Back Is in Pain

During his 27 years as a hospital corpsman, Richard Mettetal lifted injured people and remained suspended by harness from helicopters for long periods. For the 54-year-old Thurmont, Md., resident, the legacy of those years of public service is chronic back pain that has plagued him since 1984.

"It's been so long now, I can't remember when I didn't feel the pain," Mettetal says. "And I'm so angry that I can't do all that I want because of it."

Work-related back pain is among the most common occupational disorders in the United States, according to the National Institute for Occupational Safety and Health in Cincinnati, Ohio. Delay in return to work remains an expensive component in the overall cost of back pain for workers' compensation claims, as well, the institute notes. And back pain is responsible for more loss of work time and increased medical expenses related to treatment than any other ailment, says Robert Shields, M.D., an osteopathic physician practicing general medicine in Plano, Texas.

"This is one of the most common problems I see in my medical practice," he says. "Low back pain strikes 8 out of 10 adults at some point in their lives."

Understanding Back Pain

Back pain comes in two forms, acute and chronic, and is most often felt in the lower back. Acute pain comes on suddenly and intensely, usually from doing something you shouldn't be doing or from doing it in the wrong way. The pain usually lasts a short while. Chronic pain is recurring; any little movement can set it in motion and, for whatever reason, it lingers on and on for what can seem like an eternity.

Although back pain is usually preventable (See "Back to Exercise ), experts claim that 4 out of 5 Americans will experience it at some time in their lives, given that the lower back supports most of the body's weight. The stability of the lower back depends on the integrity of the vertebral bodies and the intervertebral disks.

To understand the many ways you can do injury to your back, consider that each of us has between 24 and 25 bones in and around our backs, including the neck and chest areas, which are held together by ligaments and muscles. Throw in some major nerves, a few disks (which act as shock absorbers), and joints that guide the direction of movement of the spine, and stack them all up, explains Shields. "Expect to twist and bend them in a multitude of directions, and try to imagine what might go wrong."

Shields says you can sprain the ligaments, strain the muscles, rupture the disks, and irritate the joints. While logic would point to injuries from sports or traumatic accidents as the cause of the pain, sometimes the simplest of movements will have painful results. In addition, arthritis, congenital disorders, poor posture, obesity, and psychological problems due to stress can be the source of back pain. Complicating the issue further is the fact that back pain can also directly result from internal problems such as kidney stones, kidney infections, blood clots, or bone loss.

Even with modern technology, however, the exact reason or cause of back pain can be found in very few people, according to the Clinical Practice Guideline for Understanding Acute Low Back Problems, published in 1994 by the Department of Health and Human Services' Agency for Health Care Policy and Research. X-ray examinations explain only a small proportion of the nonspecific complaints doctors receive.