Subacute Back Pain



Pain usually lasts from seven days to seven weeks. Pain usually is mild and occasionally severe. Pain generally is unrelated to other illness. About 10 to 20 percent of all back pain are subacute.


Chronic Back Pain


• Pain usually lasts more than three months.

• Pain may be mild or severe.

• Pain may be related to other illness or may have noidentifiable cause.

• About 5 to 10 percent of all back pain is chronic.Structure of Back
The back is held upright by muscles attached to the backbone. Doctors often refer to the backbone as the spine, spinal column, or backbone and find the discs located between each vertebra. These discs are made of cartilage, which is a soft, elastic material, Discs act as cushions, or shock absorbers. Their main job is to protect the joints from wearing out. Most joints contain a slippery substance called synovial fluid that keeps them moving smoothly.
The spinal cord is very important because it transmits electrical signals between the brain and the nerves in the legs, arms, back and other parts of the body. The spinal cord runs through a hole in each vertebra of the upper and middle parts of the backbone, much like a piece of string through a beaded necklace. The space it runs through is called the spinal canal. At times, a message might pain or discomfort. The pain signal is an important one, because it tells that some part of the body needs attention.


A serious injury to the neck or upper back runs the risk of damaging the spinal cord, causing paralysis of the parts of the body below the injury. It should be noted that the spinal cord is not present in the lower part of the backbone. Here the spinal canal contains a sack of nerves, the cauda equina. The backbone, with all its parts, cannot hold itself upright. It needs strong muscles, tendons, and ligaments for support. Muscles help to move or hold the position. Tendons fasten muscles to bones, and ligaments stretch from one bone to another to hold bones together.


Myelogram


During a myelogram, a special liquid dye called contrast medium is injected into the spinal canal then X-rays are taken of the area. The contrast medium can make problem areas show up more clearly on the X-ray. A myelogram may be ordered to detect problems such as spinal stenosis or spinal cord tumors. If surgery is being considered, particularly for a person who has had a serious back injury, many neurosurgeons will require a myelogram beforehand.


Bone Scan


During a bone scan, a very small amount of radioactive liquid is injected into a vein which concentrates in the bones for a short time. A special radioactive detecting machine scans the area of concern to produce a picture. Occasionally bone scans are done to look for damage or tumors in the bones themselves. However, back pain is rarely due to diseases of the bones.


Electrodiagnostic Studies


Electrodiagnostic studies are used to help confirm the presence of nerve compression in the spine. An electrodiagnostic study consists of two tests. One is an electrical test, which is designed to study nerve conduction. In this test the nerve is given an electrical stimulation, and the speed of the impulse is measured. The other test is a needle test called an electromyogram, or EMG. The purpose of this test is to study the muscles for primary disease or for the effect of nerve compression on the muscle. The compression is especially seen in herniated discs or spinal stenosis.


Blood Tests

If the doctor orders blood tests, a laboratory technician will carefully draw a small amount of blood from a vein in the arm, which will be tested in the laboratory. Anyone of the following blood tests may be advised:

• erythrocyte sedimentation rate (sed rate)

• haematocrit and haemoglobin


• white blood cell count

• HLA B-27 testchemical profile (SMAC)