1. What are the causes of back pain?
2. What are the symptoms of Back Pain?
3. What is the purpose of diagnosing the cause of low back pain?
4. What kinds of tests can determine the cause of back pain?
5. What is sciatic pain?
6. What is a Herniated Disc?
7. What is the difference between a bulging disc and a herniated disc?
8. Does back pain always need surgery?
9. Could I return to work with pain?
10. Could I do my usual exercise?
11. If my pain is severe, what should I do?
12. Do I have to change my mattress? What type of bed do you recommend?
13. What about a brace?

1. What are the causes of back pain?

Pain appreciated in the low back may have several different origins. We know that pain is transmitted through nerves and these nerves not only travel to the legs, but they also travel to the back muscles, the back joints and the discs. When these nerves are irritated, pain is appreciated.

When the disc is irritated, as in degenerative disc disease, pain is often appreciated when sitting. Pain of facet joint origin occurs when that joint is irritated on extending backwards, and is thought to occur in about 1/5 of those individuals with low back pain.

Sometimes pain is appreciated when one has an extremely unstable spine, or spinal instability. This type of pain is usually deep to agonizing and relieved by lying flat.

Other more serious causes of low back pain include fractures, infection (osteomyelitis) and tumors.

There are also many other conditions, which can contribute to back pain. These conditions are almost always treated non-surgically, resulting in a successful outcome the vast majority of the time.

2. What are the symptoms of Back Pain?

Pain that interferes with sleep. Weakness or numbness in one or both legs or groin area- can mean nerve compression by the back. Problems with bladder or bowel control can also occur due to compression. Typically there is a continuous ache in the back that is not relieved by change of position, it is worse in the morning. The individual is unable to perform normal daily chores or housework. Bending to pick up something from the floor can be a painful task.

3. What is the purpose of diagnosing the cause of low back pain?

Back pain is one of the most difficult ailments to diagnose. Sometimes a very slight injury produces a lot of pain. Other times a very severe injury causes no pain at all.

There are three main objectives of a clinical diagnosis:

• To rule out the rare but serious causes of back pain such as infection or tumor, as well as anything that would constitute a medical emergency.
  
  
• To determine whether there are nerve problems (neurological deficits).
  
  
• To categorize your back problem.

4. What kinds of tests can determine the cause of back pain?

There are many tests used to diagnose back pain: plain x-rays, bone scans, discograms, electromyography, myelogram, CT scan and MRI. Yet, despite the medical technology, the difficulties of diagnosing back pain remain a problem.

5. What is sciatic pain?

This type of pain is severe, radiates in a line down the leg. It is usually caused by compression of a nerve root by a herniated disc. In addition to severe pain, one can also have associated numbness, weakness or, rarely, bowel and bladder problems.

6. What is a Herniated Disc?

A disc herniation occurs when a portion of the intervertebral disc material bulges and "sticks out" into the neural canal. This can produce pressure on the spinal cord or nerve roots and cause pain, numbness, or tingling into the arm or leg. This is very rarely a surgical condition and usually responds with non-surgical treatment. This is also often referred to as a "slipped disc" and is much different that a ruptured disc fragment, which can sometimes lead to surgery.

7. What is the difference between a bulging disc and a herniated disc?

A disc begins to bulge when the nucleus pulposus in the center of the disc pushes out against the surrounding annulus fibrosis, much like air being blown into a balloon. In a bulging disc, the nucleus stays contained within the annulus. Bulging discs are common and will even be seen on MRI in a high percentage of people who do not have pain. A bulging disc causes problems when it balloons into the space in the spinal canal.

Think of a herniated disc like a balloon that actually pops. The disc herniates when the soft, inner nucleus actually squeezes its way through the annulus and ruptures out of the disc--like a popped balloon. Pain symptoms can be felt from the tear in the annular ligament, pressure of the disc material against the nerves, and from the inflammation caused by the nucleus material that is squeezed out of the disc. If there is pressure on a nerve, symptoms of numbness and weakness may also be noticed in the areas supplied by the nerve

8. Does back pain always need surgery?

No. Most of the back pain gets better with 48 hours of rest, medication and sometimes modification of job duties.

9. Could I return to work with pain?

Yes. If you are able to tolerate your pain.

10. Could I do my usual exercise?

Yes, all light exercises. No heavy exercises, no lifting, no bending forward.

11. If my pain is severe, what should I do?

First, inform your employer, then see the company doctor, or your family physician who will prescribe medication for relief of pain and advise for work, if required.

12. Do I have to change my mattress? What type of bed do you recommend?

In general, a firm mattress. It is recommended to sleep on a mattress or hard floor for a few weeks. No water beds.

13. What about a brace?

A back support during acute phase may be helpful.

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