diseases

LOW BACK PAIN

Low back pain can be differentiated into four types:
a) Local pain
b) Referred pain
c) Radicular pain
d) Pain arising from secondary muscle spam (A protective mechanism)

There are several symptoms in the diseases of the spine. The person may experience stiffness, limitation in the movement and deformity but pain gets the foremost importance because of discomfort and the disability that is experienced by the suffering person.

Importance must be given to the character, location and the conditions that modify the pain. This will help in correctly identifying the cause of the pain.

Local pain:
It is caused due to pathologic process, which presses upon or irritates the sensory nerve endings (Sensory nerve endings the nerve endings which carry the pain sensation). If the involved structure doesn't have sensory nerve endings then there will be no pain.

For e.g. if the central medullary part of the vertebral body is destroyed by a tumor there will be no evidence of pain due to absence of sensory nerve fibres. In the same case if the affected parts are the muscles, the ligaments or the annulus fibrosis it will cause severe pain due to involvement of the sensory nerve endings.

Often there will be swelling of the tissues involved in case of pain but it cannot be noticed if the deep structures of the back are involved. The character of the pain is described as a steady intermittent but it can also be a sharp and dull pain. The pain varies considerably with the position and the activity of the spine.

One characteristic of the local pain is that it will be felt in the area that is affected. The patient will experience tenderness if the affected part is examined by putting firm pressure. This helps in identifying the site of abnormality.

Referred pain:
As the name suggests, "referred" it is the pain that is referred to other part of the body from the site of abnormality. This happens due to the fact that the nerve that is affected also supplies to the other structures of the body. So if the nerve is compressed or impinged the pain will also be felt in the distant parts that are supplied by the same nerve.

Referred pain is of two types one type of pain is that which is projected from the spine into the regions, which are supplied by the nerves that pass from the lumbar or sacral region of the spine (Lumbar and upper sacral dermatomes).

The other type of referred pain is the one, which is referred from the abdominal structures to the spine.

If the upper part of the lumbar spine is affected the pain will be experienced in the anterior aspect of the thighs and the legs. If the lower lumbar and sacral segments are involved then the pain will be referred to the gluteal region (Buttocks) and the posterior aspect of the thighs and the calves.

The character of the referred pain is of deep aching character and is diffuse. At times the pain is felt in the superficial structures of the back. Certain movements, which give relief in the local back pain, will also relieve the referred pain.

Relief of Radicular or root pain is more precise with certain movements of the spine, which release the pressure on the affected nerves. Referred pain can sometimes be confused with the pain in abdomen but the abdominal pain will be deep and the radiation will be from the abdomen to the back.

Also if the pain is due to any pathology in the abdominal organs there wont be much change in the pain on movement as seen in referred pain. Whereas relief will be felt when there is activity of the affected part.

Radicular pain or Root pain:
As the name suggests it is caused by irritation, stretching or compression of the spinal root (other words when the nerve roots are affected). The Radicular pain has some of the characteristics of the referred pain but it differs from it by the intensity of the pain and the localized pain that is experienced. Also there will be radiation of pain to the fingers.

The pain is often of a dull aching type but if the nerve roots are compressed or irritated due to certain movements of the spine the pain can be very severe. Most of the time the radiation of pain is from the central position of the spine to the lower extremity.

Coughing, sneezing and certain movements will evoke severe pain as these things put strain on the spine. Any motion that stretches the affected nerves like the forward bending with the knees extended or straight leg raising in diseases of the lumbar spine will excite Radicular pain.

The fourth, fifth lumbar and the first sacral roots which form the sciatica nerve when affected causes pain which mainly extends down the posterior aspect of the thigh, the posterior and anterolateral aspect of the leg and into the foot as these parts are supplied by the sciatic nerve this condition is known as Sciatica.

The other complaints that accompany the radicular pain are tingling, Parestheasia, Numbness, Sensory impairment of the skin, Soreness and tenderness of the skin along the course of the nerve is present. There can also be loss of reflexes, weakness, wasting of muscle, fascicular twitching and often swelling of the leg (Stasis edema) may occur if the motor fibers of the anterior root of the spinal cord are involved.

The pain resulting from muscular spasm is most of the times mentioned in relation to the local pain. Muscle spasm maybe associated with various diseases of the spine. Due to the spasm there will be significant change in the posture of the person. The person experiences dull, cramping pain due to chronic tension in the muscles.

The person suffering from chronic disease of the lower back may experience pain, which cannot be determined in some cases. There can be pulling, drawing, cramping sensation without involuntary muscle spasm along with this there can be tearing, burning and throbbing pains. The person experiences coldness or burning which is often difficult to interpret but the possibility of Nerve or root disease should be kept in mind.

In a case of back pain it is very important to obtain a correct history along with the character, Location and radiation of the pain. The factors, which aggravate and ameliorate the pain and its consistency, should also be taken into consideration.

The physician should also take into consideration the past history, which might give vital clues like accidents or injuries that have been incurred. Also a watch should be kept on people who are hysterical and who are pretending to have severe pain for getting compensation.

Role of Homeopathy:
The role of homeopathy lies in the fact that it can bring back the lost balance in the human body when it is in a diseased state.

Homeopathic remedies act at the psycho neuro endocrinal axis. In other words it stimulates the human body which in turn will take care of the disease.

The right homeopathic remedy prescribed on the totality of the symptoms will help in relieving the pain and will help in arresting the disease. It will also improve the overall health of the person.

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