BACKACHE
Definition
Backache is also called back pain and dorsalgia
This is pain felt at back from:
 spine (bone or joint)
 muscles
 nerves
 other structures
Pain in the lower part of the back is called lumbago.

Incidence
About 90% of human beings have backache at some time in their lives. Lumbago (low back pain) is one of the commonest complaints in outpatient department worldwide.

Nature of Pain
 Sharp ,dull, piercing, burning
 Acute: duration less than 4 weeks
 Subacute: duration of 4-12 weeks
 Chronic : duration more than 12 weeks
 Continuous or intermittent
 Localized or radiating
 Most acute backache are self-limiting lasting 2 to 12 weeks

Causes
 No obvious cause in 85% cases
 Strained muscles- most cases
 Osteoarthritis
 Injury, such as slipped disc, herniated disc
 Osteoporosis
 Degenerative disc disease
 Acute inflammation
 Psychologically-induced
 Spinal stenosis
 Cancer
 Infection
 Fracture
 Radicular pain (sciatica)
 Tuberculosis of the spine
 Spinal deformity- scoliosis, kyphosis
 Poor sitting position
 Weight lifting
 Carrying/lifting of heavy objects

Predisposition
Backache is more common in the following situations:
 Age over 30
 Pregnancy- 50% of pregnant women
 Social stresses
 Bad posture
 Smoking
 Work requiring twisting of body, lifting heavy objects, lots of bending.
 Patient with arthritis or osteoporosis
 High-heeled shoes

Disease conditions
 SLIPPED DISC: bulging of disc from injury such as accident, fall, lifting heavy object, blow to back
 RUPTURED DISC: from trauma such as Road Traffic Accident, fall, subluxation of vertebral joint
 SPINAL STENOSIS: narrowing of spinal canal from arthritis usually in older people
 LUMBAGO: pain in lower lumbar spinal area
 SCIATICA: pain in the path of sciatic nerve- hips, buttocks, thighs, calf, foot
 RHEUMATISM: nonspecific term for diseases of and around joints giving pain and stiffness e.g. rheumatic fever, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, gout
 SPONDYLITIS: inflammation of 1 or more vertebrae and the attached discs and ligaments
 SPONDYLOSIS DEFORMANS: (osteoarthritis of spine) degeneration of intervertebral disc
 ANKYLOSIS: fixation of a joint
 ANKYLOSING SPONDYLITIS: spondylitis with ossification and fixation of spinal ligaments, especially sacroiliac joint, especially in young men
 OSTEOARTHRITIS (osteoarthrosis, degenerative disease of joints): wearing off of articular cartilage with formation of osteophytes
 SPONDYLOLISTHESIS: forward displacement of vertebra
 CAUDA EQUINA SYNDROME: disorder involving urine bladder dysfunction, lower limb weakness, gait disturbance, saddle (buttock) anaesthesia
 FIBROMYALGIA: pain and tenderness in muscles and ligaments of back
 OSTEOPOROSIS: loss of bone density

Investigations
Investigations to ascertain the cause of backache include:
 Blood tests, e.g. full blood count, ESR
 Diagnostic imaging tests, such as X-ray, MRI
 Urinalysis

Management of Backache
There is spontaneous recovery of acute backache within one month in about 75% of the cases.
For backache treatment options are:
 Massage
 Corsets and braces
 Drugs
 Surgery
 Local medications
 Physiotherapy
 Acupuncture, etc.?
 Psychotherapy

Drugs
These include:
 Muscle relaxants
 Non-steroidal anti-inflammatory drugs (NSAIDS)
 Opioids
 Paracetamol

Surgery
There may be need for surgery in 1-10% of people with backache. Possible surgeries are for:
 Lumbar disc herniation
 Compression fracture
 Scoliosis
 Spinal stenosis