Low back pain can be
differentiated into four types :
a)
Local pain
b)
Referred pain
c)
Radicular pain
d)
Pain arising from secondary muscle spam (A protective
mechanism)
There are several symptoms in the
diseases of the spine. The person may experience stiffness, limitation in the
movement and deformity but pain gets the foremost importance because of
discomfort and the disability that is experienced by the suffering person.
Importance must be given to the
character, location and the conditions that modify the pain. This will help in
correctly identifying the cause of the pain.
Local pain
It is caused due to pathologic
process, which presses upon or irritates the sensory nerve endings (Sensory
nerve endings the nerve endings which carry the pain sensation). If the
involved structure doesn’t have sensory nerve endings then there will be no
pain.
For e.g. if the central medullary
part of the vertebral body is destroyed by a tumor there will be no evidence of
pain due to absence of sensory nerve fibres. In the same case if the affected
parts are the muscles, the ligaments or the annulus fibrosis it will cause
severe pain due to involvement of the sensory nerve endings.
Often
there will be swelling of the tissues involved in case of pain but it cannot be
noticed if the deep structures of the back are involved. The character of the
pain is described as a steady intermittent but it can also be a sharp and dull
pain. The pain varies considerably with the position and the activity of the
spine.
One characteristic of the local
pain is that it will be felt in the area that is affected. The patient will
experience tenderness if the affected part is examined by putting firm
pressure. This helps in identifying the site of abnormality.
Referred pain
As the name suggests, “referred”
it is the pain that is referred to other part of the body from the site of
abnormality. This happens due to the fact that the nerve that is affected also
supplies to the other structures of the body. So if the nerve is compressed or
impinged the pain will also be felt in the distant parts that are supplied by
the same nerve.
Referred pain is of two types one
type of pain is that which is projected from the spine into the regions, which
are supplied by the nerves that pass from the lumbar or sacral region of the
spine (Lumbar and upper sacral dermatomes).
The other type of referred pain
is the one, which is referred from the abdominal structures to the spine.
If the upper part of the lumbar
spine is affected the pain will be experienced in the anterior aspect of the
thighs and the legs. If the lower lumbar and sacral segments are involved then
the pain will be referred to the gluteal region (Buttocks) and the posterior
aspect of the thighs and the calves.
The character of the referred pain
is of deep aching character and is diffuse. At times the pain is felt in the
superficial structures of the back. Certain movements, which give relief in the
local back pain, will also relieve the referred pain.
Relief of Radicular or root pain
is more precise with certain movements of the spine, which release the pressure
on the affected nerves. Referred pain can sometimes be confused with the pain
in abdomen but the abdominal pain will be deep and the radiation will be from
the abdomen to the back.
Also if the pain is due to any
pathology in the abdominal organs there wont be much change in the pain on
movement as seen in referred pain. Whereas relief will be felt when there is
activity of the affected part.
Radicular pain or Root pain
As the name suggests it is caused
by irritation, stretching or compression of the spinal root (other words when
the nerve roots are affected). The Radicular pain has some of the
characteristics of the referred pain but it differs from it by the intensity of
the pain and the localized pain that is experienced. Also there will be
radiation of pain to the fingers.
The pain is often of a dull
aching type but if the nerve roots are compressed or irritated due to certain
movements of the spine the pain can be very severe. Most of the time the
radiation of pain is from the central position of the spine to the lower
extremity.
Coughing, sneezing and certain
movements will evoke severe pain as these things put
strain on the spine. Any motion
that stretches the affected nerves like the forward bending with the knees
extended or straight leg raising in diseases of the lumbar spine will excite
Radicular pain.
The fourth, fifth lumbar and the
first sacral roots which form the sciatica nerve when affected causes pain
which mainly extends down the posterior aspect of the thigh, the posterior and
anterolateral aspect of the leg and into the foot as these parts are supplied
by the sciatic nerve this condition is known as Sciatica.
The other complaints that
accompany the radicular pain are tingling, Parestheasia, Numbness, Sensory
impairment of the skin, Soreness and tenderness of the skin along the course of
the nerve is present. There can also be loss of reflexes, weakness, wasting of
muscle, fascicular twitching and often swelling of the leg (Stasis edema) may
occur if the motor fibers of the anterior root of the spinal cord are involved.
The pain resulting from muscular
spasm is most of the times mentioned in relation to the local pain. Muscle
spasm maybe associated with various diseases of the spine. Due to the spasm
there will be significant change in the posture of the person. The person
experiences dull, cramping pain due to chronic tension in the muscles.
The person suffering from chronic
disease of the lower back may experience pain, which cannot be determined in
some cases. There can be pulling, drawing, cramping sensation without
involuntary muscle spasm along with this there can be tearing, burning and
throbbing pains. The person experiences coldness or burning which is often
difficult to interpret but the possibility of Nerve or root disease should be
kept in mind.
In a case of back pain it is very
important to obtain a correct history along with the character, Location and
radiation of the pain. The factors, which aggravate and ameliorate the pain and
its consistency, should also be taken into consideration.
The physician should also take
into consideration the past history, which might give vital clues like
accidents or injuries that have been incurred. Also a watch should be kept on
people who are hysterical and who are pretending to have severe pain for
getting compensation.
Role of Homeopathy
The role of homeopathy lies in
the fact that it can bring back the lost balance in the human body when it is
in a diseased state.
Homeopathic remedies act at the
psycho neuro endocrinal axis. In other words it stimulates the human body which
in turn will take care of the disease.
The right homeopathic remedy
prescribed on the totality of the symptoms will help in relieving the pain and
will help in arresting the disease. It will also improve the overall health of
the person.
Start the Homeopathic line of treatment by
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