Back pain, which afflicts four out of five Americans at one time or another, is second only to headache as a common disorder characterized by pain. Pain in the upper spine may accompany an injury; however, for the overwhelming majority, the pain originates in the lower back, or lumbar region.
Recent studies indicate that fewer than 15 percent of cases of lower back pain are traceable to structural defects, such as ruptured disks, arthritis or tumors. In most cases, the disability arises from weakness of the musculature surrounding the spine. Therefore, the most important aspect of treatment for muscle-based back pain involves strengthening and protecting these supporting muscles. With a doctor's guidance, well-informed and motivated patients can carry out most of the treatment themselves.
How the Pain Originates
The spinal column is made up of 24 separate and nine fused vertebrae, held together with tough bands of tissue called ligaments. Nerve roots pass through openings at the side of each vertebra. Thus, a wrench of the back or a failure of muscular support may result in the painful "pinching" of a nerve. The sciatic nerve--which extends from the lumbar area into the buttock, leg and toes--is particularly vulnerable to pressure. (The condition known as sciatica is a frequent companion to lower back pain, usually associated with a ruptured disk.)
Pain also is generated when muscles go into spasm. While such spasms may occur as a protective reflex, they intensify discomfort by choking off circulation and setting up an inflammatory response. Stress of any kind--physical or psychological--may cause spasms in under-exercised muscles.
Basic Causes
Recurrent back pain--leading to the deterioration of the muscles supporting the spine--usually can be traced to a specific condition. These include--singly or in combination--a sedentary life style, obesity, poor posture and a general lack of muscular tone. The type of exercise taken by usually sedentary people often fails to strengthen muscles supporting the lower back. Indeed, such popular weekend sports ans tennis, golf and skiing may actually promote back problems.
Treating the Pain
Typically, acute low-back pain comes on suddenly and without apparent reason. Symptoms of sciatic nerve involvement--twinges, numbness, burning--may also be present. For such cases, a regimen of bed rest, hot baths and aspirin or a prescribed painkiller usually provides relief. A short course of muscle relaxants may be recommended. If sagging abdominal muscles need support, a girdle is helpful.
In about 90 percent of all cases, low-back pain subsides within two months. However, if the circumstances that caused it are not altered, it is likely to recur.
Preventing a Recurrence
As soon as possible after the acute pain subsides, exercises should be undertaken to strengthen muscles in the back and abdomen. A long-term weight-reducing plan may also be advised. Yoga, meditation and breathing exercises may help reduce tension and stress.
If your daily routine involves many hours of standing, check your posture in profile. Your chest should be raised, buttocks tucked in and stomach flat. Sedentary workers should have a chair with armrests,, support for the lower back, a movable upper section and an adjustment for height, so that feet can rest on the floor. When picking things up, bend at the knees only. If the object is heavy, hold it close to flexed abdominal muscles. Sports involving sudden body movements should be avoided in favor of walking, jogging, cycling and swimming.
Chronic Disabling Pain
When diagnostic tests determine that the cause of severe and unremitting back pain is nerve damage, tumor, arthritis or bone inflammation, therapy involves more extensive treatment, which may include surgery, drugs and physical therapy.
Very often, long-time sufferers from back pain of unidentifiable origin become "lower back cripples," limiting their activities and life style for fear of provoking pain. If the back becomes an excuse for avoiding responsibilities or confronting underlying problems, professional counseling should be considered.
Summing Up
Back pain is one of our most common health problems, but it can usually be resolved by proper exercise, heat, diet and other conservative measures. While 90 percent of all back pains dissipate within a few weeks, precautions should be taken to prevent their recurrence. Less frequent causes of lower back pain include arthritis, tumors and structural or neurological defects, which require clinical treatment.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
