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When you feel pain, it is really a reaction to signals
transmitted throughout your body. These signals are sent from
the pain source -- such as a sore back, through the nerves in
the spinal cord, and up to the brain, where they are perceived
as pain.
Different Types of Pain
The origin of some pain is neuropathic, while other
pain is nociceptive. This is important to know because different
treatments work better for each type of pain.
Neuropathic pain is caused by damage to nerve tissue.
It is often felt as a burning or stabbing pain. One example of
neuropathic pain is a "pinched nerve."
Nociceptive pain is caused by an injury or disease
outside the nervous system. It is often an ongoing dull ache or
pressure, rather than the sharper, trauma-like pain that is characteristic
of neuropathic pain. One example of nociceptive pain is arthritis
pain.
Some people experience mixed pain, which is a combination
of neuropathic and nociceptive pain.
Chronic versus Acute Back Pain
Chronic back pain is commonly described as deep, aching, dull
or burning pain in one area of the back or traveling down the
legs. Patients may experience numbness, tingling, burning, or
a pins-and-needles type sensation in the legs. Regular daily activities
may prove difficult or impossible for the chronic back pain patient.
They may find it difficult or unbearable to work, for example,
even when the job does not require manual labor. Chronic back
pain tends to last a long time, and is not relieved by standard
types of medical management. It may result from a previous injury
long since healed, or it may have an ongoing cause, such as nerve
damage or arthritis.
Acute back pain is commonly described as a very
sharp pain or a dull ache, usually felt deep in the lowerpart
of the back, and can be more severe in one area, such as the right
side, left side, center, or the lower part of the back. Acute
pain can be intermittent, but is usually constant, only ranging
in severity.
Sometimes, acute back pain can be caused by injury
or trauma to the back, but just as often has no known cause. Patients
with acute back pain, even when it's severe, will typically improve
or completely recover within six to eight weeks.
Approximately half of all back pain patients have
acute pain caused by trauma. A contusion, torn muscle, or strained
joint resulting from a back injury can cause acute pain. Patients
with any of these conditions typically exhibit pain, muscle spasms,
and decreased functional activities. Treatment is short-term and
usually successful. With physical therapy, follow-up treatment,
and prevention practices, these patients typically return to full
functionality in a few weeks. Occasionally, these patients will
re-injure themselves and have to return for a short course of
treatment. Patients with acute pain occurring more than three
times in one year or who experience longer-lasting episodes of
back pain that significantly interfere with functional activities
(e.g., sleeping, sitting, standing, walking, bending, riding in
or driving a car) tend to develop a chronic condition.
Mechanical back pain - a form of acute pain - is
aggravated by movement and worsened by coughing. This type of
pain is usually alleviated with rest. Mechanical back pain is
typical of a herniated disc or stress fracture. For patients with
this condition, forward movements of the spine usually cause pain.
In addition, posture, coughing, sneezing, and movement can all
influence pain coming from the spine.
When acute back pain is severe and travels down
both legs, it could be caused by lumbar disc disease - the most
common cause of true sciatica, another form of acute pain.
Diagnosis of Acute Back Pain
X-rays - Painless, non-invasive imaging process that utilizes
photographic film to absorb electromagnetic radiation - having
an extremely short wavelength of less than 100 angstroms and the
ability to penetrate solids of various thicknesses - transmitted
through a material body. These images, also known as radiographs
or roentgenograms, are used to diagnose and monitor the treatment
of various disorders.
CAT Scan (computed axial tomography scan)[also called
a CT scan (computed tomography scan)] - Another painless imaging
technique that utilizes a computer to produce detailed three-dimensional
images of a body from a collation of cross-sectional X-rays taken
along an axis. Of all the imaging techniques that are currently
available, the CAT scan is best able to produce images of bone,
blood, and soft tissues.
MRI (magnetic resonance imaging) - Non-invasive
technique for imaging the spine that involves rotating a magnet
around the body and exciting its hydrogen atoms. A scanner is
then utilized to detect the energy emitted by the excited atoms.
MRIs provide exceptional detail of the spine's anatomy, since
the human body is composed primarily of water, which is two parts
hydrogen. The single most useful test available for diagnosing
spinal disorders.
Myelogram - A test procedure that involves injecting
a radiographic contrast media (dye) into the sac (dura) surrounding
the spinal cord and nerves, and then taking X-rays of the spine.
This allows the radiologist to specifically X-ray the nerve roots.
In this way, any abnormalities within the spinal canal can potentially
be identified to aid in the diagnosis of
Bone Scan - A test procedure that involves intravenously
injecting a small quantity of a radiographic marker into the patient,
and then running a scanner over the area of concern. The scanner
detects the marker, which concentrates in any region exhibiting
high bone turnover. A bone scan is utilized when there is suspicion
of tumor, infection, or small fractures, i.e., conditions that
all result in high bone turnover. A Bone Scan does not replace
the above tests, but may provide additional information by eliminating
other serious problems.
Provided by Medtronic Sofamor Danek
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