Extreme back pain
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Understanding Extreme Back Pain: Causes, Prevalence, and Management
Causes of Extreme Back Pain
Spinal Stenosis and Herniated Discs
Extreme back pain is often attributed to several underlying conditions. The most frequent cause is spinal stenosis, followed by herniated intervertebral discs, facet osteoarthritis, and osteoporotic compression fractures. In patients under 50, herniated discs are more common, whereas spinal stenosis is prevalent in those aged 50 and above.
Physical Load and Occupational Risks
Manual materials handling, bending, twisting, and whole-body vibration are significant risk factors for back pain. Moderate evidence also links patient handling and heavy physical work to back pain, while no substantial evidence connects standing, walking, sitting, sports, or total leisure-time physical activity to back pain.
Prevalence and Demographics
General Population
Back pain is a widespread issue, with a prevalence in the United States ranging from 8% to 56%. It is estimated that 28% of people experience disabling back pain at some point in their lives, and 8% of the working population is disabled by back pain annually. The lifetime prevalence of low back pain is between 65% and 80%.
Athletes
In athletes, the lifetime prevalence of low back pain ranges from 1% to 94%, with the highest rates observed in rowing and cross-country skiing. The point prevalence varies from 18% to 65%, with the lowest in basketball and the highest in rowing.
Age and Gender
Contrary to the belief that back pain prevalence decreases with age, severe forms of back pain actually increase with age due to conditions like osteoarthritis, disc degeneration, osteoporosis, and spinal stenosis. Women are more frequently affected by extreme back pain, comprising 66.4% of the study population in one analysis.
Management and Treatment
Spinal Injections
Spinal injections can be an effective method for managing extreme back pain or sciatica, with a 44.2% success rate in reducing pain by at least 30%. Patients who respond well to spinal injections are less likely to require lumbar surgery within six months.
Primary Care and Long-Term Outcomes
Back pain typically follows a recurrent course rather than an acute, self-limiting one. Most patients improve significantly within the first four weeks of treatment, but 66% to 75% continue to experience mild pain after one month. Long-term, about 33% report intermittent or persistent moderate pain, and 20% to 25% face substantial activity limitations.
Conclusion
Extreme back pain is a multifaceted issue with various causes, including spinal stenosis, herniated discs, and physical load during work. It affects a significant portion of the population, with varying prevalence across different demographics and activities. Effective management often involves spinal injections and addressing recurrent pain patterns in primary care settings. Understanding these factors is crucial for developing better treatment and prevention strategies.
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