Back pain or backache is defined as pain or discomfort felt in the upper, middle and lower back, arising from

structures in the back like muscles, nerves, bones or ligament.

Back is divided into three major parts upper, middle and lower. Depending upon the location, back pain is classified as Upper Back Pain (affecting the area of cervical and thoracic spine), Middle Back Pain (affecting the area of dorsal spine), and Lower Back Pain or Lumbago (affecting the area of lumbo-sacral spine). Lower back pain, or lumbosacral pain, is the commonest type of back pain. Low back pain is also known as lumbago. The backache is also classified according to the duration and intensity of the pain. Generally three type of back pain are there, acute, sub acute and chronic. Acute lower back pain persists for less than 40-45 days, while chronic lower back pain persists over three months and in-between of these two, pain can be defined as sub acute pain. The pain in back can also be one sided. Left side back pain or right side back pain commonly occour from a muscular sprain, herniated intervertebral disc, or renal calculi. Other causes of one sided back pain are listed below.

Structure the

of Back

The main parts of our back are vertebral column, posterior part of rib cage, scapula and muscles. Our vertebral column or backbone provides support to our body weight. Vertebral column consists of 33 vertebrae. In between vertebras, intervertebral discs are there. Both vertebrae and discs form spinal canal from which, spinal cord passes. Spine

also consists of blood vessels, muscles, tendons and ligaments. When all the contents work simultaneously it provides movement to the back.

Classification

Back

of

Pain
Back pain or backache can be divided into acute, sub-acute and chronic.

Acute back pain This kind of pain is usually sudden in onset, short lasting, often for few days or few weeks, usually occours in lower back. Chronic back pain Long lasting pain which persist for more then 3-4 months; deep, aching dull pain, which may extend to the leg. Backache, which persist in-between can be termed as sub-acute pain.

Causes

Back

of

Pain

Diseases of vertebral column like potts spine, tumor, and disk prolapse or herniated intervertebral disk, degenerative disk disease, osteomalacia, osteoporosis, spondylosis. Infection of the spinal cord can cause back pain. Mechanical cause includes abnormal posture, injury or trauma, extreme obesity, heavy lifting, sleeping on very soft mattresses. Referred pain of renal calculi, renal tumors, renal tuberculosis, pancreas tumor, diseases related to female genital organs. Metastasis cancer may spread to the bones like breast cancer, lung cancer and causes back pain. Compression of nerve may occur due to which the part which receives nerve supply from same nerve can become weak. For example, compression of the lumber nerve restricts the upward movement of the big toe.

Pain aggravated by movement, prolonged overwork, sitting (but inflammatory pain ameliorated by movement and aggravated by rest). Extension of the pain may occur to the other parts of the body especially to the buttocks, back of thigh, calf muscles. Sharp pain in the neck and back after lifting heavy objects. Difficulty in walking or standing straight due to muscle spasm and stiffness. Vertigo or giddiness may occour when the cervical spine is involved.

Symptoms Associated

with Back Pain

Compression of nerve may occur due to which the part which receives nerve supply from same nerve can become weak. For example, compression of the lumber nerve restricts the upward movement of the big toe. Pain aggravated by movement, prolonged overwork, sitting (but inflammatory pain ameliorated by movement and aggravated by rest). Extension of the pain may occur to the other parts of the body especially to the buttocks, back of thigh, calf muscles. Sharp pain in the neck and back after lifting heavy objects. Difficulty in walking or standing straight due to muscle spasm and stiffness. Vertigo or giddiness may occour when the cervical spine is involved.

Diagnosis

Physical examination - Includes posture, gait, movement, extension of the pain, modalities of the pain, and examination of the related joints like sacroiliac joint. Blood test Culture examination-for osteomylitis, complete blood count, ESR test. Bone density examination or densitometry - To detect osteoporosis.

X-ray spine To diagnose fracture, decreased bone mass, arthritic changes. CT scan-spine, MRI- To detect nerve compression. It can be done in the condition of long continued pain. Montoux test To diagnose tuberculosis as it can cause back pain. Bone scan To detect developing malignant diseases. Urine culture To diagnoses urinary track infection.

Treatment Back Pain

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Rest should be advised to the patient in the condition of acute back pain. Physiotherapy is often helpful in cases of chronic lumbago. The exact concomitant treatment depends upon the underlying cause and should be done only under the guidance of your doctor. Homeopathic treatment of back pain Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which a patient is suffering. The aim of homeopathy is not only to treat pain in back, but to address its underlying cause and individual susceptibility of the patient. For this patients current symptoms, past medical history and family history are taken into account. There are many homeopathic remedies which cover the symptoms of back pain and lumbago and can be selected on the basis of cause, location, sensation, modalities and extension of the pain. For individualized remedy selection and treatment of back pain, the patient should consult a qualified homeopathic doctor in person. Some important homeopathic remedies for the treatment of back pain or lumbago are given below:

Rhus tox. Muscular pain, when pain is relieved by walking and worse at rest or at first motion. There is marked stiffness and warm application gives relief. Brynoia alba. When the pain is worse on every movement and better by absolute rest and pressure. Hypericum Excellent remedy for nerve pain especially after surgery or injury. Colocynthis- Pain in the back is so severe that makes patient unable to walk or stand which finally settles down on the upper part of the thigh and buttock. Bending forward often ameliorates.

Kali carb. Lumbosacral backache, pain goes down the back to the legs. Pains, stitching, darting, worse during rest and lying on affected side. Backache and weakness after abortion, labor or profuse menses; while walking feels as if she must give up and lie down. Nux vomica - Backache due to chill, which aggravate in the morning and better from heat. Especially suited to people working for long hours in an airconditioned office and sitting in a chair for long periods. Irritability is often increased. Arnica mont. Acute pain after an injury along with sore bruised feeling. Slight touch aggravates. Actea racemosa - Pain in the muscles with intense restlessness and sleeplessness. It is particularly applicable in rheumatism affecting the bellies of the muscles. Another use of this remedy is in the condition known as spinal irritation, it is indicated when upper and lower cervical vertebrae, particularly latter, are sensitive to pressure Gnaphalium. Sharp cutting pain in anterior cervical nerve, aggravation on lying down and relieved when sitting. Aesculus hip. For persons with haemorrhoidal tendencies, and who suffer with gastric, bilious or catarrhal troubles. Severe dull backache in lumbo-sacral articulation; more or less constant; affecting sacrum and hips. Back gives out during pregnancy, prolapsus, leucorrhoea; when walking or stooping; must sit or lie down. Sensation of heaviness and lameness in back. Paralytic feeling in arms, legs and spine.
Back Pain: Belladonna: choose to use Belladonna if you have violent, acute low back pain. The pain is severe and can be burning, throbbing, shooting, or spasmodic. The intense spasms come on suddenly and leave just as quickly. You may observe more symptoms such as being worse from motion or jarring, touch, or cold. The pain is also worse from lying on the painful side, at 3 p.m., and after midnight, and is better sitting up. Bryonia: choose you use Bryonia if you have extreme back pain with a stitching quality. Your back pain should be worse from the slightest motion and much better from rest and hard pressure. You should be worse from warmth and better from cold air and cold applications. Although Bryonia back pain is intense, it comes on relatively slowly (e.g., compared to a Belladonna case). You may also have great thirst for cold drinks and may be irritable with a desire for quiet. Rhus toxicodendron: choose to use Rhus toxicodendron if your back pain comes on after overexertion, especially lifting something too heavy. The pain is aching and the low back is stiff. It is worse from first motion, yet better from continued motion and hard pressure (such as lying on something hard). You should be restless from the pain, which compels you to move constantly or to frequently change positions. The pain may come on with exposure to cold wet air, cold drafts, or before storms, and it is much worse from cold applications. The pain is better from warm applications (often as hot as possible). Pulsatilla: choose to use Pulsatilla if you have back pain that is worse from first motion and better from continued motion and rest, just like Rhus tox. Unlike Rhus tox, however, Pulsatilla back pain is much better from cold applications and worse from warm ones.

Kali carbonicum: choose to use Kali carbonicum if you have a sense of exhaustion in the back, or the back may feel broken. Perhaps most important, the pains have a stitching nature and are much better from pressure, yet are worse lying on the affected side (compare this to Bryonia). You may also have to walk stooped over, and the low back pain may extend down the thighs. In women, back pain may occur during labor or the menstrual period. The pain is worse from cold and better from warmth; and worse from 2-5am. Natrum muriaticum: choose to use Natrum muriaticum if you feel as if the small of your back is broken, and you feel better lying on a hard surface or firm support. The back pain is often accompanied by a depressed mood, in which you think about the past frequently. Sepia: choose to use Sepia if you have a weak feeling in the low back, and the pain is better with hard pressure, from lying on something hard, from warmth, and, most characteristically, from vigorous exertion. The back pain is often worse in the late afternoon from 3 to 5 p.m. Phosphorus: choose to use Phosphorus if you have pain is as if the back is broken (similar to Natrum mur), or it may be a burning pain. The back pain is better from rubbing/massaging. You should be chilly and have great thirst for ice-cold water. You may also be extremely sensitive to noise, odors, and light. Magnesia phosphorica: choose to use Magnesia phosphorica if you have a classic sciatica pattern of nerve pain extending from the low back down the back of the buttocks and leg. The pain can be cramping (often from overexertion) or sudden, violent, and neuralgic (such as cutting, shooting, or sharp, lightning like pains). When the sciatica is on the right side and is better from warmth and pressure, yet the warmth is more relieving than pressure, consider this remedy. Colocynthis: choose to use Colocynthis if your sciatica is left-sided and the pain is better from warmth and hard pressure, but pressure gives the most relief (opposite of Magnesia phosphorica). In the state of violent pain, you may be angry, indignant, and impatient, yet these mental-emotional symptoms are not as necessary to the prescription of Colocynthis as are the physical symptoms. The most common potencies (strengths) of homeopathic remedies you can by over the counter are 6c and 30c. Either of these potencies is fine for most conditions you will treat at home with the information in this article. Typically, it is recommended to take a dose (2 pellets) of the homeopathic remedy 1-4 times per day. If your condition is more acute in nature, take the remedy 3-4 times per day. If your condition is more chronic in nature, take the remedy 1-2 times per day. You can buy homeopathic remedies at most health food stores. They are usually inexpensive, ranging from approximately $5-10 each. There are also remedy kits available to purchase online, with approximately 100 of the most common homeopathic remedies. Note: If your condition becomes worse or you are not sure how to treat a condition, make sure to call or visit a doctor for further evaluation.

Now that winter is here, its cold season again! As mentioned in my previous article, the best ways to fight the common cold are anticipation and prevention. While you have many over-thecounter, conventional

remedies to choose from, homeopathic, herbal remedies and nutritional supplements may be your antidote of choice to relieve the symptoms. If you get lucky this cold season, here is a list of some of the more common treatments you can try: Homeopathic Remedies: Indications for Usage 1) Allium cepa: Used for burning watery eyes and running noses. 2) Arsencum album: This is indicated for a runny, congested nose. It is also good for diminishing chills, anxiety, nervousness, restlessness and thirst. 3) Belladonna: Soothes a raw, sore throat and decreases flushed cheeks. 4) Ferrum phosphoricum: Indicated when you feel the onset of a cold, without the significant signs or symptoms. 5) Kali bichromicum: Used for sinus pain and nasal discharge of thick, greenish-yellow, string consistency. 6) Mercurius: This is recommended for temperature sensitive people who are cold or heat intolerant; have yellow-green colored mucus accompanied by bad breath. 7) Pulsatilla: Indicated for those who have a full-blown cold with the symptoms of irritable mood swings, whiny disposition and a lack of thirst. Natrum muriaticum: Use if you have thick, egg white nasal discharge and cold sores. 9) Eucalptus radiate oil: This is a good decongestant and expectorant. Just put a few drops in a diffuser/steamer or a bowl of boiling hot water and inhale. 10) Plantain: Used as a good expectorant, mix 2 teaspoons of dried plantain leaves with boiling water and drink. It will help you recover quickly. 11) Nux vomica: Suggested when experiencing irritability, impatience or light and sound sensitivity- while having a cold. These symptoms may also come from being overworked and going outdoors. So, be sure it is a cold. 12) Baryta cabonica: This reduces tonsil and lymph node inflammation. 13) Aconitum napellus: It relieves a dry, stuffy nose, chest tightness, dry throat or a choking cough. Herbal Remedies: Usage 1) Astragalus (Astragalus membranaceus): Use as an antiviral or anti-inflammatory to enhance the immune system; it is also an anti-oxidant. 2) Echinacea (Echinacea spp.): This is an optional antiviral or anti-inflammatory to enhance the immune system; but it is not an anti-oxidant. 3) Hyssop (Hyssop officinalis): Also used as an antiviral or anti-inflammatory to enhance the immune system; but it is an expectorant. 4) Lomatium (Lomatium dissectum): Use for hard to treat respiratory tract infections; it is also an antiviral. 5) Osha (Ligusticum porter): This supports the immune system and it is indicated for viral respiratory infections. 6) Oregon Grape (Mahonia spp.): Recommended as an astringent, antimicrobial, antinflammmatory and antioxidant, which supports the immune system.

7) St. Johns Wort (Hypericum perforatum): Use as an antiviral and anti-inflammatory agent. Nutritional supplements 1) Beta-carotene: Take, at least, 200,000 IU per day. 2) Bioflavonoids: Take, at least, 1000 mg a day. 3) Garlic: Eat a minimum of 3 cloves a day or take 2-3 capsules of 500 mg a day. 4) Vitamin C: You may need to take 500 -1000 mg, every 2 hours when you have a cold. Be sure to hydrate yourself and drink plenty of water. 5) Zinc: It has been suggested that taking 1 zinc lozenge (contains 23 mg of zinc), every 2 hours has an effect in battling the cold. Try a combination of these and other remedies to combat the cold. This list mentions several suggestions, but is not comprehensive. It is up to you to further research and discover what your needs are and what is best for you! Remember, these remedies and supplements are not foolproof- and results do vary. If you are unfamiliar with them and their usage, it is best to seek the advice of a qualified health professional that is knowledgeable in herbal/homeopathic remedies. Again- Stay well and healthy during these cold winter months through anticipation and prevention! E. Kevin Mar M.D. appears courtesy of Pinetop-Lakeside Integrative & Physical Medicine LLC where he specializes in Pain Management, Acupuncture, Musculoskeletal Injury & Sports Medicine. He can be reached at 928-358-1648 or plintegrativephysicalmedicine@ yahoo.com. (This article is intended for informational purposes only. The authors information is intended to be accurate; however inaccuracies may occur. It is advised that the reader consult a knowledgeable health professional before beginning any herbal regimenespecially if one is taking western medication. In rare cases, herb-western medication interactions can be harmful.)

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