29 January 2021 Author : Ricardo Frada Two out of three adults suffer from back paint some point in their life. The physical limitation that this pain can cause interferes in everyday life, from compelling absenteeism to preventing physical exercise. Complaints of back pain, most often in the low back (lumbar) or cervical (in the neck), are one of the main reasons that lead to seeking orthopedic consultations. The good news is that in 90% of people with complaints of back pain, the pain is acute. This means that it is short term pain that will disappear in a few days or weeks. In fact, in most people the cause of back pain is mechanical, and the pain resolves without any treatment. What are the causes of back pain? In most cases, back pain is due to muscle contracture caused by weight load, spinal sprains, impact trauma, mechanical overload of the spine, resulting in disc herniation or painful arthrosis of the spine joints. However, in addition to mechanical or functional causes , which represent about 97% of cases, back pain may also be due to : Inflammation; Fracture; Active infection; Neoplasia. In order to define the best treatment, the medical evaluation will identify the cause of the pain , also considering the possibility that it may be a problem not related to the spine, but that radiates pain to the spine. Diagnosis To make a correct diagnosis it is essential: A complete medical history and also directed to complaints; A physical examination also directed to find warning signs that justify a need for imaging tests, such as radiography, magnetic resonance imaging (MRI) or computed tomography (CT). Sometimes, the pain located in the lumbar or cervical region does not originate in the spine, but in diseases of the hip or shoulder, respectively. This relationship may justify a directed physical and imaging examination. The work of a multidisciplinary and dedicated team in each anatomical area allows an integrated and complete approach to the patient . Treatment of back pain Conservative or non-surgical treatment Most back pain does not require surgery. With proper treatment, 80%-90% of people show a good level of recovery in 6-8 weeks. For pain treatment , the following may be indicated: Medicines such as paracetamol, some non-steroidal anti-inflammatory drugs (NSAID) or opioids, which should always be taken according to the medical advice; Epidural infiltration may be an option when pain does not respond to drug treatment. Bed rest for more than 2 to 3 days is not useful in most cases; Patients should resume activities as soon as possible; Exercise is an effective way to speed recovery and to help strengthen your back and abdominal muscles; Exercise also helps to reduce the risk of low back pain recurrence. Physiotherapy is important in resolution and rehabilitation: The use of advanced physiotherapy techniques, namely global postural reeducation and clinical training have proven to be fundamental in the treatment of functional spine diseases. It allows the improvement of the quality of life in patients with complaints that are often disabling. Surgical treatment Correct diagnosis and surgical indication are determinants of successful spine surgery. Surgery is an option to consider whenever: Non-surgical treatment did not have the desired success; Pain complaints are associated with progressive neurological deficits, signs of myelopathy, and cauda equina syndrome, that are the absolute indications for emergency surgery. Currently, spine surgery is ideally performed using minimally invasive techniques , which have great advantages for patients: Minimally invasive techniques allow to obtain results equivalent to those of classic open techniques; Safety is also equivalent; They allow greater preservation of tissues and anatomical structures, because are much less aggressive, and in the medium / long term they help to delay the degenerative process of the spine; Postoperative pain is less and recovery and return to active life are faster. Meet the orthopedics team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
