Back pain

Back Pain

Back pain refers to temporary or persistent discomfort in the back region, typically caused by muscle or ligament strain due to improper lifting techniques, weak or fatigued lower-back muscles, poor posture (sitting, standing, walking, running, sleeping), prolonged standing, obesity, stress, or inflammatory conditions of spinal ligaments or joints.

Back pain can be classified into two types: acute back pain (lasting less than 6 weeks) and chronic back pain (lasting longer than 6 weeks). Pain not caused by muscular or ligamentous strain may indicate other underlying conditions such as cancer or spinal joint diseases.

Patient Advice

• Exercise regularly to strengthen spinal and back muscles, facilitating faster recovery.
• Maintain correct posture when sitting, walking, or driving.
• Avoid bending the back when lifting objects; instead, squat with a straight back to lift items safely.
• Frequently change posture during prolonged sitting or standing.
• Maintain an optimal body weight.
• Sleep in proper positions, such as lying on the back with a pillow under the knees, or sleeping on the side with a pillow between the knees.
• Avoid wearing high-heeled shoes.
• Quit smoking.

When to See a Doctor

Seek medical consultation if:

• Pain does not improve after 2-3 weeks of self-care, or worsens over time.
• Pain interferes with daily activities.
• Pain intensifies at night, disrupting sleep.
• Sudden back pain following a fall, severe accident, or back injury.
• Muscle swelling or deformity.
• Back pain accompanied by fever.
• New onset of bowel or bladder dysfunction accompanying back pain.
• Increased pain upon sneezing, coughing, or bowel movements.
• Pain radiating down one leg, especially beyond the knee.
• Weakness, numbness, or tingling sensations in one leg, genital region, or buttocks.
• Unexplained weight loss.
• First-time back pain occurring in patients older than 50.
• Chest pain or pain between the shoulder blades.
• History of cancer, osteoporosis, chronic steroid use, drug abuse, or heavy alcohol consumption.

Treatment Options

1. Non-Opioid Analgesics and Antipyretics

Paracetamol:

• Relieves pain without anti-inflammatory effects.
• Maximum daily dosage should not exceed 4,000 mg.

2. Opioid Analgesics

Opioids (e.g., tramadol, morphine,fentanyl):

• For moderate to severe pain management.
• Major side effect: respiratory depression; use cautiously in patients with respiratory disorders (e.g.,asthma).
• Requires careful monitoring by healthcare professionals.

3. Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Risk of tinnitus with overdose.
• Contraindicated in individuals under 19 years with influenza, chickenpox, or dengue fever due to risk of Reye’s syndrome.

• Have fewer gastrointestinal side effects than non-selective NSAIDs.
• Still carry potential risks to cardiovascular and renal systems.