THE BACK FACTS


It is estimated that back pain afflicts over 31 million Americans and is the number one cause of activity limitation in young adults.1 Within a given year, up to 50% of U.S. adults suffer from back pain.2
  • Americans spend at least $50 Billion each year on low back pain and it is the second most common neurological ailment in the United States.3
  • Low back pain is the second most frequent reason for visits to the physician.4
  • 80% of people over the age of 30 will experience back problems at some point in their lives. 30% of those will have recurring problems. 5
  • Each year, there are approximately 916,000 spinal surgeries performed in the US.6
  • Back pain accounts for almost one fourth of all occupational injuries and illnesses.7
  • In the United States, back surgery rates increase almost proportionately with the supply of orthopaedic and neurosurgeons.8

CAUSES OF BACK PAIN

Back pain can be caused by many different diseases and conditions. Some of these conditions can be very serious but fortunately they are for the most part uncommon. These serious conditions include; cancer, tumors, neoplasm, inflammatory arthritis and infection. Several common conditions that can cause back pain are listed below.

Common Causes of Back Pain Fractures and Dislocations

Fractures and dislocations can occur anywhere in the body. The vertebral bodies which help support the weight of the upper body can break resulting in a compression fracture. These types of fractures can be very painful and even disabling.

It is important for the physician to determine the nature of these fractures. Some fractures can be caused by dangerous or serious conditions such as cancers, malignancies, or advanced osteoporosis. These are called pathological fractures. Other types of fractures may occur through traumatic events.

A dislocation is a term used to describe a condition where a joint has been disrupted and has separated to the point where the two adjacent bones are no longer aligned or touching. When a joint is dislocated the spine becomes unstable and is unable to protect the spinal cord or nerves.
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Degenerative Disc Disease

Degenerative Disc Disease (DDD) is a natural condition of the body that causes deterioration of the intervertebral discs. This is a gradual process that may compromise the spine. Although DDD is relatively common, its effects are usually not severe enough to warrant significant medical intervention. The intervertebral disc is one structure prone to degenerative changes associated with aging. Long before Degenerative Disc Disease can be seen radiographically, biochemical and histologic (structural) changes occur. Over time the collagen (protein) structure of the annulus fibrosis weakens and may become structurally unstable. Additionally, water and proteoglycans(PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc's inability to handle mechanical stress.
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Herniated Disc

Herniation of the nucleus pulposus (HNP) occurs when the nucleus (gel-like substance) breaks through the annulus fibrosis (tire-like structure) of an intervertebral disc (spinal shock absorber). Injury to the disc may result in pain, numbness, tingling or loss of muscle strength. Disc injuries in the neck region may affect the arms or hands while disc injuries in the low back may affect the legs or feet. People between the ages of 30 and 50 appear to be vulnerable because the elasticity of the disc and water content of the nucleus decreases with age.
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Facet Syndrome

Facet syndrome is a common spinal disorder affecting the posterior joints that results in pain, stiffness and inflammation. Increased stress at the facets results in stretching of the ligamentous capsule, deterioration of the smooth cartilaginous surfaces and increased friction at the joint. In facet syndrome, the symptoms of pain, discomfort and weakness frequently localize to the spine, nonetheless a small percentage may be felt in the extremities or other body areas.
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Foraminal Stenosis

The spinal nerves pass through openings on the side of the spine called intervertebral foramen. Foraminal stenosis occurs when these openings are smaller than normal. This condition can be the result of injury, degenerative change or congenital anomaly. The smaller opening may result in compression of the nerve. This irritation often causes symptoms of numbness, weakness, burning or tingling in the involved extremity. Long standing or severe stenosis may result in a functional loss.
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Spinal Stenosis

Spinal stenosis is a condition where the size of the spinal canal is reduced. This may lead to compression of the spinal cord. Symptoms often include pain, numbness, tingling and weakness. Severe cases may actually cause loss of function and may even lead to disability. Spinal stenosis is more common in patients over fifty years of age. Many factors can cause stenosis including injury and degenerative change.
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Fibromyalgia

Fibromyalgia is a chronic disorder associated with widespread soft tissue pain, tenderness and fatigue. A person with fibromyalgia will experience pain when up to 18 specific areas called tender points are pressed. Pushing carefully on these specific points during an examination causes discomfort or pain. The pain of fibromyalgia is more than normal muscle aches common after physical exertion. Fibromyalgia often can be severe enough to disrupt a person's daily work and activities. The cause of fibromyalgia is not known.
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Osteoporosis

Osteoporosis is commonly called the "fragile bone disease." It is due to loss of bone density caused by a deficiency in such bone-building nutrients as calcium, vitamin D and other vitamins and minerals. The most common complication of osteoporosis is compression fracture. In people with advanced osteoporosis, compression fractures can occur as the result of simple daily activities such as bending, carrying heavy loads, or a minor fall.
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Osteoarthritis (DJD)

Osteoarthritis, also called degenerative joint disease (DJD), is the most common type of arthritis. OA can occur in almost any joint of the body but most commonly occurs in the fingers, hips, knees and spine. Over time changes occur within the smooth cartilaginous surfaces of the joint. These changes lead to a loss of elasticity and the cartilage becomes stiff or brittle making it susceptible to injury. This will lead to stiffness, pain and crepitation at the joint. Advanced cases may actually result in significant damage to the bone itself.
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Spondylolisthesis

Spondylolisthesis occurs when one vertebrae slips forward (translation) in relation to the adjacent vertebrae. Stability is inversely proportional to the degree of translation. The ability of a vertebrae to "slip" in relation to its neighbor can be caused by many factors, including facet or disc degeneration, trauma or a defect in a region of the vertebrae called the pars interarticularis. Severe cases may result in spinal cord or nerve compression and can require surgical intervention.
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Sprain/Strain

Sprains and strains are two of the most common causes of back pain. They can be caused by trauma, overuse, lack of conditioning, and improper body mechanics. The term sprain is used when this injury occurs in a ligament. Conversely, strain is used when the affected tissue is muscle or tendon. Typically, patients will complain of increased pain with activity and relief at rest. Treatment will often include a period of rest followed by a therapeutic exercise program to increase flexibility and strength.  
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References

1. National Committee for Quality Assurance, NCQA News, HEDISĀ® 2005; Focus is on Health Issues Familiar to Seniors, Working Americans, July 8, 2004.

2. Counseling to prevent low back pain: Section II. In: O'Malley AS, DiGuiseppi C, for the U.S. Preventative Services Task Force. Guide to Clinical Preventative Services: Report of the U.S. Preventative Services Task Force. 2nd Ed. Baltimore, MD: Williams & Wilkins; 1996.

3. National Institute of Neurological Disorders and Stroke, National Institutes of Health, "Low Back Pain Fact Sheet," July 2003.

4. Meta-Analysis: Acupuncture for Low Back Pain, Eric Manheimer, MS; Adrian White, MD, BM, BCh; Brian Berman, MD; Kelly Forys, MA; and Edzard Ernst, MD, PhD, April 19, 2005, Volume 142 Issue 8, Pages 651-663.

5. "Fast Facts on Back Pain." North American Spine Society-A Non-Profit Corporation. Date Retrieved: May 11, 2007. .

6. National Hospital Discharge Survey: 2003. Vital and Health Statistics Series 13, Number 160, U.S. Department of Health and Human Services Center for Disease Control and Prevention, National Center Health Statistics, Hyattsville, Maryland.

7. Bureau of Labor Statistics, U.S. Department of Labor, Survey of Occupational Injuries and Illnesses, 2002.

8. Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G. Department of Health Services, University of Washington, Seattle. Spine. 1994 Jun 1;19(11):1201-6.


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