Not Tonight I Have a Backache

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The most common condition in people is pain, of which a large section complains of back pain. Statistics say as much as 60 per cent of the adult population have suffered at least one episode of back pain. But only 20 per cent of them have a major attack and need hospitalization. Of that, only 20 per cent have a prolapsed disc problem. And only 20 per cent of them require surgery. Most backaches are self-limiting and the person can get back to work in 3-12 weeks.

Pain is often the price we pay for being at the desk for many hours at a stretch. It is not a disease but only a primitive sensation that indicates some tissue damage. Sometimes pain is felt somewhere when the condition is somewhere else. This type of pain is called referred pain.  For example, a backache could be because of a deep-set ulcer or urine infection.


The axial skeleton or the spine, which enables us to maintain balance and stand erect, is under a lot of strain. In fact, human beings are the only species that stand erect and this position is not easy on the spine. The taller you are, the more pressure you put on the spine.

With every movement, the ligaments that are attached to the joints take stress and strain. Beyond a point, they cannot take it anymore and tear. The disc, which we often blame for any severe pain, has a jelly like substance and it acts like a cushion against shock; the muscles around the spine help us move; and the thread-like nerves around the spine stimulate the muscles.

The reasons for backache are many: anatomical, everybody is structured differently; biomedical, abnormal loading; and mechanical, which could even be everyday vibrations like while running a hair dryer or a mixer. In 60 per cent of cases, lower back pain is due to muscle or ligament injury. It could even be due to some unaccustomed activity, prolonged activity, ill-fitting furniture and asymmetry of the limbs. Hormonal imbalance, improper nutrition and psychological problems can also lead to it.

Then there is another condition, called the Good Sports Syndrome, which means some sudden sports activity is done without a proper warm-up. People also develop pain due to age, when the lubricants in the joints dry up. The best way to delay this process is by regular exercise and yoga.  To prevent backache, one must use chairs that suit your body with proper back, thigh and arm support, not use too hard or too soft bed, use a pillow that allows your head to be on the same line at the shoulder and carry weight close to your body.

The other common pain related to brain and spine is headache. There are different types: vascular and muscle contraction (tension), which constitutes 90 per cent of headaches, and traction and inflammatory that constitutes the remaining 10 per cent. Interestingly, of the first two types which constitute the highest number of cases, there are no known causes of the problem.

Vascular headaches are migraine, toxic and cluster. In a migraine, one feels throbbing pain on one side of the head and it can be treated with regular medication. Toxic is a bursting type of headache, and in cluster, the headache comes and goes and it could be because of undetected high blood pressure. In tension headaches, the muscle around the skull contracts and one feels spasms. Coffee could help and a paracetamol tablet is a relatively safe drug in this condition.

Traction headache is due to increased pressure because of a tumour in the brain. Inflammatory headaches take place because of an infection of the sinus, eyes or teeth.
In most cases, inflammatory headaches do not require a doctor’s visit, but you should consult a doctor if you have the following conditions: headaches come three times or more in a week; you’re taking pain killers almost everyday; the headache is associated with stiff neck and/or fever (could be meningitis); headache is accompanied with slurry speech, blurred vision, confusion and drowsiness; headache is getting worse each time, if it’s a never-experienced-before type of headache, or for the first time after you’re 50 and it’s eyesight-related.

The other more severe, often fatal condition following a headache is a brain attack. But unlike in a heart attack, it’s difficult to look for early signs. Moreover, it’s crucial for the patient to reach the hospital and be treated within the first three hours of a brain attack. And it’s often not possible because of the conditions in which we live in our cities.

The usual tests for diagnosis are an MRI scan or a brain angiogram. Treatment could be either medicine or surgery, or both.  However, there are ways to prevent severe, regular headaches: exercise, adequate sleep, regular sleep timings, not too much of non-vegetarian food, no smoking, drinking or drugs.

If you are experiencing headaches, it would be a good idea to keep a journal describing your headaches so that you may provide accurate information to your physician.

By Dr K N Krishna and Dr DV Rajkumar and senior consultants and neurosurgeons at
Wockhardt Brain and Spine Centre, Bangalore.