Health Management

Back pain – Symptoms, Causes, Treatment and Medication

Back pain.

Back ache or back pain is an unpleasant, disturbed sensation felt in the back. The pain can range between mild to extreme unbearable level depending on the cause of pain. Visual analogue scale (VAS) is used widely do scored the pain levels.
The reasons of back pain may be muscular, neurological, Ligamentous, tendonous, articular or any other pathology (Mechanical or structural). Injury that’s causes any of these problems will induce pain in associated area. The commonest of all is the injury to ligaments or muscles. Sprain and strains as a result of mechanical loading (destructive forces), postural defect or injuries cause pain all over the back. The major causes of back pain are musculoskeletal strains, disc bulge, arthritis, osteoporosis and ankylosing spondylitis. Children and kids are affected with back pain then adults. Back pain can be acute (symptoms appear from less than 4 weeks), Subacute (pain accruing for 4 to 12 weeks) and chronic (patient have symptom from more than 6 months). Oftenly, the patients who visit doctors suffer with chronic pain. Chronic pain is most probably due to postural abnormalities as people with acute and moderate pain usually manage their symptoms at home. Regional classification of back pain says back pain can upper back pain middle or low back pain all three of these have their distinct causes.

Upper back pain and lower back pain

Upper back pain

The between the base of neck and bottom of rib cage is upper backache. This pain is often confused with shoulder or neck pain. Fractures, trauma, stress, abnormal posture, disc problem, long standing arthritis or shoulder pathology all can cause upper back pain. Studies have showed that students suffer with upper back pain the most. Students encounter numerous faulty ergonomic factors daily. The schools going children carry heavy shoulder bags, may have to climb stairs to reach classroom, sits on a faulty chair, desks are standardized size, despite of variation height and weight of students and the board or multimedia is hung above eye level which altogether become the cause of upper back pain. To manage the pain students should change their positions frequently while attending lectures or studying for longer period, take short breaks, exercise daily and use heat modalities on back to relieve pain. Medications available today are for controlling the pain only. Physiotherapy has shown positive results to resolve all kind of back pain.

Middle back pain refers to pain in thoracic spine area. the cause of middle pain is most probably associated with spine. may be arthritis, scoliosis spinal stenosis, degeneration, rapture or herniation of spine. middle back pain can also be referred from kidneys which can easily be differentiated based on sign and symptoms for example difficulty in urination, fever, urine colour changes, nausea or vomiting. in case of extreme pain or other symptoms such as discomfort, weakness or numbness, patient should cancel doctor immediately.

lower back pain

lower back is the region where spine connects with the pelvis. it is the most common region for pain in adults because this is the region where centre of gravity lies, the causes of lower back pain include muscular or tendinous strain, arthritis, osteoarthritis, trauma, structural or postural problems and disc injuries. Muscular and ligament injury are the most common cause of lower back pain. Females (especially pregnant women) are more affected with lower back pain then males due to weight changes and associated changes in centre of gravity and other body mechanics. It is observed that prolong sitting on hard surface is also causes Lower back pain. Lower back pain can also be associated with overuse injuries. lower back pain can be mechanical (due to disturbance in body mechanics) or radicular pain (due to association with nerve). Lower back pain can also be the cause of other pathologies such as pancreatitis, appendicitis, alterative colitis, gynaecological disorders, liver problems, etc. Lower back pain result in sleep disturbances (insomnia). Potion adjustments during night help patient to sleep properly. The best position to sleep at night for lower back pain patient is to lie flat on back. Physical therapy techniques, excercises, chiropractors and massage techniques What can help align the spine and correct postural defaults. Surgeries are also carried out in advanced cases.

lower back pain

Pathogenesis of pain

When are disturbing stimulus is applied, an action potential is generated in sensory neurons which travels across the pain pathway (A pathway through which multiple neurotransmitters and receptors Work in coordinated effort From peripheries to CNS to perceive pain) and enters the brain thus we feel pain. This pathway comprises of four major Stages. The four stages of pain pathway are transduction, transmission, modulation and reception.
First stage of pain pathway is transduction in which the sensory stimulus is changed in The form of nerve impulses.
Second stage of pain pathway is transmission In which the nerve impulses are transmitted to CNS.
whereas the third stage of pain pathway is modulation in which the nerve impulses are change or modulated in the form of electrical activity/ our signals (as brain only respond to electrical activity) for brain to understand the signal.
Lastly, in the fourth stage i.e., reception, The brain collects and analyse the transmitted information to produce appropriate reaction/action.
The detailed pain pathway is shown in the diagram below,


Treatment of back pain includes home management, medication, massage, alteration in physical activity, physiotherapy, chiropractic therapy, electrotherapy, laser therapy acupuncture and surgery.

  • Medication

Pain killers, spasmolytic and cortisone injections are being used as only medication available to relieve pain.

  •  Home management

Avoid getting heavy loads on back, alternating the positions frequently, avoiding prolonged bed rest, using heat pads And doing exercise regularly will help relieve pain at home.

  • Massages

Frictional massages have proved to produce positive effects in case of back pain. Massages relief the pain by relaxing the muscles spasm, improving the Blood supply and lymphatic drainage and reducing the inflammation.

  •  physical therapy

physical therapy techniques including electrotherapy Should be patients first choice to relieve pain. physical therapy techniques such as stretching, heat and cold therapy, postural training, spine manipulation and etc, can help relieve pain whereas electrotherapy procedures such as use of ultrasound, interferential currents, TENS, heat pads all effectively ease back pain.

  •  Chiropractic therapy

chiropractors are specialised people who use their hands to treat and examine spine, bones, joints and muscles. nowadays chiropractic therapy is used as non-surgical method for spine adjustment.

  •  Acupuncture

Though classified as quackery, Acupuncture is Chinese complementary medicine and have proved to produce positive effects in relieving chronic back pain.

  •  Surgery

the last option left to treat pain is surgery. if the pain is associated with stenosis laminectomy is suggested. this helps to release pressure on spine thus relieving the pain.


Many research studies nowadays are being conducted to resolve the causes of back pain in daily life. Researchers are studying the effects of knew as well as old methods to reduce back ache. The epidemiologists claim that 80% of individual experience back pain at different occasions in their life for one or more than one time. Nothing developing countries al comparatively more affected by back pain as majority of people work as labour as a result they have to carry heavy objects on their backs. the epidemiologist Calculated The 1-month prevalence of back pain Around 23%. Musculoskeletal conditions are the major cause of lower back pain around the globe i.e., 7.4%.


Back pain can be caused by multiple reasons and can cause multiple further complications; thus, it should be considered seriously and appropriate doctors should be consulted on time. home management should not include high dosage of pain relievers instead patient should avoid heavy loading forces and other Compensatory postural alignment. Non-surgical methods to treat back pain Should be prioritised rather than rushing for surgical procedures.

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