Sick people

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Some illnesses cause back pain. Pain of this kind is a reaction in the back to a general disorder. It is therefore not a "genuine" back pain like what doctors call unspecific low back pain, and it is the underlying disorder wich has to be treated.

A chronic illness can increase the risk of back pain if it entails physical inactivity and repose. The section on "Sedentary People" explains the mechanisms whereby these factors increase the risk of back pain and describes ways of preventing this. Anyone with a chronic illness should consult their doctor in order to adapt these measures to their particular case.

The information in this section is therefore intended for people who actually suffer back pain.

Causes of pain

It was once thought that back pain was always due to disorders of the spinal column such as scoliosis or herniated disc. We know today that this is not the case.

Back pain is produced by a neurological mechanism that causes pain, inflammation and muscle spasm. Only in a few cases is pain caused by an organic disorder of the spinal column, such as a herniated disc or spinal stenosis, but that is not generally the case. Most alterations of the shape of the spinal column are variants of the norm. They do not cause problems and are found as often in healthy people who suffer no discomfort as they are in people who suffer pain.

Repeated strains in bad postures, and above all the lack of sufficient muscular strength and balance, can be predisposing factors. Examples of other factors that have been shown to increase the risk of back pain include the fear of back pain and exposure to vibrations.

How to avoid back pain

To avoid back pain, it can be important to keep as physically active as possible, to exercise and to observe rules of postural hygiene like those listed in this site.

How to diagnose the cause of back pain

The most important and most reliable sources of information are clinical history and physical examination.

Contrary to what was once thought, X-rays are not very useful for detecting the cause of back pain. Only where the clinical history and physical examination suggest that it is necessary is there any point in having:

a. X-rays or blood analyses to determine that the pain is not due to general ailments manifesting themselves in the back.

b. Magnetic Resonance. This is a mistake unless it is warranted by a clinical history or physical examination (for example, about 30% of healthy people have herniated discs that give no problems, and their identification by magnetic resonance can lead to the prescription of inappropriate treatment).

c. Neurophysiological tests, essentially to detect or monitor compression of nervous structures.

How to treat back pain

Contrary to what was once thought, when your back hurts it is important to keep active and move as much as the pain allows, and to avoid taking repose in bed.

In most cases the pain disappears in less than 7 days, practically irrespective of the treatment administered.

The vast majority of patients with more persistent back pain can be satisfactorily treated with medication, neuroreflexotherapy, exercise or other non-surgical treatments.

Contrary to what was once thought, we now know that surgery is indicated in less than 1% of patients with chronic back pain and should only be resorted to when there is clear evidence of the need and the prognosis is favorable.

This site contains a section that lists all the existing treatments for back problems. Another section lists the common patterns of treatments that have been scientifically proven effective.