Back pain often occurs as the result of a traumatic injury like a fall or automobile accident. It can also result from chronically poor posture and body mechanics, or from degenerative spinal problems – the result of long-term wear and tear on the spine. All of these can result in structural changes in the back, nerve pressure, and irritation. Other sources of back pain include inflammatory conditions like arthritis, spinal tumors (although these are uncommon), narrowing or bony overgrowth in the spinal canal, and spondylolisthesis, a condition in which a bone in the spine slips out of place.
Many older adults develop back pain, and after it occurs once, it is more likely to occur again. Much of the problem has to do with the fact that humans have two legs instead of four. The highly complex and flexible spine can be overloaded quite easily if people carry heavy weights and use poor body mechanics. After age 30, blood supply to the discs (cartilage cushions between spine bones) diminishes, which means the discs begin to degenerate.
Minor back pain is usually treated with rest, the application of heat or cold and anti-inflammatory medications. Other conservative therapies for chronic back pain include oral pain medications, and spinal injections of medications called epidural steroids, or of ketamine, a type of anesthetic. Physical therapy and massage can be helpful for many people. Postural correction and training in body mechanics can help prevent movements that make pain worse. Surgery may be recommended in some cases.
For many people, surgery is a last resort. In many cases, surgery is not indicated, and medical management is the best treatment option. Neurologists begin their careers as physicians in internal medicine, which means the focus is on day-to-day medical management and long-lasting primary care, rather than surgical intervention. Neurologists are also trained to manage chronic pain conditions and can perform diagnostic procedures, such as EMG testing to determine if nerve damage is causing the pain.
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