What is pain in the spine?
Spinal pain or back pain is pain that occurs in part of the spine. This pain or soreness can occur in the cervical spine (cervical spine), upper and middle back (thoracic spine), lower back or waist (lumbar spine), and/or tailbone (sacro-coccygeal spine).
Pain can occur in one specific area of the spine or along the vertebrae of the back. Most of this pain is temporary, but if not treated properly it can become chronic and recurring pain.
What causes spinal pain?
Spinal pain is generally the result of sudden injury or long-term overuse. This makes the muscle fibers (ligaments) stretch abnormally so they may cramp or tighten. Muscles that are stretched due to injury can result in inflammation of the surrounding soft tissue. This inflammation causes the spine to feel painful due to muscle spasms.
The causes of spinal pain, whether in the neck, upper or lower back, or tail, can also come from several other conditions, such as:
- Fracture
Physical injuries that cause spinal fractures can cause pain. This pain can be caused by high force injuries (motor vehicle accidents, contact sports), but can also be caused by low force injuries such as slipping (usually in older people who have osteoporosis).
- Spinal curvature abnormalities
The normal shape of the spine is aligned straight down when viewed from the front and back, with a natural curve like the letter "S" when viewed from the side. This natural curve helps support your posture and balance your body. When this curvature exceeds normal values, it can cause complaints of spinal pain in the future. This deformity will put excessive pressure on the spinal segments and their bearings, which can cause pain.
- Spinal cushion aging
Aging of the discs of the spine can occur due to the normal aging process, but can also occur prematurely due to injuries that were not treated properly beforehand. Because the natural "spring" of the spine has reduced its elasticity, it can impact the pain felt by the patient.
- Herniated nucleus pulposus (HNP) or Pinched Nerve
Hernia of the nucleus pulposius or the release of the gel-like contents of the spinal column from the ring. This can cause excessive pressure and stimulation of the nerves that exit the spine, causing pain that radiates to the arms (if it occurs in the neck) or to the legs (if it occurs in the lower back). Some people may also experience weakness in the back and legs. If you encounter problems with defecation or urination accompanied by numbness in the groin, this is an emergency and the patient must immediately go to the emergency unit for immediate medical treatment.
- Narrowing of the spinal cord gap
Narrowing of the spinal nerve gap or canal stenosis is a narrowing of the gap where the central nerve passes in the spine. If this gap is pinched it can cause leg pain, and if the patient tries to walk more than 100 meters, they must sit or bend first to reduce the pain.
In general, the following are the characteristics and symptoms that can be felt when the spine hurts:
- Pain or pain like being stabbed which can last up to 10-14 days.
- The pain may radiate to other areas of the body, such as the legs, arms or chest, or worsen with movement.
- The lower back feels stiff making it difficult to move.
- Posture looks abnormal.
- Muscle spasms occur during activity or rest.
- Loss of motor function such as standing on tiptoes.
- Slowed reflexes.
- Numbness or tingling.
How to treat bone pain
Your doctor may advise you to first reduce activity and rest for 1-3 days when symptoms appear. This time period is ideal because resting for too long can actually increase pain and loss of muscle strength.
If just resting the pain has not subsided, the doctor can recommend treatment. Here are several ways, including medication, to treat spinal pain, which are commonly given by doctors:
- Anti-pain medication
Non-steroidal anti-pain and anti-inflammatory drugs can be an option to relieve mild to moderate pain in the spine. These drugs are safe if used for less than 3 weeks, and should be avoided in patients who already have impaired kidney function.
- Physiotherapy
Doctors may also recommend physiotherapy as a way to help reduce or even eliminate spinal pain. This method can also help build strength and flexibility, and prevent future injuries. Physiotherapy includes physical exercise, massage therapy, traction, stretching exercises, ultrasound, ice and heat therapy, and electrical stimulation.
- Spinal injection
Injections or injections into the spine are recommended by doctors to treat inflammation and reduce pain directly at the source. The advantage of the injection is that it can be used for 2 things at once, namely to confirm the diagnosis and reduce pain complaints.
Common injection procedures include:
- Epidural steroid (cortisone) injections or in the nerve roots, in the area near the nerve roots or in the spinal canal.
- Injections into the facet joints (facet block ) , in or near the small joints in the spine.
- Sacroiliac joint injections , usually for persistent pain in the buttocks.
- Ganglion impar block injection, to relieve pain in the tailbone that is difficult to go away after injury.
- Decompression using a laser (percutaneous laser disc decompression)
In cases of contained HNP where the spinal column bearing core protrudes without a tear in the protective ring (annulus) , decompression can be carried out using a needle injection which is then heated (laser) so that the bearing core shrinks and releases the nerves from the clamp.
- Surgery
If spinal pain is severe, it is possible that you will need a surgical approach, either with or without implants:
- Decompression: surgical action to release nerve clamps by widening the hole where the spinal nerves pass without using implants for stabilization (can only be done on a spine that is stable and does not shift when bending or looking up). This procedure can be performed openly ( open surgery ) or minimally invasively using endoscopic tools.
- Decompression and stabilization: a surgical procedure that releases nerve clamps and simultaneously installs implants (pedicle screws and rods) to stabilize an unstable spine.
- Decompression, stabilization and fusion: surgical procedures that release nerve clamps, install pedicle screw and rod implants and artificial bearing implants so that the vertebrae at the upper and lower levels fuse (fusion).
Prevention of spinal pain
There are many ways you can prevent back pain, such as:
- trains the abdominal muscles to provide spinal stability. Exercises that can be done include swimming, yoga, cycling and light aerobics.
- Use proper lifting and body movement techniques, such as squatting to lift heavy objects.
- Maintain correct posture when sitting and standing
Article written by dr. Jephtah Tobing, MD, B.Med.Sci (Hons), Sp.OT (K-Spine) (Orthopedic & Traumatology Specialist, Spine Consultant at EMC Alam Sutera Hospital).