Back Pain Overview

Back pain costs Americans around $15 billion per year, for medical care and disability payments.1 Mechanical low back pain is one of the most common complaints expressed to emergency physicians in the United States, and accounts for more than 6 million cases annually. As a health problem, back pain is the 3rd most expensive disorder, after heart disease and cancer.

Occupational injury is a big contributor to the country's back pain woes. According to the Bureau of Labor Statistics, in private industry alone, there were approximately 123,000 work related back injuries in 2004. This is roughly around 10% of all on the job injuries reported by private industry. The good news is that the number of back injuries at work is declining: in 2003 there were 132,000 reported cases.3 Productivity suffers as well. While the specific numbers in citable reports vary, rest assured that back problems cost employers many billions of dollars in lost productivity each year.

Types of Back Pain

• Acute or Chronic
  • Acute is a word used to describe an injury or illness that comes and goes. Acute injuries come on quickly, have very definite symptoms which can be quite intense, and heal in a relatively brief period of time, usually around 6 weeks. Often, and unfortunately, acute injuries to the back or neck can be the precursor to chronic pain.
  • Chronic pain is also referred to as persistent pain. Doctors generally categorize pain as chronic if the same type of pain in the same place has lasted more than between 3 and 6 months.
• Specific Back Pain or Non-Specific Back Pain
  • Specific back pain is back pain that is attributable to identifiable conditions such as those listed below. According to the National Pain Foundation, less than 15% of diagnosed back pain cases can be attributed to a particular cause.
    
    Back Pain Conditions
    
    • Cervical Spondylosis, or Arthritis of the Neck
    • Spinal Stenosis
    • Spondylolisthesis
    • Cervical Kyphosis
    • Scoliosis
    • Kyphosis
    • Whiplash Injury
    
    
  • Non-specific back pain might come from muscles or other vertebral structures. Often non-specific back pain responds well to conservative treatment. The National Pain Foundation 18 has further subcategorized non-specific back pain by type of body system or process causing the pain:
    • Musculoskeletal (includes all soft tissue)- Nocioceptive pain is caused when there is irritation to muscles, bones, tendons, ligaments and/or fascia. The presence of irritation causes the nervous system to send messages to the brain about damage to the soft tissue and bony structures. (It is about this time when your doctor suggests asprin to control inflammation.) The brain then responds by sending out chemicals meant to contain the damage. The brain also sends pain signals.
    • Neuropathy means nerve pain. Neuropathy is a type of back pain that is caused by a pinched nerve or other radiculopathy. Examples of neuropathy include:
      • Parasthesia
      • Radiculopathy
      • Pinched Nerve
    • Discogenic pain is pain from an intervertebral disk that does not cause neuropathy pain. That is, there is an interruption in the disk structure, but the nucleus pulposus has not caused nerve pain symptoms, such as numbness, tingling, parasthesia, etc.
• Anatomical Region
  Back pain can be divided up into locations along the spine. This is the way most non-medical people refer to their back pain concern. The most common terms for back pain based on anatomical location are:
  • Back Pain
  • Neck Pain
  • Sacroilliac Pain
  • Upper Back Pain
  • Mid-back pain

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