Pain felt anywhere between the cervical to coccyx region along the back is referred to as back pain. The back comprises the vertebrae, intervertebral disc, spinal cord, muscles, ligaments and tendons.

The vertebrae are bony structures d include 7 cervical, 12 dorsal, 5 thoracic, 5 sacral and 4 coccygeal vertebrae.

The intervertebral discs are flexible, cartilage structures. One intervertebral disc lies between two vertebrae. These intervertebral discs act as cushions to absorb shock and maintain flexibility of the spine. The vertebrae collectively make the vertebral column with the vertebral canal running through its length in the centre.

The spinal cord is enclosed between the vertebral canal. The cause of back pain can lie in any of these structures that form the back.

The bony lumbar spine is designed so that vertebrae “stacked” together can provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord’s nervous tissue from impact trauma. Vertebrae also have a strong bony “body” (vertebral body) in front of the spinal cord to provide a platform suitable for weight-bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joints of the buttocks.

The discs are pads that serve as “cushions” between the individual vertebral bodies. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central, softer component (nucleus pulposus) and a surrounding, firm outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating as in a herniated disc) through the outer ring, irritating adjacent nervous tissue and sciatica as described below. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.

The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) all exit the lumbar spinal column through bony portals, each of which is called a “foramen.”

Many muscle groups that are responsible for flexing, extending and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.

The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph nodes (lymph glands) and tissues of the involuntary nervous system that are important in maintaining bladder and bowel control.

The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.

The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.

The lower back, however, is most vulnerable.

Common causes of low back pain (lumbar backache) include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.

Lumbar strain (acute, chronic): A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as “acute” if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as “chronic.” Lumbar strain can happen at any age.

The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back. The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, X-ray testing is only helpful to exclude bone abnormalities.

Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure (impingement) by bone or other tissues, or from disease, anywhere along their paths — from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles).

Lumbar radiculopathy: Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration (“wear and tear”) of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized “sciatica” pain of a herniated disc that shoots from the low back and buttock down the leg. A history of localized low-back aching can precede sciatica, or it can follow a “popping” sensation and be accompanied by numbness and tingling. The back pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels. The sciatica of lumbar radiculopathy typically affects only one side of the body, such as the left side or right side, and not both. Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating back pain when the lower extremity is lifted supports the diagnosis.

Bony encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body, commonly as a result of arthritis), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation).

Bone and joint conditions: Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are due to inflammation of the joints (arthritis).

Degenerative bone and joint conditions: As we age, the water and protein content of the body’s cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal “disc space” between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain (“lumbago”) in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing.

Injury to the bones and joints: Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.

In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a “cement” (methyl methacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.

Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter’s disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing inflammation. Homeopathic and biological medications have been greatly successful in both quieting the disease and stopping its progression.

Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.

Kidney problems

Kidney infections, stones, and traumatic bleeding of the kidney (hematoma) are frequently associated with low back pain. Diagnosis can involve urine analysis, sound-wave tests (ultrasound), or other imaging studies of the abdomen.

Pregnancy

Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to the loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors’ advice. Natural labor can also cause low back pain.

Ovary problems

Ovarian cysts, uterine fibroids, and endometriosis may also cause low back pain. Precise diagnosis can require gynecologic examination and testing.

Paget’s disease of bone

Paget’s disease of the bone is a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget’s disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.

Paget’s disease can be diagnosed on plain X-rays. However, a bone biopsy is occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is helpful to determine the extent of the disease, which can involve more than one bone area. A blood test, alkaline phosphatase, is useful for diagnosis and monitoring response to therapy.

Bleeding or infection in the pelvis

Bleeding in the pelvis is rare without significant trauma and is usually seen in patients who are taking blood-thinning medications, such as warfarin. In these patients, rapid-onset sciatica pain can be a sign of bleeding in the back of the pelvis and abdomen that is compressing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is infrequent but can be a complication of conditions such as diverticulosis, Crohn’s disease, ulcerative colitis, pelvic inflammatory disease with infection of the Fallopian tubes or uterus, and even appendicitis. Pelvic infection is a serious complication of these conditions and is often associated with fever, lowering of blood pressure, and a life-threatening state.

Tumors

Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.

Infection of the cartilage and/or bone of the spine

Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott’s disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat’s milk.

Aneurysm of the aorta

In the elderly, atherosclerosis can cause the weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause pulsating low back pain. Aneurysms of a certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.

Shingles

Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with more chronic nerve pain (postherpetic neuralgia).

Symptoms and Causes of Back pain :

A major symptom that may accompany the pain is stiffness of the back.

In case of pain in the cervical back, pain from neck may radiate down the arms. This may be attended with numbness, tingling in hands. Pain in the cervical back that radiates down to the arms could be caused by pinching of nerves in the cervical region. Nerves in the cervical region could get pinched due to a disc bulge, herniated disc, cervical spondylosis, bone spurs, and spinal stenosis.

Pain from the lower back may radiate down the lower limbs. This may also be attended with numbness, tingling and increased sensitivity in lower limbs.

Other symptoms may include weakness in the back, lower limbs or upper limbs.

Among the various causes behind back pain, the major ones include disc bulge, osteoarthritis, muscle strain, trauma and degenerative disc disease.

Disc bulge refers to slipping of the intervertebral disc from its place.

Osteoarthritis of the back refers to degenerative changes in the bones, disc, cartilage or joint of back.

Muscle strain refers to overstretching of muscle arising from overuse, fatigue or lifting heavy weights.

Degenerative disc disease refers to damage, dryness or breakage of the intervertebral disc mainly because of age-related wear and tear or from injury.

Lower back pain that radiates down to legs :

Lower back pain radiating down the lower limbs basically indicates sciatica which may arise from compression, pinching or irritation of the sciatic nerve in the back.

The various causes of sciatica include spinal stenosis, disc bulge, disc degeneration, bone spurs, and spondylolisthesis.

Does back pain indicate a serious condition ?

In most cases, back pain does not indicate a serious condition and does not require urgent medical aid. However, bowel/bladder incontinence or progressive weakness in legs together with back pain needs urgent attention as it may be an indication of the cauda equina syndrome, which is an emergency condition.

Diagnosis for Back Pain :

The diagnosis of low back pain involves a review of the history of the illness and underlying medical conditions as well as a physical examination. A complete story of the back pain must be reviewed including injury history, aggravating and alleviating conditions, associated pain symptoms (fever, numbness, tingling, incontinence, etc.), as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms (EMG) and nerve conduction velocities (NCV).

Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with imaging tests, such as CAT or MRI scanning.

Lifestyle changes will help manage back pain ?

Adopting some basic lifestyle measures can go a long way in managing back pain. Some of these are:

• Maintain proper posture while sitting
• Lose weight
• Avoid lifting heavy weights
• Avoid bending and twisting the back
• Avoid prolonged, constant sitting and standing
• Exercise and physiotherapy will help relax muscles and eventually, pain

The treatment very much depends on the precise cause of the back pain. Moreover, each patient must be individually evaluated and managed in the context of the underlying background health status and activity level. As has been highlighted by research a very important aspect of the individual evaluation is the patient’s understanding and perception of their particular situation.

• Treatment of bony encroachment varies, depending on their severity, and ranges from rest and exercises to epidural cortisone injections and surgical decompression by removing the bone that is compressing the nervous tissue.
• Degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasms, and inflammation.
• Treatment options for Paget’s disease include aspirin, other anti-inflammatory medicines, pain medications, and medications that slow threat of bone turnover, such as calcitonin, etidronate, alendronate, risedronate, and pamidronate.
• Treatment of shingles (herpes zoster) can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir, for the infection and pregabalin or lidocaine patches for the pain.

Self-care remedies for pain relief include cold packs and heat applications, topical analgesic balms, avoiding re-injury, eliminating heavy lifting, and taking over-the-counter pain relievers such as acetaminophen, naproxen, and ibuprofen.

• The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Initial treatment at home might include heat application, acetaminophen or ibuprofen, and avoiding re-injury and heavy lifting. Prescription medications that are sometimes used for acute low back pain include non-steroidal anti-inflammatory medications, such as sulindac, naproxen, and ketorolac by injection or by mouth, muscle relaxants, such as carisoprodol, cyclobenzaprine, methocarbamol, and metaxalone, as well as analgesics, such as tramadol.

Long periods of inactivity in bed are no longer recommended, as this treatment may slow recovery. Spinal manipulation for periods of up to one month is helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.

• Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscle spasms, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage by a therapist, ultrasound, exercises, electrical stimulation), and rest (not strict bed rest but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

Homeopathic Treatment for Back pain and its Cause

The Homeopathic treatment too very much depends on the precise cause of the back pain. Each patient must be individually evaluated and managed in the context of the underlying background health status and activity level.

1. Rhus Toxicodendron

Rhus Tox – characteristic symptoms are – the back pain arises from muscle strain due to overstraining or overstretching or from lifting heavy weight, it worsens with rest while the person feels relief from walking or motion. Also, in cases where the back pain gets better with hard pressure.

2. Bryonia Alba

Bryonia Alba’s prominent symptom is the back pain gets worse with motion/Walking, Rest brings relief; back pain more severe with stooping and standing.

3. Aesculus Hippocastanum

Aesculus Hippocastanum – back pain affecting the sacrum region. The pain may extend to the hip along with sacrum back. Walking and stooping increase the pain; rising from a sitting position is a challenge. Intense stiffness is observed in the sacrum and hip region along with the pain.

4. Kali Carbonium

Kali Carb is very effective in lower back pain. The pain – get worse on walking patient have to stop and take some rest before starting to walk again. There is a desire to lie down for relief from back pain. Stiffness or excessive weakness in the back, back pain during menses or after a miscarriage.

5. Cimicifuga Racemosa and Guaiacum Officinale

The most effective medicines for treating cervical back pain, sensitivity in the neck, worsening of pain from pressure, stiffness in the cervical back and shoulders, aching pain in the neck.

6. Arnica Montana

Back pain arising from injury, from falls blows – of both recent and remote origin; sore, bruised pain in the back as after being beaten, lameness in the back, extreme sensitivity which makes it impossible to walk or stoop.

7. Hypericum Perforatum

Hypericum Perforatum is most significant medicine for coccyx pain (coccydynia) arising from a fall over the coccyx.

8. Cobaltum

Cobaltum should be advised where pain in the back is worse in the sitting position. The pain radiates from the lower back down the legs and feet. Weakness in the legs, Walking may relieve the back pain.

9. Phosphorus

Phosphorus is indicated where prolonged sitting leads to back pain. Weakness in the back may also be felt. Burning sensation in the spine is another feature that may attend.

10. Colocynthis and Megnesium Phosphorica

Colocynthis and Megnesium Phosphorica are very effective medicines for back pain radiating down the legs.

Colocynthis is helpful for back pain radiating to the left lower limb, relief from pressure. The pain can be tearing or drawing in nature.

While Megnesium Phosphorica is indicated for lower back pain that radiates down the right lower limb. The pain can vary from sharp, shooting, lightning-like or cramping in nature. Warm applications gives some relief.

11. Kalmia Latifolia and Paris Quadrifolia

Kalmia Latifolia and Paris Quadrifolia are top grade medicines for cervical back pain radiating to the arms/hands. The radiating pain is accompanied by weakness, tingling, numbness in the arm/hands.

Symptoms guiding the use of Paris Quadrifolia are a sensation of weight in the neck, worsening of symptoms from exertion (either mental/physical) and numbness in fingers.

12. Causticum

Back pain which has soreness, weakness and stiffness in the muscles that is worse from over exertion. Pain is also worse when the weather is dry and tends to be better in rainy weather.

The muscles in the legs feel contracted, tight and sore, with restlessness at night. The forearms are weak, even though they are also stiff. These patients feel better in a warm bed or warm shower.

12. Cimicifuga

When there are spasms in the large muscle groups. Body feels sore and bruised all over, jerking and twitching of the muscles. The spine feels sensitive, and there is pain especially in the back, neck and shoulders.

13. Gnaphalium

Medicine for upper back pain. Sharp cutting pain in anterior cervical nerve, aggravation on lying down and relieved when sitting, chronic backache or lumbago, worse by constant motion; better by taking rest; pain in back along with sensation of numbness; lumber region is mainly affected; weight in pelvis.

14. Agaricus Muscarius

Stiffness in the whole spine; single vertebrae sensitive to heat; shooting pain. Burning along spine; pain in lumbar region and sacrum; pain worse stooping; sensation of cold needles pricking in the back; lumbago which worce in open air, sitting; tightness of the muscles of the back, as if they would break on bending; as if cold air were spreading along the back; painful weakness and soreness of the back; spine sensitive to touch; worse in dorsal region; twitching of cervical muscles. Best medicine for middle back pain.

15. Dulcamara

Backache due to living in damp basements or house; pain in the small of back; as after long stooping; pain along with stiffness of the back.

16. Ledum Palustre

Gouty pains shoot all through the foot and limb, and in joints, but especially small joints. Swollen, hot, pale. Throbbing in right shoulder. Pressure in shoulder, worse motion. Cracking in joints; worse, warmth of bed. Gouty nodosities. Knee swelling. Rheumatism begins in lower limbs and ascends. Ankles swollen. Soles painful, can hardly step on them. Easy spraining of ankle.

17. Arctium Lappa

Pains in back about eighth dorsal vertebra. Rheumatoid and gouty pains.-Soreness of muscles. Pains in all spinal joints. Sharp, darting, fugitive pains in tendons. Bunion.

My (Dr. Qaisar Ahmed) advice for Back pain Cause and Treatment is, make combination of two or three or even more highly diluted medicines to cover maximum symptoms and achieve maximum; in minimum time and money.

Learn making good combination(s), contact me at +923119884588 (wapp).

P. S : This article is only for doctors having good knowledge about Homeopathy and allopathy,  for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

Location, address and contact numbers are given below.

NoN of above mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

To order medicine by courier, please send your details at WhatsApp– +923119884588

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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