Chronic Back Pain

Known as the most high-priced breed condition in industrialized countries, chronic back pain is also the most common cause of performance stumbling block in persons younger than 45 years old.

Chronic back pain is defined as a kind of ache that persists longer than 12 weeks and is often associated with degenerative forms of the spine. It is brought about by the following: fibrositis, inflammatory spondyloarthropathy and metallic bone circumstance.

Even if it bears a favorable diagnosis, the effect of chronic back pain and its related disability are tremendous. The difference of which from acute is that, it serves no biological purpose and it evolves in an intricate milieu influenced by many factors. It changes the person’s productivity to the point over what the initiating pathologic dysfunction would have.

Contextual Approach

An estimate percentage of 80 Americans have chronic back pain during their lifetime. The twinge felt of about 15%- 20% have it prolonged while 2%- 8% have it constantly. In an annual basis, a percentage of 3-4 is temporarily immobilized and fortunately, only 1% are rendered entirely paralyzed.

It is the only second usual point of blame in the lost of work time, fifth frequent cause for hospitalization and fifth common reason to undergo surgical procedure. In the United States, the productivity loss reached up to $28 billion annually.

After three months, it is declared as chronic back pain when the normal connective tissues heal between six to twelve weeks unless pathoanatomic instability continues. A timid rate of tissue repair in the relatively avascular intervertebral disk may impair its total recovery.

Epidemology Framework

The approximate occurrence of chronic back pain in the Untied States is 5%- 20% while there is 25%- 45% in Europe. Two percent of American laborers have compensable injuries each year. It accounts to 19% of all the employees’ salary claims in the United States.

Metal workers in the otherhand, 76% declared strains or sprains according to the statistics of US Bureau of Labor. It was concluded that jobs requiring manual- handling activities accounted for more than half of the reports. The highest cases were of drivers and masons.

Between 1985 to 1988, about 4.1 million Americans already have symptoms of intervertrebral disk disorder. It had annual prevalence of about 2% in men and 1.5% in women. As for a study conducted in Finland, it revealed that there are 295 Finnish construction workers aged 15- 64 years old have sciatica. After five years, the lifetime pervasiveness had risen to about 42% to 59%.

Chronic Back Pain Causes

Chronic back pain is often attributed to degenerative changes or traumatic conditions of the spine. Additionally, it is also connected with various conditions, including fibrositis, inflammatory spondyloarthropathy, and metabolic bone conditions.

There is no definitive cause of chronic back pain but epidemiologic data suggests the following risk factors:

• Cigarette smoking
• Occupations that require repetitive lifting
• Morbid obesity
• Twisting positions
• Forward bending
• Exceeding physical capacity
• Exposure to vibration caused by motor vehicles or industrial machinery

Chronic Back Pain Treatment

Chronic back pain may be treated without resorting to surgery. An uncontrolled study conducted by Saal et al showed that 90% of patients with herniated lumbar disk and radiculopathy (symptoms of chronic pain) were successfully treated with aggressive rehabilitation and medical therapy. This only goes to show that surgery is not an absolute necessity when it comes to treating chronic back pain.

Most healthcare professionals suggest a three-phase treatment plan for chronic back pain, consisting of the following:

• Bed rest
• Medications
• Physical therapy

Bed rest for chronic back pain is only advisable for two days. Several studies have shown that two-day bed rest is more effective than 7-day rest period in increasing a person’s recovery rate. In addition, it has been found that prolonged bed rest can make chronic back pain worse instead of better as the long bout of inactivity may cause secondary complications to arise.

An inactive patient with chronic back pain may experience deleterious physiologic effects, which could lead to shortened muscles and other soft tissues, decreasing flexibility and range of motion and reduce muscle strength.

Medications for chronic back pain includes tricyclic antidepressants that can alleviate insomnia, enhance endogenous pain suppression, reduce painful dysesthesia, and eliminate other painful disorders such as headaches.

Additionally, anticonvulsant medications (useful for reducing paroxysmal or neuropathic pain) and calcium channel blockers and alpha-adrenergic antagonists (for treating complex regional pain syndrome) may also be used for treating chronic back pain.

Physical therapy for chronic back pain may be divided into passive and active categories. For passive therapies, the patients are subjected to the ministrations of a physiotherapist, often with the aid of modalities (like ultrasound, electric muscle stimulation, etc.) and manual therapy. Active therapy, on the other hand, involves exercises which a person with chronic back pain may perform to help build up and maintain muscle strength and increase recovery rate.