described by Dr. John E. Sarno in his books Healing Back Pain: The Mind-Body Connection (ISBN 0-446-39230-8), The Mindbody Prescription: Healing the Body, Healing the Pain (ISBN 0-446-67515-6), and The Divided Mind: The Epidemic of Mindbody... Upper back pain, also called middle back pain or thoracic pain, is pain that is felt between the bottom of the neck and top of the lumbar spine. ...

References

The American Academy of Family Physicians (AAFP) was founded in 1947 to promote the science and art of family medicine. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• Back Pain - Information for Patients
• Back pain at the Open Directory Project
• backpain at NINDS
• Handout on Health: Back Pain at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Back Pain Information for Patients: Spine-health.com
• Patient's guide to back pain
• Back pain, on Medline plus, a service of the National Library of Medicine