In most cases, back pain is caused by muscle strain, trauma or deformity of the spine. Approximately one in every 10 cases has its roots in a systemic disease.
Back pain can occur anywhere in the column from the neck to the lumbar region and can be located in a small area or spread over a wide area and can also radiate from the area of origin.
WHAT IS YOUR CAUSE?
• Back pain has many causes, including degeneration of the vertebrae, infection, tumor, overloading and trauma. The exact cause can be difficult to identify because it can arise in soft tissues, bone, intervertebral disc or nerves that innervate these structures. • Risk factors for low back pain include jobs that require repetitive motion, exposure to vibration caused by vehicles or industrial machinery, including cigarette smoking. Certain sports, such as running pedestrian, skiing, or driving for long periods of time may also be associated with low back pain. • Diseases such as arthritis of the spine, spondylitis and osteoporosis can also cause pain. Some of these diseases are more prevalent in the elderly and, therefore, older people have higher risk of back pain. • Situations such as depression, anxiety, alcoholism or divorce, have been associated with low back pain. However, no studies conclusively demonstrate whether these problems are the cause or consequence of pain.
IMPACT ON POPULATION
Back pain is the most prevalent medical problem in industrialized societies. Back pain is the most common cause of temporary disability in people over 45 years. Approximately 80% of the population suffers from at least one episode of back pain during their lifetime.
Two out of three patients recover within a period of less than one month and about 5% suffer persistent discomfort for more than 6 months. About half of patients with chronic LBP can resume their work.
The doctor must determine if the pain is musculoskeletal origin, neurological or visceral. The diagnosis is based on a careful history and physical examination. Sometimes, local injection of anesthetic or a corticosteroid in certain structures or joint space can help in the diagnosis and treatment of back pain.
The imaging techniques, including radiography, scintigraphy, computed tomography, myelography and nuclear magnetic resonance, can be used to identify the source of pain. Neurophysiological studies also may be useful at times. The more expensive imaging techniques should be reserved for those patients whose diagnosis can not be effected by conventional procedures included physical exam.
• Pain relievers such as Aspirin, Paracetamol and NSAIDs sometimes are the only necessary treatment for back pain. Avoid activities that increase the pain. If pain is persistent, the patient should be evaluated by a rheumatologist. • Treatment should be directed to the specific cause of the pain therapy options include nalgésicos, NSAIDs, antidepressants, muscle relaxants and rehabilitation exercises. • In certain situations, for example, post-operative or spine surgery may be advisable to use a brace, if after a reasonable period of time there is no improvement can be tested using injections of local anesthetics or corticosteroids. • Surgery should be reserved for situations where conservative procedures fail. • In some patients unresponsive to conservative treatments are used electrical stimulators or pumps morphine continuous infusion.
The Rheumatologist's Role IN THE TREATMENT OF BACK PAIN
The rheumatologist is the right specialist to conduct a comprehensive evaluation of patients with back pain, and establish a treatment program. Since surgery is indicated only a small percentage of patients, it is clear that the performance of Rheumatologist can significantly reduce the economic impact of back pain by reducing the periods of hospitalization and the need for expensive procedures and techniques.
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