Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. WebMD takes a look at living with and managing chronic back pain. Back pain symptoms can range in intensity from mild to severe. Back Strain One of the main causes of back pain, whether acute or chronic, is low back strain.
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Back pain Different regions curvatures of the vertebral column Specialty Orthopedics Back pain is pain felt in the back. Retrieved 1 August Diagnosis and treatment of back pain. Accessed December 12, The Anatomy of Pain in Backache". From Occiput to Coccyx. New England Journal of Medicine. American Academy of Family Physicians. Retrieved March 12, Annals of Internal Medicine. Archived from the original on May 6, Retrieved April 30, Implications for the diagnosis and treatment of pain".
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Why you probably don't need them. Occupational medicine practice guidelines: The relation to outcome in nonoperated lumbar disc herniation". Journal of General Internal Medicine. American College of Radiology. Accessed Dec 12, A Systematic Review and Meta-analysis". European Journal of Pain. American Journal of Nursing. The Cochrane Database of Systematic Reviews 6: The Cochrane Database of Systematic Reviews 3: The Cochrane Database of Systematic Reviews 9: Complementary Therapies in Clinical Practice.
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Walter George Seventh ed. Retrieved June 18, Rathmell, MD; Christopher l. Practical management of pain. Howard Franklin , Headache Neck Odynophagia swallowing Toothache. Arthralgia joint Bone pain Myalgia muscle Muscle soreness: Cold pressor test Dolorimeter Grimace scale animals Hot plate test Tail flick test. Risk factors for the transition from acute to chronic back pain include signs of nerve root involvement, an ongoing compensation claim, long time off work, high levels of psychological distress and depression, poor physical fitness, and heavy smoking.
Chronic back pain can be triaged into three categories: Simple musculoskeletal back pain accounts for the majority of cases. It is mechanical in nature and occurs in the age group of 20—55 yr.
Pain occurs mainly around the lumbosacral area and the buttocks; it is often associated with referred leg pain into the upper thighs that rarely extends below the knees. The pain is typically described as a dull ache that varies with physical activity. Patients are generally otherwise physically well. The intervertebral discs form the main articulation between the vertebral bodies. The disc is formed by an outer layer annulus fibrosus that consists of concentric bands of fibrous lamellae.
The disc receives its sensory innervation from the sinuvertebral nerve and grey rami communicantes. The nucleus pulposus occupies the central area of the disc and it consists of a network of collagen fibres enmeshed in a mucoprotein gel.
The nucleus pulposus has no sensory innervation, so its degradation is not a direct cause of pain. Discogenic pain probably occurs as a result of internal disc changes that lead to leakage of the contents of the nucleus pulposus into disruptions within the annulus fibrosus.
The sacroiliac joint is the largest axial joint in the body and it is surrounded by a fibrous capsule. Pregnancy may lead to pain in the sacroiliac joints. In sacroiliac pain, as with the majority of causes of mechanical back pain, there are no unique identifying features in the history and physical examination to pin point this diagnosis. However, pain arising from this joint has been recorded rarely above the level of the transverse process of L5.
Stressing the joint may reproduce the patient's pain. The facet joints zygapophysial joints consist of paired synovial joints formed from the superior articular process of one vertebra and the inferior articular process of the vertebra above Fig.
These joints function to stabilize the spine and limit rotation and shift. Certain features in the history may suggest facet joint involvement in the generation of pain e. Unfortunately, these signs are not specific to facet joint pain and a diagnosis cannot be made by history and examination alone. Ligaments of the spinal column help to stabilize the spine and set limits to certain movements.
Strains or tears in these ligaments can cause chronic back pain. The muscles of the lumbar spine may also be a source of pain myofascial pain. Such pain is characterized by the presence of trigger points in the muscles. This is defined as a tender point in a taut band of muscle that can cause referred pain. Palpation or needling of these trigger points can reproduce the patient's pain.
Spinal nerve root pain is often well localized, radiating down the leg in a dermatomal pattern. The radicular element is characteristically much worse than the associated back pain because it is neuropathic. The pain typically radiates below the knee into the foot. It is described as a sharp, electric shock-like pain and is well localized. Nerve root pain should not be confused with referred back pain; the latter rarely extends below the knee and is poorly localized.
Paraesthesia may occur along the same dermatomal distribution as the pain. Coughing, straining and sneezing often reproduce or exacerbate radicular pain. Both the straight leg raise test and femoral stretch test can be used to elicit signs of nerve root irritation.
Neurological examination may reveal sensory, motor and reflex abnormalities. Nerve root pain can be caused by disc herniation, spinal stenosis and epidural adhesions.
The nerve roots leave the spinal canal via the intervertebral foramina. These are bounded anteriorly by the posterior longitudinal ligament, intervertebral discs and vertebral bodies. I was hit by a car while cycling, leaving me with a fracture in my vertebrate and chronic pain. It happened on 28 August at 8. Forms of Pain Toggle navigation. Management The most effective way to manage chronic back pain is with multidisciplinary pain management combined with self-management. Information sheet Arthritis Australia Back pain: APMA Low back pain: Best-selling book about self-management written by a team of Australian health professionals The Pain Book:
Chronic Pain Center
Back pain is one of the most common reasons people go to the doctor. Back pain that lasts more than three months (chronic) is less common. I have worked with many truly miserable chronic low back pain patients, and of course the huge economic costs of back pain are cited. Surgery can also be an option for chronic back pain if there is a known cause confirmed by imaging and if other treatments didn't help. “Get opinions from at least.