In most cases, back pain is caused by muscle spasm, trauma or deformity of the spine. Approximately in one in 10 cases, has its origin in a systemic disease.
Back pain can appear anywhere in the column, from the neck to the lower back and can locate in a small area or spread to a large area; Likewise, may radiate from the area of origin.
WHAT IS ITS CAUSE?
Back pain has many causes, including degeneration of the vertebrae, infection, tumor, overloading and trauma. The exact cause can be difficult to identify, since it may originate in soft tissue, bone, the intervertebral disc or nerves innervating these structures.
The risk factors for low back pain include jobs that require repetitive motion, exposure to vibration caused by vehicles or industrial machinery, even smoking. Certain sports, such as the pedrestre race, ski, or driving for long periods of time, may be also associated with back pain.
Diseases such as osteoarthritis of the spine, spondylitis and osteoporosis can also be causes of pain; Some of these diseases are more prevalent in the elderly and, therefore, the elderly have higher risk of suffering from low back pain.
Situations such as depression, anxiety, alcoholism or divorce, have been associated with low back pain. However, there are no studies that show conclusively if these problems are the cause or the consequence of pain.
IMPACT ON THE POPULATION
Back pain is the illness most prevalent in industrialized societies. Low back pain is the most common cause of temporary disability in people over 45 years. Approximately 80% of the population have, at least, an episode of low back pain in the course of his life.
Two of every three patients recover within a period of less than one month time and approximately 5% suffers persistent discomfort for more than 6 months. Approximately half of patients with chronic low back pain can resume its work.
DIAGNOSIS
The physician should determine if the pain is of origin musculoskeletal, neurological or visceral. The diagnosis is based on a thorough medical history and physical examination. Sometimes, local injection of anesthetic or a corticosteroid in certain structures or space to articulate, can help in the diagnosis and treatment of back pain.
Imaging techniques, including simple x-ray, scan, CT scan, myelography and nuclear magnetic resonance, can serve to identify the source of the pain. Neurophysiological studies can also be useful on occasions. Imaging techniques more expensive must be reserved for those patients whose diagnosis can not be by conventional procedures, including physical examination.
TREATMENT
Painkillers such as aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs, sometimes are the only necessary treatment for back pain. Activities that increase the pain must be avoided. If the pain is persistent, the patient must be valued by a rheumatologist.
The treatment should be addressed to the specific cause of the pain; the therapeutic possibilities include analgesics, anti-inflammatory drugs, antidepressants, relaxing muscle and rehabilitation exercises.
In certain situations, for example, in post-operative surgery or the rachis may be advisable the use of Orthopedic corset; If there is no improvement after a reasonable period of time, can be tested the use of infiltration with corticosteroids or local anaesthetics.
Surgery should be reserved for those situations in which the conservative procedures fail.
In some patients who do not respond to conservative treatments, stimulators used electrical or continuous morphine infusion pumps.
THE ROLE OF THE RHEUMATOLOGIST IN THE TREATMENT OF BACK PAIN
The rheumatologist is the proper specialist to perform a complete assessment of patients with back pain, and establish a treatment program. Since surgery is indicated only in a small percentage of patients, it is clear that the performance of the rheumatologist can significantly lower the economic impact of back pain by reducing hospitalization periods and the need for costly procedures and techniques.
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