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“НАШЕ ЖИТТЯ”, СІЧЕНЬ 2011 23 Oh My Aching Back Ihor Magun, MD, FACP F our out of five adults experience back pain that requires a medical consultation at least once in their lifetime. And that statistic doesn’t take into account the high incidence of back pain that flares up and dies down and never gets medical attention at all. The extent of back pain and its importance is underscored by the sheer fact that approxima tely one percent of the United States population is chronically disabled because of back pain and related issues. The prevalence of back pain is not sur - prising when you consider that the human back is a complex structure composed of vertebrae, muscles, li gaments, joints, and inter vertebral discs. Any one of these substructures of the back can be affected in a way that causes pain. And once pain flares up, resolving it and recovery may take some time. Back pain can occur at any age. In youth, the most com mon causes are physical injury, overexertion, or trauma. As we age, our anatomy changes and all the injuries that occurred at every previous stage of life make their presence felt. Past injuries become additive and are exacerbated by poor physical fitness, excess weight, improper posture while sitting, and chronic improper lifting, pushing or pulling. All of these factors increase the chances of this dreaded malady. But back pain can also be signal of other conditions or ailments: infections, pregnancy, kid ney stones, scoliosis, endometriosis, fibromyalagia and even some tumors may first present as back pain. Typically, back pain that is really back pain (and not an underlying symptom of something else) can be classified into five distinct categories that ar e described below. Fortunately, most causes of back pain are muscular in nature. Not so fortunately, the pain may not occur exactly at the time of injury, so the underlying cause of the discomfort is frequently unknown because the pain is not associated w ith the forgotten injury. Another cause of back pain is spinal stenosis, a narrowing of the spinal canal. Pain is typically induced by walking or standing and abated by sitting or lying down. Osteoporosis presents as pain mainly due to compression fractu res of the vertebrae. These are chronic in nature and seen more commonly in women after menopause. The sole manifestation may be a localized ache (exacerbated with move - ment) after a trivial injury. Spondylolisthesis produces discomfort due to the instabil ity of the vertebrae, which, in turn, leads them to begin to slip. The most common cause is linked to degenerative changes, which lead to loss of normal stabilizing structures of the spinal column. Herniated discs can compress spinal nerves as they exit th e spinal column. This can be the result of improper lifting or repetitive vibrating motions (like those experienced by machine operators and truck drivers). Frequently the pain radiates in a band - like pattern along the course of a nerve. Acute back pain is defined as pain that persists for up to six weeks, and chronic back pain persists for more than three months. Diagnosing back pain generally combines a review of medical history and a physical examination. X - rays, CAT scans, or MRI scans are incorporated as needed. The primary goal of treatment is pain management, but treatment aimed at recovery can be frustrating and prolonged, especially if a diagnosis is inexact. Treatment usually includes using a com - bination of measures, including hot and cold applic ations and medications. Heat reduces spasms and pain, while cold can decrease swelling and help with deep pain. Analgesic medications (either over - the - counter medications or more potent prescription medications) are the mainstay of treatment. Muscle relaxa nts, supervised physical therapy, or local injections may be necessary. Prompt medical attention after trauma that affects the back is critical, especially if the injury results in numbness or severe pain. Changes in urination or bowel habits, fever, or un explained weight loss should also signal that a physician ‘s evaluation is necessary. T he best way to fight back pain and strengthen your back is to minimize strain. Sit properly with your back against a chair back and your feet on the floor. When lifting something, keep your back straight and bend your knees. Do stretching exercises to loosen tight muscles. Your back will thank you.
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