For all the happiness mankind can gain Is not in pleasure, but in rest from pain. — John Dryden (1631-1700), English poet, The Indian Emperor (1665) act 4, sc. 1

“Oh my aching back!” Chances are you have said this yourself, at one time or another.

It is said that eight out of ten adults will experience some form of back pain.

After the common cold, back pain is the most common complaint prompting a visit to the doctor. Fortunately, 50 percent of patients will be relieved of their pain in two weeks and nearly 90 percent will get better in three months. It’s the 10 percent that we’re worried about. If the back pain is associated with progressive weakness and numbness of the legs and feet (or the arms and hands); if there is difficulty in moving the bladder or bowel (incontinence), the spinal nerves are involved.

Anatomy and pathology. The spinal column is work of Divine art. The bones that make up the spine are called “vertebrae” and they can be likened to a child’s building blocks stacked on top of one another. Now imagine that in between these building blocks are marshmallows – the intervertebral disks. In real life, they are flexible pads. The problem is that as we age, these pads become inelastic. They even harden over time.

With stress on the back, the disks can sometimes dislodge. Sometimes it is the whole disk but most of the time, its inner core (the nucleus pulposus) protrudes and pinches the nerve that exits the spine. It is this impingement that causes pain, numbness, or weakness of the extremities. In theory, all disks can displace. However, the most common herniations are found in the lower back and in the neck.

Signs and Symptoms. Think HNP (herniated nucleus pulposus) or simply “slipped disk” if any of these are present:

* Sharp “electric” pain shooting down from the back to one or both legs immediately after lifting a heavy object or falling on your back or some other back injury.
* Back pain especially after sneezing, coughing, or straining during a bowel movement.
* Numbness or tingling of the arms and hands (cervical or neck disk) or of the legs and feet (lumbar or lower back disk).
* Difficulty in bending or straightening the back because it is very painful.

Time to see the doctor. What kind of doctor should you see? The general practitioner should be able to screen the cause of back pain. You could be suffering from a sprain or strain of the back that can immediately be relieved by OTC (over the counter) pain-killers. When the pain has not gone away after several weeks and the signs and symptoms are clear, it is time to see the orthopedic surgeon or the neurosurgeon. Provocative tests are in order here. These specialists will attempt (gently) to recreate the pain of a pinched nerve. Having said that, most specialists will still insist on some form of imaging.

Diagnostic imaging. Certainly the cheapest and most readily available is the xray. The xray will reveal tumors, fractures, and instability of the spine. These will all cause pain. Unfortunately, the disks and nerves aren’t seen on xrays. To visualize these structures, the CT scan with injected dye (computerized tomography) or the MRI (magnetic resonance imaging) is requested. These technologies provide the details that the doctor will combine with his physical findings and sometimes, blood tests, to arrive at a diagnosis.

Treatment. Don’t worry! A disk problem will not always need surgery. The good doctor will give anti-inflammation drugs, muscle relaxants, and the occasional corticosteroid injection. He will also send you to Rehabilitation Medicine for a thorough evaluation of the Physiatrist or the rehabilitation medicine doctor. From this point on, the choices for treatment are plenty. To name a few: Gentle massage, hot or cold packs, TENS (transcutaneous electrical nerve stimulation), exercise and Back schools. When these fail, surgery is the last option. The surgeon will usually do a laminectomy (unroofing the vertebra) followed by the diskectomy (removal of the offending disk).

Prevention. A good back is a product of regular exercise. Toning exercises for the abdomen and for the rest of the body make it easier to stand tall. Good posture keeps the back elongated allowing it to assume its three natural curves (seen from the side). When sitting, choose a chair that supports the lower back. A footrest relieves pressure on the lower back. When driving, adjust the seat so that the hips and knees are on the same level. Use a firm (not hard) mattress for sleeping.

A slipped disk is a devastating condition.

Keep the chances of it occurring slim. Take care of your back now.

Dr. Pujalte is an orthopedic surgeon. E-mail jspujalte@yahoo.com webpage http://www.orthopedicspujalte.com