Back Pain Is Not Always About The Back

By Jan Howard

Eighty to 90 percent of adults suffer with back problems at some time during their lifetime. Some are even incapacitated by it.

In most cases, however, problems are resolved within two weeks through rest and use of anti-inflammatory medications. Resolution may take up to a month if associated with leg pain.

Dr Alan Blasic of Newtown, an orthopedic surgeon who specializes in spinal disorders, discussed the various causes and treatments of back pain during a Parish Nurse Ministry program, “Up Front About Back Pain,” March 31 at St Rose School.

Dr Blasic suffered a neck injury that forced him to give up his surgical practice in 1999.

“Back pain is an immense topic,” Dr Blasic said. “It can be a controversial topic.” He explained that there are differences of opinion from physicians in various parts of the United States as to how to treat someone with a particular back disorder.

“Not everything is known about the spine,” he said. He noted if there are good results, it is a wonderful subspecialty, but it can be challenging at the very least.

If symptoms persist for more than a year, which is true in about two percent of the cases, there will be persistent problems, according to Dr Blasic.

In 80 to 90 percent of the people, cause of the back problem cannot be found. There are certain risk factors, such as from occupations that cause vibration or require lifting, and heavy smoking, he said.

Dr Blasic said the spine has joints that provide flexibility and movement, and problems can occur that are the cause of future problems. These include congenital problems, developmental problems, metabolic, such as vitamin or hormonal deficiencies, tumors, infections, such as Lyme disease, and degenerative problems, the wear and tear of elements of the spine as a person gets older, such as arthritis.

“This is a basic group of what can happen in the spine and contribute to back pain,” he said.

The spinal cord is composed of the cervical spine (neck), thoracic spine (upper and middle back), and lumbar spine (lower back). There are seven cervical vertebrae, 12 thoracic vertebrae, five lumbar vertebrae, the sacrum, and the coccyx, better known as the tailbone.

The vertebrae are each separated by disks and joints that allow bending and give the spine movement.

In the neck, nerves come together to form main nerves that transmit information, such as to muscles in the back. In the lumbar area, there are thick nerves, such as the sciatic nerve. “There can be irritation of some component of the nerve,” Dr Blasic said.

“The purpose of nerves is they are basically wires, sending signals from the brain,” he said. “Other nerves send signals back to the brain, such as pain or pressure.”

He said nerves come out of the spinal cord at each level.

“Everything in the body has a nerve supply,” he said. “Any place in the body can cause pain.” There can be inflammation of the nerves.

“Back pain doesn’t mean the problem is in the back,” he said. Diseases, such as gall bladder disease, and vascular and pelvic problem could be the source of the problem. Pain from the back can be either muscular or from the nerve roots, he said.

Spinal stenosis is a degenerative condition, but it can occur in children. It is caused by tightness around the nerve elements. “As we get older, there is a thickening of ligaments that surround the spinal cord,” Dr Blasic said. Bone spurs can also form. “The nerves don’t have enough room. There is a compression of the nerves.” The treatment of choice is usually surgery, he noted, and the results are good, but the condition could be treated with anti-inflammatory drugs, exercise, or injections of steroids.

“Pain can be reduced by reducing inflammation,” he said.

Exercise is important for a number of reasons, Dr Blasic said. It strengthen muscle and stretches ligaments. “As we get older, there is wear and tear on disks,” he said. “With exercise, the attempt is to transfer more load to stronger muscles and less on the spine.” He added that bone responds to weight put on it so exercise strengthens bones.

Disks serve as a cushion between the bony elements of the spine and help with motion, Dr Blasic said. As the disk loses water, it become more brittle and can form a tear. The center part, the nucleus, can protrude in any direction, but usually takes the path of least resistance, which is backwards to the nerve roots. With a large herniation, a person could have pain in both legs, he noted. A person could have pain or numbness or a combination of both or muscle atrophy.

“When it extrudes out, enzymes are released that contribute to symptoms you have,” he said. “This causes an inflammation reaction.”

A herniated disk is usually resolved with bed rest to calm down the inflammation, painkillers, and physical therapy. The next step might be injections.

A video of Dr Blasic’s presentation may be borrowed from the Parish Nurse Ministry office at St Rose of Lima on Church Hill Road.