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Back pain can occur at any point of the spine, and is characterized by a range of symptoms including pain, muscle tension or stiffness, weakness in the legs or feet, and a possible tingling or burning sensation, often traveling down the legs (sciatica). It is often caused by stresses on the muscles and ligaments that support the spine. Thus, the most common site affected is the lower back because it bears the most weight and physical stress.
Back problems are among the most common chronic conditions in Canada.9 Four out of five adults will experience at least one episode of back pain at some time in their lives,10-13 although occurrence is most often between the ages of 30 and 50.14 Back problems appear with equal frequency in men and women. Back pain is generally mechanical in nature, or a result of a trauma or another underlying medical condition. For example, a herniated (bulging, slipped) disc occurs when the cushion between two vertebrae of the spine pops out of place and bulges into the spinal canal, putting pressure on the nerves. If pressure is applied to the sciatic nerve (the main nerve to the leg), severe pain radiates down the buttocks and the leg to below the knee; a condition known as sciatica. Another example is degenerative disc disease (ICD-9 code: 722.6), a disorder associated with aging; specifically, wear and tear over time result in a loss of disc height, thereby reducing the disc’s ability to act as a cushion for the vertebrae. Back pain may also be due to inflammation in the spine. Ankylosing spondylitis (ICD-9 code: 720.0), for example, is a progressive, inflammatory disease that affects the joints between the vertebrae of the spine. Over time, the disease spreads along the spine, and eventually causes the affected vertebrae to fuse together, resulting in progressive loss of mobility and loss of function.
The cause of back pain, however, is not always apparent;11 in fact, in approximately 85% to 90% of individuals with back pain, no specific cause can be identified.12,15 Contributing factors include poor muscle tone, especially in the back and abdominal muscles; sedentary lifestyle; obesity; smoking; poor posture; and in particular, improper or heavy lifting. There is also evidence suggesting that psychosocial factors (e.g., chronic stress and depression) are determinants of back pain.16,17
Both low back pain (pain in the lumbar region of the spine) and neck pain (pain in the cervical region) will be described in this section. Symptoms may be acute, lasting six weeks or less, or chronic, lasting longer than three months. Generally, symptoms of neck and back pain include pain that varies in intensity, at times described as “unbearable.”10 This pain interferes with social roles and activities because of concern that the activity will increase the pain or cause further injury. Stiffness and tension are also commonly experienced. While there can be considerable variation in the underlying causes of both back and neck pain (i.e., biomechanical, ankylosing spondylitis, degenerative disk disease, etc.), the ultimate consequences for functional health are similar; therefore, the health states presented in this section are considered to summarize the impact of the pain on daily living, regardless of its actual cause.
Treatment is aimed at alleviating pain and restoring proper function and strength to the back. Bed rest for the first one or two days will reduce the symptoms, and applying heat or ice to the affected area will improve blood flow, reducing inflammation. Resuming normal activities as soon as possible is regarded as the best way to cope with the pain as it will prevent stiffness and keep the back flexible and strong. Pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Pain killers (analgesics) are also a key part of a typical treatment regimen, for example, acetaminophen in addition to NSAIDs. Efforts for prevention include losing weight if obese, regular exercise, strengthening the back and abdominal muscles, maintaining correct posture, lifting by bending at the knees rather than at the waist, avoiding standing or working in any one position for too long, and quitting smoking.