By Stephanie Tweito Jacob
Be it tension from working at a computer all day or a stiff feeling when you get up in the morning, almost 96 percent of us experience back pain at some point in our lives, according to Reza Ghorbani, M.D., a board-certified interventional pain management specialist and president and medical director for the Advanced Pain Medicine Institute in the greater Washington, D.C., area.
But diagnosing what your back pain means can be difficult. The back is loaded with nerves, bones, discs, muscles, ligaments, tendons and joints, making it complex and sensitive to pain, he says.
AOL Health asked Ghorbani to explain what different kinds of back pain really mean and when you should see your doctor.
When to See a Doctor
Your first defense against back pain should be over-the-counter medications (pain relievers and anti-inflammatory tablets, creams or patches) and some physical therapy, says Ghorbani.
“This can even resolve a herniated disc within a month, without having injections or surgery,” he says.
If, however, your pain doesn't go away within a month, gets worse or prohibits you from going to work or maintaining most of your daily activities, or if you develop numbness or weakness in your legs, then you should see your doctor right away. He or she will examine you and may prescribe medication or order an MRI or X-ray to further determine what course of treatment should be taken.
And remember, back pain is preventable. Maintaining a healthy weight, exercising and not smoking can all help keep your back in good shape.
Muscle Strain
Dull, aching pain usually signals muscle strain, which is one of the most common causes of back pain, says Ghorbani. It can occur anywhere you have a muscle, which means the neck and upper and lower back are all at risk. Twisting the neck or torso, lifting something, exercising without stretching properly first or working behind a desk or computer are frequent causes of strained or pulled muscles in the back and neck, says Ghorbani.
Degenerative Disc Disease
Dull, aching pain could also signal degenerative disc disease if you're over 30 years of age. As we age, the discs between the vertebrae in our spine naturally start to shrink, placing more pressure on the spine. While not everyone will develop symptoms (genetics can play a role in whether you will), that increased stress can mean dull, aching pain on a daily basis, at the end of the day for some. And, depending on how worn the disc is, the pain can turn from dull and achy to sharp, shooting and burning if the disc tears or becomes herniated. DDD commonly occurs in the low back, but it can affect the upper back or neck, too.
Herniated Disc
A sharp, burning pain is often a sign of a herniated disc. Intense pressure on the discs between the vertebrae can cause them to rupture or herniate. Herniated discs often occur in the lower part of the back and tend to be accompanied by a stinging sensation that travels from the low back to the buttocks, says Ghorbani. Pain from herniation in the upper part of the spine can coincide with discomfort in the front of the thigh, while neck herniation often means headache pain or a burning sensation down the shoulders and arms, too.
Sciatica
A sharp, shooting pain indicates a nerve is being affected, says Ghorbani. The most common cause of sciatica pain is a herniated disc in the low back pressing into the sciatic nerve, causing pain to shoot from the lower back to your buttock and all the way down to your toes. If pain is projecting from the neck to the shoulders, elbows and fingers, you may have a herniated disc in your neck (the term sciatica does not apply to the neck). If you develop numbness or weakness in your legs, see your doctor right away. It could be a sign of nerve damage, says Ghorbani.
Facet Joint Disease
Facet joint disease is a common cause of low back pain, says Ghorbani, although the upper and middle spine is not exempt. When the facet joints between each vertebra in the spine degenerate -- either from arthritis or age -- the joints can become inflamed and painful. The dull, achy symptoms tend to be concentrated in one area (not shooting down a leg), and spasms can occur as an attempt to stabilize the back. Standing or moving around can ease the pain associated with facet joint disease, while sitting or resting for too long can make it worse. If getting out of bed in the morning is difficult because of a stiff back, facet joint disease may be to blame, says Ghorbani.
Failed Back Syndrome
Between 15 and 40 percent of people who have had back surgery have failed back syndrome, a condition that leaves you in either more or the same amount of pain as you were in prior to surgery, says Ghorbani. The pain is usually constant.
“You don't have to stand up, walk or twist. It comes from a malfunction of your nerves,” he says.
Symptoms can be a dull, achy pain that radiates into the hips, buttocks and thighs or sharp stabs of pain in the back and legs.
Spinal Stenosis
Stenosis is a narrowing of one or more areas in the spinal canal, which causes pressure on the spinal cord or nerves. It's often a condition that follows other back disorders such as herniated disc, arthritis or degenerative disc disease, says Ghorbani, and it can cause cramping, pain and numbness in the legs, back, neck, arms or shoulders; a loss of feeling in the extremities and sometimes problems with bladder or bowel function. The symptoms tend to get worse with walking or with activities and somewhat better with rest. If you develop numbness or weakness in your legs, see your doctor right away.
More on Back Pain: Treatment ChoicesWho Develops Back Pain Last Updated (Monday, 30 August 2010 20:10)
Back Pain
Back Pain in 2nd & 3rd Decades of Life
Medical Author: William C. Shiel Jr., MD, FACP, FACR
 I am a rheumatologist. We are medical doctors that are responsible for the non-surgical treatments of conditions that involve the muscles and joints of the body. We do not perform surgery, but refer patients for consideration of surgical procedures to orthopaedic surgeons when appropriate.
In the course of treating many patients over the years, I have come upon many instances in which a patient had received unnecessary surgery for conditions that could have either been diagnosed or treated without surgery.
It is unfortunately too frequent that we diagnose spondylitis after a patient has already undergone a surgical procedure of the low back.
Back pain in adolescents and young adults is commonly attributed to injury resulting from athletic activities. Guess why...because this it the time of life when humans typically are most involved with sports. The fact is, however, that it is very possible that the two events can be true and not related.
Back Pain Overview
Pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease. Rather, it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified.
Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter tries to touch on many of the causes of back pain and proper evaluation and diagnosis. Please make sure to discuss your individual symptoms as well as the suggested treatments with your health-care provider to determine the appropriate diagnostic and treatment plan for your circumstances.
- Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department.
- For 90% of people, even those with nerve root irritation, their symptoms will improve within two months no matter what treatment is used, even if no treatment is given.
- Doctors usually refer to back pain as acute if it has been present for less than a month and chronic if it lasts for a longer period of time.
Back Pain Causes
Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many intra-abdominal disorders, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.
- Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.
- Herniated discs are produced as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in one-third of adults older than 20 years of age. Only 3% of these, however, produce symptoms of nerve impingement.
- Spondylosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc height. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.
- Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These changes in the disc and the joints produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.
- Cauda equina syndrome is a medical emergency whereby the spinal cord is directly compressed. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence or the inability to begin urination.
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| Picture of a herniated lumbar disc, a common cause of sciatica |
- Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
- Myofascial pain is characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve. Relief of pain is often reported when the involved muscle group is stretched.
- Fibromyalgia results in widespread pain and tenderness throughout the body. Generalized stiffness, fatigue, and muscle aches are reported.
- Other skeletal causes of low back pain include osteomyelitis (infections of the bones of the spine). Noninfectious inflammation of the spine (spondylitis) can cause stiffness and pain in the spine that is particularly worse in the morning.
- Tumors, possibly cancerous, can be a source of skeletal pain.
- Inflammation of nerves from the spine can occur with infection of the nerves with the herpes zoster virus that causes shingles. This can occur in the thoracic area to cause upper back pain or in the lumbar area to cause low back pain.
Last Updated (Monday, 30 August 2010 20:08)
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Asthma In The Classroom
 By Corey BinnsWhen your kids hop back on the school bus this year, they could be headed for an asthma attack. School can worsen a child's asthma symptoms, thanks to seasonal allergens, the close confines of a classroom, and exposure to germs and allergens carried by other kids. Asthma is the No. 1 cause of school absenteeism among children, according to the U.S. Department of Education, and accounts for more than 14 million total missed days of school. That's approximately eight days for each student with asthma. The Asthma and Allergy Foundation of America estimates that the illness sends more children to the hospital than any other childhood disease. Some research has also demonstrated that asthma-related visits to the emergency room peak 17 days after Labor Day. "For so many parents, it's confusing because so much has changed since they were kids and had asthma," said Dr. Jacqueline Eghrari-Sabet, who treats allergy immunology and pediatric allergy at her private practice in Gaithersburg, Md. "What so many people think about asthma is that you have to react to it, instead of preventing it." Here's Eghrari-Sabet's advice on how to keep your child's asthma under control on campus: Know Your MedsIf your child's an asthmatic or you suspect your child is, ask your pediatrician to test for the illness during a back-to-school checkup. Eghrari-Sabet recommends children take a pulmonary function test to measure their breathing. Once you have inhaler prescriptions in hand, be sure to follow the doctor's orders when it comes to your child's drug regimen. Medications for asthma are categorized into two different classes: long-term control and quick relief or rescue. "Controller medications are like toothpaste," said Eghrari-Sabet, regarding the drugs often prescribed to be taken twice a day on a long-term basis. These include inhaled corticosteroids and long-acting bronchodilators. "If you only brush your teeth or take your asthma med when you feel you need it, you'll end up getting a cavity or an asthma attack." Children should take their controller medication regularly -- such as before bed and when they wake up. "So many kids stop taking their maintenance medications over the summer, so their tank is on empty." If they take it every day, she said, they won't need to rely on a rescue medication. Albuterol and other rescue medications should be used more sparingly than controller medications and inhaled only as needed. "They're meant to be taken just to rescue you," said Eghrari-Sabet. "If you need to be rescued every day, you're taking the wrong medicine." Treat AllergiesFor most children with asthma, allergies can inflame their lung airways and trigger an attack. More than 2.5 million children under age 18 suffer from allergic asthma, according to the AAFA. What's worse, several allergens common to the classroom this time of year can exacerbate a child's asthma. Knowing what triggers your child's allergies can help you avoid and treat them. The top three allergens children will likely encounter when they head back to school are ragweed, dust mites and mold. About 20 percent of Americans are allergic to ragweed, according to the AAFA. The weed grows throughout the country and releases pollen into the air beginning in late summer until frost kills the plant. Dust mites are microscopic creatures that feed off dead skin cells buried in classroom carpeting, mats and blankets. After being closed all summer, a classroom is likely to have higher numbers of mites that can set off an allergic reaction. Another nasty trigger is mold, which can live in any climate and tends to thrive in classrooms during the humid summer months. "Of course, we don't want to keep our kids hidden away," said Eghrari-Sabet. "There are definitive way for kids to get tested to find out exactly what they're allergic to." At the pediatrician's office, your child can receive a RAST test, which scores each of their potential allergies on a scale of one to 10. For more specific results, Eghrari-Sabet recommends requesting pharmaceutical company Phadia's ImmunoCAP test. Once you and your child's doctors learn the allergic triggers, your child can be immunized with allergy shots. It's good to take care of allergy shots early on, said Eghrari-Sabet, as immunization favors youth. "Allergy shots 'stick' in younger kids best," she said. Avoid InfectionWhen kids first rush back into school hallways, they carry with them -- and pass along -- a host of germs. Sick children are more likely to suffer from asthma attacks. Respiratory infections, such as colds, the flu, sore throats and sinus infections, are the No. 1 asthma trigger in children, according to the AAFA. You can protect your child from some respiratory infections by making sure he's vaccinated with this year's flu shot, said Eghrari-Sabet. And rest assured, the swine flu will already be included in the shot. "If your kid is immunized, you've protected your own kid and probably protected his classmates," she said. More on Asthma in Children: Asthma Action PlanBest Children's Hospitals for Respiratory ConditionsTylenol and Teen Asthma Have Strong Link
Last Updated (Friday, 27 August 2010 00:45)
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1. Why immunize? Vaccines safeguard children and adults from illnesses and death caused by infectious diseases. According to the Centers for Disease Control and Prevention (CDC) “immunization is one of the most significant public health achievements of the 20th century.” Without vaccination programs, epidemics of many preventable diseases could return which would result in increased illness, disability and death.
2. Vaccine preventable diseases:
3. Immunization schedule. Click here for view the CDC immunization schedules.
4. How Immunizations work. A vaccine protects you by preparing your body to fight serious and potentially deadly diseases. Active immunity occurs when the immune system is exposed to a disease and produces antibodies to that disease. By introducing a killed or weakened form of the disease organism through a vaccination the body produces the antibodies in preparation for later exposure.
5. Vaccine side effects. Slight discomfort at the site of the injection is normal. Depending on the vaccine a slight fever or rash might occur. A severe allergic reaction to a vaccination should be reported to your physician immediately. Serious reactions to vaccines are very rare. The risk of contracting a serious disease from deciding to not vaccinate is far greater than the risk of a serious reaction from a vaccination. If a reaction is severe get the person to medical treatment immediately. Ask your doctor or nurse to file a Vaccine Adverse Reporting System (VAERS) form documenting the reaction and the circumstances around the vaccination. 30,000 VAERS reports are filed yearly with 10-15% being classified as serious.
6. Are vaccines safe? The United States has one of the best vaccine safety programs in the world. All vaccines as with other medicines in the US are put through rigorous testing by the US Food and Drug Administration (FDA). Only when the FDA is satisfied with both computerized models and clinical trails will the FDA issue a license for use.
7. Don’t wait – vaccinate. Vaccine preventable diseases are costly involving physician visits, absence from work for parents, hospitalizations and premature deaths. Newborn babies are immune to many diseases because they carry over antibodies they received from their mothers. However this is short lived (1mth – 1year), afterwards babies are vulnerable to diseases that they might not be strong enough to fight off. Many children died from diseases that are now preventable because of vaccines (whooping cough, measles and polio).
8. Keep an updated shot record. A vaccination record helps you keep track of your or your child’s vaccinations and allows you to stay on schedule. An accurate record will help prevent repeating vaccinations. A shot record should be started when your child receives his/her first vaccination and updated with each shot. A Personal Health Record (PHR) such a Google Health is very helpful. This technology can even be downloaded onto a mobile health application such as iTriage and then become a portable shot record which can be reviewed and updated on the go.
9. Free Vaccinations. Vaccines for Children (VFC) is a federally funded program for children who might not otherwise be vaccinated because of their inability to pay for services. Children who are eligible for VFC vaccines are entitled to receive pediatric vaccines that are recommended by the Advisory Committee on Immunization Practices.
10. Where to get more information:
- CDC Contact Center 1-800-232-4636
- CDC website on vaccines and immunizations
- Your practitioner’s office – use iTriageHealth.com to find a physician
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Last Updated (Friday, 27 August 2010 00:45)
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Monday, 30 August 2010 20:13 | 
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Reflux means that 
