When you feel pain, it is really a reaction to signals transmitted throughout your body. These signals are sent from the pain source -- such as a sore back, through the nerves in the spinal cord, and up to the brain, where they are perceived as pain.
Different Types of Pain
The origin of some pain is neuropathic, while other pain is nociceptive. This is important to know because different treatments work better for each type of pain.
Neuropathic pain is caused by damage to nerve tissue. It is often felt as a burning or stabbing pain. One example of neuropathic pain is a "pinched nerve."
Nociceptive pain is caused by an injury or disease outside the nervous system. It is often an ongoing dull ache or pressure, rather than the sharper, trauma-like pain that is characteristic of neuropathic pain. One example of nociceptive pain is arthritis pain.
Some people experience mixed pain, which is a combination of neuropathic and nociceptive pain.
Chronic versus Acute Back Pain
Chronic back pain is commonly described as deep, aching, dull or burning pain in one area of the back or traveling down the legs. Patients may experience numbness, tingling, burning, or a pins-and-needles type sensation in the legs. Regular daily activities may prove difficult or impossible for the chronic back pain patient. They may find it difficult or unbearable to work, for example, even when the job does not require manual labor. Chronic back pain tends to last a long time, and is not relieved by standard types of medical management. It may result from a previous injury long since healed, or it may have an ongoing cause, such as nerve damage or arthritis.
Acute back pain is commonly described as a very sharp pain or a dull ache, usually felt deep in the lowerpart of the back, and can be more severe in one area, such as the right side, left side, center, or the lower part of the back. Acute pain can be intermittent, but is usually constant, only ranging in severity.
Sometimes, acute back pain can be caused by injury or trauma to the back, but just as often has no known cause. Patients with acute back pain, even when it's severe, will typically improve or completely recover within six to eight weeks.
Approximately half of all back pain patients have acute pain caused by trauma. A contusion, torn muscle, or strained joint resulting from a back injury can cause acute pain. Patients with any of these conditions typically exhibit pain, muscle spasms, and decreased functional activities. Treatment of acute back pain is short-term and usually successful. With physical therapy, follow-up treatment, and prevention practices, these patients typically return to full functionality in a few weeks. Occasionally, these patients will re-injure themselves and have to return for a short course of treatment. Patients with acute pain occurring more than three times in one year or who experience longer-lasting episodes of back pain that significantly interfere with functional activities (e.g., sleeping, sitting, standing, walking, bending, riding in or driving a car) tend to develop a chronic condition.
Mechanical back pain—a form of acute pain—is aggravated by movement and worsened by coughing. This type of pain is usually alleviated with rest. Mechanical back pain is typical of a herniated disc or stress fracture. For patients with this condition, forward movements of the spine usually cause pain. In addition, posture, coughing, sneezing, and movement can all influence pain coming from the spine.
Diagnosis of Acute Back Pain
- X-rays—Painless, non-invasive imaging process that utilizes photographic film to absorb electromagnetic radiation—having an extremely short wavelength of less than 100 angstroms and the ability to penetrate solids of various thicknesses—transmitted through a material body. These images, also known as radiographs or roentgenograms, are used to diagnose and monitor the treatment of various disorders.
- CAT Scan (computed axial tomography scan)[also called a CT scan (computed tomography scan)]—Another painless imaging technique that utilizes a computer to produce detailed three-dimensional images of a body from a collation of cross-sectional X-rays taken along an axis. Of all the imaging techniques that are currently available, the CAT scan is best able to produce images of bone, blood, and soft tissues.
- MRI (magnetic resonance imaging)—Non-invasive technique for imaging the spine that involves rotating a magnet around the body and exciting its hydrogen atoms. A scanner is then utilized to detect the energy emitted by the excited atoms. MRIs provide exceptional detail of the spine's anatomy, since the human body is composed primarily of water, which is two parts hydrogen. The single most useful test available for diagnosing spinal disorders.
- Myelogram—A test procedure that involves injecting a radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves, and then taking X-rays of the spine. This allows the radiologist to specifically X-ray the nerve roots. In this way, any abnormalities within the spinal canal can potentially be identified to aid in the diagnosis of certain spinal problems, such as nerve compression or a disc rupture.
- Bone Scan—A test procedure that involves intravenously injecting a small quantity of a radiographic marker into the patient, and then running a scanner over the area of concern. The scanner detects the marker, which concentrates in any region exhibiting high bone turnover. A bone scan is utilized when there is suspicion of tumor, infection, or small fractures, i.e., conditions that all result in high bone turnover. A Bone Scan does not replace the above tests, but may provide additional information by eliminating other serious problems.
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