Pain in the low back and neck is common. Low back pain affects up to 80% of all people at some time during life, and neck pain affects up to 50% of the population. In the overwhelming majority of people, back pain does not signal a serious disease or suggest that one should avoid normal daily activities. On the contrary, scientific studies show that healing is promoted by staying active, returning to work, and exercising at an appropriate and increasing intensity.Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department.
In some people, the effects are more severe and more frequent, but most experience mild effects and only occasionally. Few experience constant, persistent pain. Research seldom explains why or how pain in the low back or neck originates, or how long it will last, ie, whether it is acute and temporary or will remain a chronic problem. It can result from different, but perhaps associated, factors. The relationship of these factors often remains unknown. Although it is not always possible to cure back pain, treatment methods are available which can effectively relieve pain in most people.
The back is a well-designed structure made up of bone, muscles, nerves and other soft tissues. You rely on your back to be the workhorse of the body — its function is essential for nearly every move you make. Because of this, the back can be particularly vulnerable to injury and back pain can be disabling.
Back pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease. Rather, it is a symptom that may occur from a variety of different processes.
Low back pain can be either an acute or chronic disabling condition. For many, it may be an ongoing condition that flares up occasionally for a few days or weeks, then becomes more manageable again. It will affect most adults at some stage in their life and accounts for more sick leave taken than any other single condition.
Low back pain without sciatica, stenosis, or severe spinal deformity is common, with a reported point prevalence as high as 33 percent and a one-year prevalence as high as 73 percent. In physically active adults not seeking medical attention, the annual incidence of clinically significant low back pain (pain level, 4 or more on a 10-point scale) with functional impairment is approximately 10 to 15 percent. Acute low back pain (lasting three to six weeks) usually resolves in several weeks, although recurrences are common and low-grade symptoms are often present years after an initial episode. Serious or persistent disability is uncommon even among those with low back pain lasting more than three months. Risk factors for the development of disabling chronic or persistent low back pain (variously defined as lasting more than three months or more than six months) include preexisting psychological distress, disputed compensation issues, other types of chronic pain, and job dissatisfaction.However, even among patients with one or more of these factors, only 6 percent were out of work for more than one week during a five-year period.
Strong scientific evidence shows that muscle relaxants, (eg, benzodiazepines) and anti-inflammatory drugs (NSAIDs) relieve pain in patients with acute and subacute low back problems, ie, problems which have existed up to 3 weeks or up to 12 weeks .Limited scientific evidence suggests that these drugs are effective in treating chronic low back pain.
Several different types of injections are used at times to treat both acute and chronic back problems. The injections reviewed were: epidural steroid injections, ie, injections in the spinal cord canal, injections in trigger points and ligaments, and injections in facet joints (small joints in the vertebral column).Limited evidence suggests that epidural steroid injections are more effective than placebo for acute and chronic low back problems involving nerve root pain.
With epidural anesthesia, a thin plastic catheter (which looks much like fishing line) is placed between two bones in your back by an anesthesiologist. This plastic catheter is called an "Epidural Catheter". Where the catheter is placed in your back depends upon the type of surgery you will have and the medicine you will receive. For example, the catheter may be placed in your lower back if you are having knee surgery and higher up for gallbladder surgery.
This pain control method usually causes less sleepiness than medicine given through your IV or as a shot. Epidural medicine stops your pain early and blocks its path to your brain. Patients may have shorter hospital stays and fewer problems after surgery when they have epidural analgesia.
Epidural steroid injections provide limited short-term -- but no long-term -- relief for lower back pain that radiates down a leg, according to a new guideline from the American Academy of Neurology.
The authors of the guideline analyzed studies on the topic and concluded that epidural steroid injections may provide some pain relief for between two to six weeks, but the average amount of pain relief is minor.
"While some pain relief is a positive result in and of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful," noted guideline author Dr. Carmel Armon, chief of the division of neurology at Bayside Medical Center in Springfield, Mass., and a professor of neurology at Tufts University School of Medicine in Boston.
The authors also concluded that epidural steroid injections don't provide long-term pain relief beyond three months and usually don't help patients "buy time" to avoid surgery. The use of these injections for these purposes is not recommended, says the guideline.
"The use of epidural steroid injections to treat chronic back pain is increasing over time despite limited quality data. Recent figures show 1999 Medicare Part B claims for lumbar epidural steroid injections were $49.9 million, for 40.4 million covered individuals," Armon said in a prepared statement.
The guideline authors also said there is not sufficient evidence to use epidural steroid injections to treat neck pain or radicular cervical pain.
Epidural pain control will be used only if you, your surgeon, and the anesthesiologist all agree that this is a good pain management plan. If you feel you would like an epidural for pain control after surgery, please ask. An anesthesiologist can discuss an epidural with you in more detail and answer your questions.
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