Hectic & stressful lifestyle makes it tough for us to properly take care of our back. At some point, almost everyone experiences lower back pain. This lower back pain may be a result of improper lifestyle, excessive strain on the spine or merely due to age factor. It can vary from mild to severe & can be short-lived or long-lasting. Severe lower back pain can make it difficult for a patient to perform common everyday activities. If back pain does not settle down by itself, patients have to opt for either surgery or look for nonsurgical alternatives. Studies state that, in most of cases, back pain does not require any surgery but if the condition persists for a longer period, patients must consult a spine specialist.
Spinal column is made up of a set of bones accumulated onto each other. The spinal column has seven bones in the cervical spine, five in the lumbar spine, twelve in the thoracic spine &coccyx & sacrum at the base. All these bones are supported by discs. These discs cushion & protect the bones by absorbing shocks from routine activities like twisting, lifting & walking. Lower back pain basically refers to pain that patients feel in the lower back area. They may also experience decreased motion of lower back, back stiffness & difficulty standing straight. Long-term pain in lower back is termed as chronic lower back pain which needs special care & attention.
There are various causes of lower back pain. Sometimes it happens after a certain movement such as bending or lifting. Merely getting older also plays a major role in many back conditions. Patients suffering from low back pain may have extra wear & tear on the spine, which may be due to the following factors.
- Injuries or fractures
- Strain from sports or work
- Back surgery
Patients may have had a herniated disc, in which a portion of the spinal disc is pushed onto the surrounding nerves. Spinal discs generally provide cushion & space in patient’s spine. When these discs dry out & become more brittle & thinner, patients can lose movement in spine over a period of time. If spaces between the spinal cord & nerves become narrowed, it may cause spinal stenosis. These issues are termed as degenerative joint or spine disease. Some other causes of chronic low back pain include the following.
- Health issues, such as rheumatoid arthritis or fibromyalgia
- Curvature of spine, such as kyphosis or scoliosis
- Pain disorder called piriformis syndrome, which involves a muscle in buttocks known as piriformis muscle
Patients are at greater risk for lower back pain if they fall under the following set of categories.
- Above 30 years of age
- Do not exercise
- Feel depressed or stressed
- Heavy lifting
- Bending & twisting
Back pains vary. Sometimes it may be stabbing, while otherwise it can be achy or dull. Extent & type of pain will mostly depend on the underlying cause of back pain. Most patients find that lying down or reclining improves lower back pain despite underlying conditions. Patients with low back pain may often experience the following.
- Back pain may be worse with lifting & bending movements
- Sitting worsens pain
- Standing causes worsening of back pain
- Back pain suddenly comes at any time & goes away & usually, follows an up & down course with good days & bad days
- Pain may develop from the back into out hip region or buttock or but not down the leg
- Sciatica is most common with a herniated disc condition. This involves buttock & leg pain & even tingling, numbness or weakness that goes down to the foot. It is also possible to develop sciatica without back pain.
Regardless of patient’s symptoms or age, if back pain does not get better within a couple of weeks, or is associated with chills, fever or unexpected weight loss, patients should contact a surgeon.
- Medical History – Patients should discuss their symptoms & complete medical history with doctors. Doctors will examine patient’s back & push on different regions to see if it hurts. Doctors will ask patients to bend backward, forward & side to side so as to check for pain or limitations.
- Physical Examination – Doctors may evaluate nerve function in patient’s legs. Doctors will carefully check reflexes at patient’s ankles & knees as well as sensation testing & strength testing. This might confirm if patient’s nerves are severely affected.
Following imaging tests may help doctors confirm patient’s diagnosis.
- X-rays – X-rays may help determine if patients have the most common causes of back pain. It clearly shows aging changes, broken bones, curves, or deformities.
- Magnetic Resonance Imaging (MRI) – This test produces better pictures of gentle tissues, such as nerves, muscles & spinal discs. Severe conditions such as a herniated disc or serious infection are evident in MRI scan tests.
- Computerized Axial Tomography (CAT) Scans – When doctors expect any bone problem, they may ask the patient to undergo CAT scan.This test primarily focuses on bones.
- Bone Scan – Bone scan may be recommended if doctors need more details to examine for lower back pain.
Surgeons may ask patients to stop taking certain medications or to quit smoking while preparing for back pain surgery. Depending upon the patient’s age & overall fitness level, surgeons may ask patients to undergo a complete health checkup.
- Medications – Several medicines may affect the outcome of back pain surgery. They may cause heavy bleeding post-surgery. Most commonly, these medications comprise aspirin & non-steroidal anti-inflammatory medicines. Surgeons may ask patients to discontinue these medications prior to back pain surgery.
- Donating Blood – Donating blood generally is not required for most low back surgeries. However, there are chances that small amounts of blood loss will happen during surgery. Surgeon will explain benefits as well as disadvantages of donating patient’s own blood compared with using someone else’s blood. If patients decide to donate their own blood, they will be prescribed an iron supplement to help build up their blood before surgery.
Following this comprehensive list of questions may help patients to choose a better alternative for lower back pain. Patients may ask these questions to clear their doubts during initial consultation with the neurosurgeon.
- What is my current health status?
- What are the causes of my chronic lower back pain?
- What kind of surgery is suitable for my condition? Why?
- Can you explain the whole procedure in detail?
- What are my non-surgical alternatives?
- What will happen if my condition is not surgically addressed?
- What are the benefits of surgery for me?
- How long will it take for back pain surgery to complete?
- Are there any side effects, potential risks & complications following proposed surgery for low back pain?
- Can you elaborate risks & how they relate to me personally?
- How many years of experience do you have in handling this surgery?
- What are the long-term effects of the proposed procedure?
- If I wish to have a second opinion, who would you suggest I consult?
- What is your success rate in performing this type of surgery?
- Can you provide contact details of patients who have undergone similar procedure for back pain?
- What type of pain should I expect after surgery?
- What restrictions will I have after surgery & for how long?
- When can I return back to performing normal household chores?
Treatments for Low Back Pain
Treatment for lower back pain falls into one of the following three categories – medications, physical measures& surgery.
- Medications – Various medications may be prescribed by doctors to help relieve pain of patients.
- Acetaminophen or aspirin helps in relieving back pain with very few side-effects.
- Non-steroidal anti-inflammatory medicines like naproxen & ibuprofen minimize pain & swelling.
- Narcotic pain medicines such as morphine or codeine may also help.
- Physical Medicine – Lower back pain can be exhausting. Therapeutic treatments & medications which are often combined diminish pain enough for patients to do all basic activities they want to do.
- Physical Therapy – It can include passive techniques such as ice, heat, ultrasound, massage & electrical stimulation. Active therapy includes weight lifting, stretching & cardiovascular exercises. Exercising to restore strength & motion to patient’s lower back can be extremely helpful in alleviating pain.
- Braces – The most popular brace is a corset-kind that can be wrapped around the stomach & back of patients. Braces are not always convenient, but many patients report feeling more stable & comfortable while using them.
- Chiropractic or Manipulation Therapy – It is given in several different forms. Many patients experience comfort from lower back pain with these kind of treatments.
- Exercises – Some exercise-based programs, such as yoga or Pilates are beneficial for some patients.
- Surgical Treatment – Surgery for lower back pain should only be performed by doctors when other nonsurgical treatment alternatives have failed. It is best to try nonsurgical alternatives for at least a year before considering surgery for low back pain. Chronic low back pain can be effectively treated with the following two types of surgeries.
- Spinal Fusion – Spinal fusion surgery is fundamentally a ‘welding’ process. This primitive concept is to fuse together painful vertebrae so that they result in a strong & solid bone. Spinal fusion eradicates movement between vertebral segments. It is an alternative when movement is the root source of pain. Surgeons may suggest spinal fusion if patients have spinal instability, scoliosis (a curvature), or serious degeneration of discs. Theory behind this concept is that if the distressing spine segments do not move, they should not get affected or hurt. Spinal fusion in lower back has been performed for several decades by now. A number of surgical methods have evolved. Bone graft may be used to join vertebrae. Rods, screws or a ‘cage’ are used to keep patient’s spine strong & stable as bone grafts heal. Spinal fusion surgery can be performed through patient’s back, abdomen or side or a combination of all these. This procedure can also be performed via a small opening next to the tailbone of patients. Outcomes of spinal fusion surgery for treating low back pain may vary. It may prove very effective at eliminating low back pain or sometimes not at all. Complete recovery may require more than a years’ time.
- Spinal Disc Replacement – Spinal disc replacement surgery involves removing the impaired disc & substituting it with artificial parts, identical to replacements of the knee or hip.The aim of spinal disc replacement is to allow spinal segment to have flexibility & maintain normal movement. This procedure can be performed through the patient’s abdomen, most commonly on the lower two discs of spine.
Recovery following low back pain surgery usually takes about two to three months to fully recover after undergoing surgery for low back pain. Recovery phase generally involves a blend of physiotherapy, such as exercise & massage & pain medications to alleviate pain in low back area. It is extremely essential for patients to stay active. Initially, moving may be tough to begin with, but patients should start moving around after resting for a few days. This will help keep the back mobile & prevent joints from becoming thick & stiff & the muscles that hold the spine from becoming fragile. These steps will speed up recovery. Patients should only exercise smoothly & lightly & ensure they do not put extra strain on the back. At first, patients should avoid strenuous & high-impact exercises, such as jumping, twisting or running as these may cause pain to burst up.
Severe pain in low back area can lead to permanent nerve impairment. If surgery is performed for treating low back pain, it may cause certain complications. One of the major long-term complication of surgery is saddle anesthesia. In this case, the damaged spinal disc compresses nerves & causes patients to drain sensation in inner thighs, the back of legs & around rectum area. Numbness & tingling may also persist. Blood clots & infections may result following surgery. Surgeon will carefully handle all these complications & patients must obey their instructions in order to avoid complications when they get back home. If patients cannot perform daily activities they once could, they should take follow-up appointments with surgeon.
It may not be possible to completely cure low back pain despite various treatments & surgeries that are available. One cannot avoid general wear & tear on spine which usually goes along with the aging process. But there are certain things patients can do to minimize impact of low back pain issues. Having an active lifestyle is a nice start.
- Exercise – Performing aerobic exercises, swimming, walking will keep muscles in patient’s abdomen & back flexible & strong.
- Proper Lifting – Patients should make sure that they avoid lifting heavy items.
- Weight – Every patient is advised to maintain a normal healthy weight. Being overweight creates extra stress on lower back.
- Quit Smoking – It should be noted that smoking & nicotine cause the spine to age faster than normal.
- Proper Posture – Good posture is essential for avoiding future spinal complications. Patients should therefore carefully stand, sit & properly lift.
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