Generally refers to moderate to severe distress in the spinal column or in the general back region. Back pain may result from injury to the back or to the supporting discs, ligaments, or muscles. Back pain can also be due to many illnesses, including KIDNEY DISEASE, CANCER, DISEASES, osteoarthritis. Frequently, the pain is concentrated in the low back because it’s this region that receives the most weight and stress of the body. Luckily, in many instances of back pain, the issue goes away by itself, and as many as 90 percent of back pain patients will recover in several weeks or months. Nevertheless, low back pain may also become a chronic illness needing focus.
Many individuals older than age 65 have back problems, and back pain is really common among individuals of all ages. Based on the centres for disease MANAGEMENT AND PREVENTION (CDC), 70 to 85 percent of all individuals have problems with back pain sooner or later in their own lives. In accordance with Doctors Cohen and Chopra in their 2001 article in Geriatrics on the primary care work-up of back symptoms, in a survey of 3,000
Americans older than age 65, 20 percent of the respondents reported difficulties with low back pain.
Looking At The Back
The spinal cord constitutes the vertebrae of the cervical spine (neck region), the thoracic spine (mid back), and the lumbar-sacral spine (the lower back). There are disks between each vertebrae, and occasionally these disks become inflamed due to arthritis, normal aging, or from other causes.
Most back pain is “mechanical,” which means that it comes from a structural issue (some part of the components which make up the back), rather than from illnesses or disorders. But when low back pain occurs in people age 65 and older, it’s important to rule out other potential causes too, like cancer. This is especially significant if patients have previously had cancer, have had pain for a month or more, and have experienced an unplanned weight reduction.
Back pain varies from person to person, and pain may be light or moderate to quite serious. Some people also experience weakness or numbness within their legs, along with pain.
The doctor tries to discover where the patient is feeling pain. The place where the pain is sensed may also be the source of the issue, or the pain could be a “referred pain,” that is pain that comes from another part of the body but which is sensed elsewhere.
Most doctors will perform a fundamental neurological examination, including testing the patient’s reflexes, to ascertain if there’s any fundamental weakness or a lack of feeling, in addition to requesting the patient to perform simple plays, like standing on the toes or walking on the heels. The patient is frequently asked to lie flat, and the doctor will perform the “straight leg test. In this test, the patient lifts one leg as high as possible and then steadily lowers it. Subsequently the same test is performed on the other leg. The physician is looking for any pain with this move, which might signal inflammation or lower back damage.
Most patients are also requested to rate their pain on a scale of 1 to 10, with 1 being very mild to 10 being the worst pain they ever experienced. This self-evaluation can help the physician judge the severity of the issue. Patients are often asked what actions they’ve had to limit due to their pain and what actions they cannot perform at all because of it. It’s additionally crucial that you ascertain what, if any, actions happened around the time of the start of the back pain; for example, if the patient had just moved heavy furniture or had lately been involved in a car crash.
The medical history of the patient is, in addition, essential, including whether or not there were previous operations, drugs the patient is taking, previous illnesses, and whether close relatives have had similar issues.
In instances of moderate to severe back pain, the doctor typically purchases additional testing, like a complete blood count (to check for anemia or illness), an erythrocyte sedimentation test (to assess for rheumatoid arthritis, lupus, or other autoimmune diseases), and a urinalysis (to assess for bladder infection).
The doctor may also determine that simple X-rays of the back are suggested or may choose magnetic resonance imaging (MRI) of the region of the spinal column that’s causing pain. Patients with pacemakers, nevertheless, cannot have an MRI, although a CT scan is a diagnostic possibility, as is an ultrasound test.
A physical examination of the patient with back pain is crucial. The physician must understand how much it hurts and where it damages, in addition to whether the pain extends into the legs. Various movements by the patient will be assessed, such as having the patient bend sideways, forwards, and backwards. The physician may also find the patient’s gait to see if she or he can walk comparatively generally or not.
Treatment for Back Pain
How the illness is treated depends upon the Diagnosis. Bed rest is recommended much less than in the past; yet, elderly patients may need at least a couple of days of bed rest if they can be afflicted by acute to moderate pain.
Drugs may be prescribed to treat the illness, including nonsteroidal anti-inflammatory drugs (NSAIDs) or painkilling medicines. Doctors must be cautious within their selection of drugs because many drugs pass through the liver, the kidneys, or the gut. If the elderly man is having difficulties with any of these organs, then the doctor will have to contemplate which drug to prescribe in addition to tailor the dose to the needs of the individual.
Even if there are not any disorders aside from the back pain, elderly individuals’ bodies may process drugs at a substantially slower speed than when they were young, which is another variable the physician must consider in discovering drugs and dosages. Many patients with back pain are given NS HELP drugs, and the doctor typically requests the patient to report any gastrointestinal difficulties which could grow.
If the patient is understood to have had previous difficulties with taking NSAIDs, the physician may attempt a COX-2 inhibitor, for example Celebrex (celecoxib) or Vioxx (rofecoxib). A prostaglandin analogue, Cytotec (misoprostol) may be prescribed with an NSAID drug, to help protect the stomach lining.
Some patients have such intense pain they may need an opium-based narcotic, including morphine sulfate, methadone, OxyContin, or Duragesic (fentanyl). As of this writing, many doctors are incredibly reluctant to prescribe OxyContin because it has grown into a drug of abuse for some people. Nevertheless, patients with pain usually don’t abuse OxyContin or other narcotics.
Doctors may also prescribe low doses of antidepressants for pain control, for example Elavil (amitriptyline) or Sinequan (doxepin Hcl). The antiseizure drug Neurontin (gabapentin) may be prescribed to alleviate pain. Other antiseizure drugs which were used to treat back pain include Dilantin (phenytoin sodium), Tegretol (carbamazepine) Topamax (topiramate), and Lamictal (lamotrigine).
Other drugs that could be helpful are the muscle relaxant Flexeril (cyclobenzaprine) or dextromethorphan (usually used for cough but also helpful in pain control).
Some patients may receive epidural injections of corticosteroid drugs, which can supply short term (weeks or months) relief from pain. During the less distressing period after receiving the shot, most patients are strongly encouraged to make lifestyle changes to reinforce their backs and reduce the chance of having another serious flare up of their pain.
Many patients with back pain are advised to make lifestyle changes, including instituting a fitness plan the moment the pain becomes tolerable. Doctors may recommend physical therapy to empower patients to learn exercises which will help their particular issue. Doctors may also use transcutaneous electric nerve stimulation (TENS), proper electric stimulation, ultrasound, and associated treatments. Aquatic exercise is frequently quite helpful because water reduces the pressure on the body and enables many patients to move around more easily.
Most patients are counseled to treat their own pain with ice or heat. They may be additionally advised to wear comfy shoes. Girls are told to take light pocketbooks rather than hefty shoulder bags.
Many patients with back pain may discover that their sexual activities are curtailed. Nevertheless, some sexual positions are less debilitating than others, according to Doctors Kandel and Sudderth in their publication,
Pain: What Works! An All-Inclusive Guide to Preventing and Curing Back Problems. Positions which don’t put physical stress on backs are usually the greatest, like side manner postures.
If Surgery Is Needed
Some patients will need back surgery. The operation may be comparatively restricted or may be quite complicated, determined by the patient’s needs. Back surgery should only be performed by an extremely seasoned back surgeon.