The very design of the human body seems to leave the back vulnerable to injuries and aches. But determining whether it's a muscle, nerve or spinal problem isn't always easy. Add in the fact that some people "carry their stress" in their backs and chronic back pain is a challenge for both patient and physician.
What causes back pain is sometimes a mystery.
"From the scientific point of view, there's a lot we don't know about what causes back pain," said Dr. Mark Passey, medical director of the pain program at Cottonwood Hospital and a physician with the Intermountain Spine Institute there. One thing is definitely known: "Lower back pain is the No. 1 cause of work-related disability in the country by far. It's the No. 1 monetary risk in the insured workers' compensation population."
Lower back pain is often a combination of different factors, he said. The misery can dominate an individual's life.
Passey and Leslie Lawson, a physical therapist at the Cottonwood Hospital Back Institute, will be featured Saturday on the Deseret Morning News/Intermountain Health Care Hotline. They'll take phoned-in questions about chronic back pain, from prevention to surgical and nonsurgical treatments.
Only a small percentage of patients with chronic back pain require surgery, though the spine institute is a referral center so many potential back patients have already been screened. Generally, at least 90 percent of people who have acute lower back pain severe enough to see a doctor do not need surgery. "It gets better more or less on its own," Passey said. But over the course of a life span, "well into the high 90s" percent of people will have at least an episode of back pain.
How the pain is processed by the body varies. Passey has seen MRI scans on people with fairly significant ruptured disks who have no pain and no back problem. Others, clearly in distress from chronic back problems, look normal on the MRI. "We clearly don't understand every pathway into which a person can get back pain."
One of the problems with any chronic pain is that the pain itself "starts to become its own disease," Passey said. "It makes changes in people's nervous system, leading to poor sleep, depression and further deconditioning because they're afraid to move. They become more and more sedentary, which aggravates muscle pain and back pain. It's a self-perpetuating, vicious downward cycle, independent of how it even started."
Though back pain seems eventually to resolve itself in most patients, it doesn't for everyone. Some injuries must be repaired surgically. Back injuries in some people seem "resistant to treatment." And there are medications that can help in the short term, especially the ibuprofen-type drugs. Occasionally stronger pain pills or muscle relaxers are prescribed, Passey said. Then issues of addiction can begin to surface. "By the time patients end up at a pain clinic, addiction is a problem."
Back problems come, to some degree, with living. "Every human being is subject to degenerative changes along the spine with time," said Passey, who added that if you went to a local mall and examined people 40 and older, "a high percentage would have some abnormalities in their disks and spine," whether they had any pain or not.
Those changes in the back's structure precede most of what people consider "the injury that caused the pain." Most injuries have structural degeneration as their foundation.