any pain in the back, usually in the
lumbar or
cervical region; it is often dull and continuous, but sometimes sharp and throbbing. This is the most common cause of disability and time lost from work for people 18 to 65 years old. Between 50 and 80 per cent of individuals will be disabled by back pain, even if only for a short period, at some time during their lives. About 60 per cent of all backache is related to non-sciatic muscle strain and ligament sprain. Approximately 30 per cent of backache can be attributed to the back component of
sciatica, although leg pain is usually a more prominent feature. Roughly 10 per cent of backache can be attributed to other causes, such as urinary tract infection, kidney stones, multiple myeloma, metastatic carcinoma, osteoporosis, osteomalacia, abdominal aortic aneurysm, spondylosis, and spondylolisthesis.
A sudden action, using muscles that are already fatigued or out of condition, is particularly likely to cause acute strain. In such cases rest and time usually bring recovery. A very sharp, persistent pain following the use of unusual force against something (for example, trying to open a jammed window) could indicate a herniated intervertebral disk or sacroiliac strain. Night pain or pain that wakes the patient from sleep often points to a diagnosis of infection or tumor.
Treatment. The initial treatment for backache usually is nonoperative.
nonsteroidal antiinflammatory drugs and postural rest are the hallmarks of conservative therapy and are based on the principles of reducing inflammation about the spinal nerve or related structures such as the disk or posterior facet joints, and decreasing at least temporarily the tremendous loads borne by the spine. Epidural steroids are helpful in some cases. Surgical treatment is usually a last resort and involves excision of a herniated disk,
laminectomy to allow the surgeon to visualize the area, with fusion to stabilize the spine or some other type of orthopedic surgery, depending on the cause of back pain. Minimally invasive surgical procedures may also be performed.
Chronic backache that does not respond to other modes of treatment sometimes can be relieved by
transcutaneous electrical nerve stimulation and other modalities such as back school, antidepressants, muscle-strengthening exercises, and weight-reduction programs.