We are all familiar with the word “stress”. Stress is when you are worried about getting laid off your job, or worried about having enough money to pay your bills, or worried about your mother when the doctor says she may need an operation. In fact, to most of us, stress is synonymous with worry. If it is something that makes you worry, then it is stress.
Your body, however, has a much broader definition of stress. TO YOUR BODY, STRESS IS SYNONYMOUS WITH CHANGE. Anything that causes a change in your life causes stress. It doesn’t matter if it is a “good” change, or a “bad” change, they are both stress. When you find your dream apartment and get ready to move, that is stress. If you break your leg, that is stress. Good or bad, if it is a CHANGE in your life, it is stress as far as your body is concerned.
Even IMAGINED CHANGE is stress. (Imagining changes is what we call “worrying”.) If you fear that you will not have enough money to pay your rent, that is stress. If you worry that you may get fired, that is stress. If you think that you may receive a promotion at work, that is also stress (even though this would be a good change). Whether the event is good or bad, imagining changes in your life is stressful.
Anything that causes CHANGE IN YOUR DAILY ROUTINE is stressful.
Anything that causes CHANGE IN YOUR BODY HEALTH is stressful.
IMAGINED CHANGES are just as stressful as real changes.
Let us look at several types of stress — ones that are so commonplace that you might not even realize that they are stressful.……
Emotional Stress
When arguments, disagreements, and conflicts cause CHANGES in your personal life — that is stress.

Illness
Catching a cold, breaking an arm, a skin infection, a sore back, are all CHANGES in your body condition.

Pushing Your Body Too Hard
A major source of stress is over driving yourself. If you are working (or partying) 16 hours a day, you will have reduced your available time for rest. Sooner or later, the energy drain on your system will cause the body to fall behind in its repair work. There will not be enough time or energy for the body to fix broken cells, or replace used up brain neurotransmitters. CHANGES will occur in your body’s internal environment. You will “hit the wall,” “run out of gas”. If you continue, permanent damage may be done. The body’s fight to stay healthy in the face of the increased energy that your are expending is major stress.
Environmental Factors
Very hot or very cold climates can be stressful. Very high altitude may be a stress. Toxins or poisons are a stress. Each of these factors threatens to cause CHANGES in your body’s internal environment.

The Special Case of Tobacco Use
Tobacco is a powerful toxin!! Smoking destroys cells that clean your trachea, bronchi, and lungs. Smoking causes emphysema and chronic bronchitis, which progress to slow suffocation. The carbon monoxide from cigarette smoking causes chronic carbon monoxide poisoning. Tobacco use damages the arteries in your body, causing insufficient blood supply to the brain, heart, and vital organs. Cigarette smoking increases the risk of cancer 50 fold.
Chewing tobacco or snuff is no safe haven. It also damages your arteries, and it carries the same cancer risk. (Cancers of the head and neck are particularly vicious, disfiguring, and deadly).
Poisoning the body with carbon monoxide, and causing the physical illnesses of emphysema, chronic bronchitis, cancer, and arterial damage, tobacco is a powerful source of added stress to one’s life.
Hormonal Factors
PUBERTY
The vast hormonal changes of puberty are severe stressors. A person’s body actually CHANGES shape, sexual organs begin to function, new hormones are released in large quantities. Puberty, as we all know, is very stressful.
PRE-MENSTRUAL SYNDROME
Once a woman passes puberty, her body is designed to function best in the presence of female hormones. For women past puberty, a lack of female hormones is a major stress on the body. Once a month, just prior to menstruation, a woman’s hormone levels drop sharply. In many women, the stress of sharply falling hormones is enough to create a temporary OVERSTRESS. This temporary OVERSTRESS is popularly known as Pre MenstrualSyndrome (PMS).
POST-PARTUM
Following a pregnancy, hormone levels CHANGE dramatically. After a normal childbirth, or a miscarriage, some women may be thrown into OVERSTRESS by loss of the hormones of pregnancy.
MENOPAUSE
There is another time in a woman’s life when hormone levels decline. This is the menopause. The decline in hormones during menopause is slow and steady. Nevertheless, this menopausal decline causes enough stress on the body to produce OVERSTRESS in many women.
Taking Responsibility for Another Person’s Actions
When you take responsibility for another person’s actions, CHANGES occur in your life over which you have little or no control. Taking responsibility for another person’s actions is a major stressor.
Allergic Stress
Allergic reactions are a part of your body’s natural defense mechanism. When confronted with a substance which your body considers toxic, your body will try to get rid of it, attack it, or somehow neutralize it. If it is something that lands in your nose, you might get a runny, sneezy nose. If it lands on your skin, you might get blistery skin. If you inhale it, you’ll get wheezy lungs. If you eat it, you may break out in itchy red hives all over your body. Allergy is a definite stress, requiring large changes in energy expenditure on the part of your body’s defense system to fight off what the body perceives as a dangerous attack by an outside toxin.
On a typical day in the brain, trillions of messages are sent and received. The messages that are happy, up beat messages are carried by the brain’s “HAPPY MESSENGERS” (technically known as Biogenic Amine/Endorphin System). Other messages are somber and quieting. They are carried by the brain’s “SAD MESSENGERS”. Most nerve centers receive input from both types of messengers. As long as this input is balanced, everything runs along on an even keel.
Stress, however, causes problems with the brain’s Happy Messengers. When life is smooth, the happy messages keep up with demand. But when too much stress is placed on the brain, the Happy Messengers begin to fall behind on their deliveries. As the stress continues, the happy messages begin to fail. Important nerve centers then receive mostly SAD MESSAGES, and the whole brain becomes distressed. The person enters a state of brain chemical imbalance known as — OVERSTRESS.
OVERSTRESS makes people feel terrible. With SAD MESSAGES overwhelming the happy messages, a person feels “overwhelmed” by life. People complain of being tired, unable to fall asleep or to obtain a restful night’s sleep. They have plagues of aches and pains, lack of energy, lack of enjoyment of life. They feel depressed, anxious, or just unable to cope with life.

Low Stress Tolerance — The Inherited Factor
Everyone inherits a certain ability to make and use Happy Messengers in the brain. As long as you can make enough Happy Messengers to keep up with the stress in your life, you will find stress to be fun, exciting, enjoyable, challenging. In fact, without it you would be bored.
However, when the amount of stress in your life is so great that you begin to run out of Happy Messengers, then bad things begin to happen. You may have sleep disturbances, aches and pains, lack of enjoyment of life and even panic attacks.
The amount of stress that you can tolerate before your Happy Messengers malfunction is referred to as your “Stress Tolerance”. Your Stress Tolerance is set by your genetic inheritance. Most of us have inherited sufficient Stress Tolerance to allow us to weather the stresses of daily living. We still feel well and enjoy life. Yet, each of us, at some time has experienced short periods of brain chemical imbalance.
The night you couldn’t sleep before your big test at school, or your important job interview, or your “fabulous date”…
The sadness and crying you may have felt when a friend or relative passed away, or a girlfriend or boyfriend left…
The chest pains or the headaches that you may have thought were heart problems or migraine, but your doctor said came from too much stress and strain…
WE HAVE ALL EXPERIENCED SUCH BRIEF EPISODES OF HAPPY MESSENGER MALFUNCTION. BUT, FULLY 10% OF OUR POPULATION FEELS LIKE THIS ALL OF THE TIME!
You see, one in ten persons has inherited a LOW STRESS TOLERANCE. This means that his/her Happy Messengers “poop out” at stress levels which the rest of us would consider “normal, everyday stress.” The result of inheriting such a Low Stress Tolerance may be a disaster. Such a person will be operating his or her life in practically permanent OVERSTRESS. Sleep disturbances, aches and pains, fatigue, depressions, mood swings, anxiety attacks, and even drug addiction can become life long problems.
Since one in ten persons have inherited a Low Stress Tolerance, we are describing an enormous number of people.
Ten percent of your friends, your acquaintances, your employees, your co-workers, your employers… everywhere around you there are persons who are not able to cope with the stress of daily life.

To understand how stress results in this disastrous condition for so many people, let us begin by examining the brain’s HAPPY MESSENGERS.
There are three Happy Messengers: SEROTONIN, NORADRENALIN, and DOPAMINE. These are the brain chemicals that begin to malfunction when stress levels become more than a person can handle.
Serotonin
SEROTONIN LETS YOU SLEEP
The Happy Messenger, Serotonin, must work properly in order for you to sleep well. Serotonin is responsible for making sure that your body’s physiology is set for sleeping. If Serotonin does not do its job properly, you will not be able to obtain a restful sleep, no matter how hard you try.
SEROTONIN SETS YOUR BODY CLOCK
Inside every one of our brains is a very accurate “Clock”. This time keeping apparatus functions like the conductor of a symphony orchestra. Just as the conductor of the orchestra keeps all the various instruments playing in rhythm, so the Body Clock keeps all the various functions of your body coordinated, and moving to the same rhythm.
The Body Clock is located deep in the center of the brain, in a little group of cells known as the Pineal Gland. Within the Pineal Gland is a store-house of the messenger Serotonin, which is the chemical “mainspring” of the Clock. Each day the Serotonin is chemically converted to a related compound, Melatonin; and then the Melatonin is converted right back to Serotonin. The whole cycle from Serotonin to Melatonin and back to Serotonin takes exactly 25 hours — and this forms your Body’s Clock.
Twenty five hours? Yes, under experimental conditions of an unchanging environment, such as in a cave kept at a constant level of illumination for weeks on end, this Body Clock cycles every 25 hours. If, however, a person is exposed to a natural outdoor cycle of daylight and darkness, the Pineal Gland will automatically set itself to a 24 hour day. That is, the Pineal Gland will automatically match its cycle to the length of one Earth’s day. That way, noon in the Pineal Gland is always noon on Earth. If exposed to daylight, the Pineal Gland will neither gain nor lose time, but will always cycle exactly in concert with the Earth as our planet twirls through space. The whole process of setting the Body Clock to Earth time takes about three weeks.
The 24 hour cycling of the Body Clock is important. It adjusts your body chemistry for sleeping and for waking. Every evening your Body Clock will set your physiology for sleeping; then you feel drowsy and sleep soundly. After a while, your Body Clock adjusts your physiology for waking. You then wake up and feel refreshed.
We mentioned that the Body Clock is the coordinator of your physiologic orchestra. Three important players in that orchestra are your body temperature, stress fighting hormone, and sleep cycles. Each of these must be properly coordinated by the Body Clock in order for you to sleep soundly, and awake feeling rested.
THE BODY CLOCK AND YOUR BODY TEMPERATURE
Every 24 hours, your body temperature cycles from high to low, varying by as much as one degree. When it is time to wake up and be active, your body temperature rises slightly. When it is time to fall asleep, your body temperature dips slightly. Most of us have felt how difficult it is to fall asleep on a very warm night, when you toss and turn and wish you could cool off. Contrast this with the relative comfort when one is tucked in a nice bed in a room that is slightly cool, or even downright cold. To achieve the best sleep, the body thermostat is supposed to lower slightly at night, a timing which is coordinated by your Body Clock.
THE BODY CLOCK AND YOUR STRESS FIGHTING HORMONE
The body has a vital hormone called Cortisol, which is the body’s chief stress fighting hormone. When Cortisol secretion is high, the body shifts to a “war footing”. It is prepared for stress conditions such as hunger, trauma, hemorrhage, fighting, or running. Ordinarily, one’s Cortisol drops substantially in the evening, as one relaxes, settles down, and prepares for sleep.
As with body temperature, the ups and downs of your stress fighting hormone must cycle properly during a 24 hour day for you to achieve a restful night’s sleep and awake refreshed. Any disruption of your Cortisol cycle, and restful sleep will become very difficult.
THE BODY CLOCK AND YOUR SLEEP CYCLES
After falling asleep, one normally goes DEEPER and DEEPER into sleep, finally reaching a state of deep restorative sleep. Then sleep becomes LIGHTER and LIGHTER until one enters dreaming sleep. Then the whole cycle begins over again. About every 90 minutes one goes through this cycle. In the early part of the evening the cycle pauses a relatively long time in the deepest restorative phase. As the evening progresses, the amount of time spent in deep restorative sleep lessens, and one spends more and more time dreaming. In order for one to feel rested, this sleep pattern must be cycling properly. And, of course, the cycle is regulated by your internal Body Clock.
STRESS DESTROYS YOUR SLEEP
The Body Clock is essential for the proper harmony of your body temperature, stress fighting hormone, and sleep cycles. In order to fall asleep easily, sleep soundly, and awake refreshed, your Body Clock must be functioning properly. The Happy Messenger, Serotonin, is the “mainspring” of the Body Clock. If stress causes Serotonin to fail, the Body Clock will stop working. You will not be able to obtain a restful sleep, no matter how hard you try.
SINCE SEROTONIN IS USUALLY THE FIRST HAPPY MESSENGER TO FAIL UNDER STRESS, THE FIRST SIGN OF OVERSTRESS WILL USUALLY BE INABILITY TO OBTAIN A RESTFUL SLEEP.
Noradrenalin: Giving Us Energy
I am sure you have all heard of “Adrenalin”. When you are frightened, Adrenalin is released into your blood stream by your adrenal glands. Your heart beats faster, blood flow is shunted away from your skin and intestines and towards your muscles. Perspiration appears on your palms and forehead. You are ready for “fight or flight”. A cousin of Adrenalin, named Noradrenalin is one of the Happy Messengers. Noradrenalin has many important functions in the body’s nervous system. The one that most concerns us here, however, is the role of Noradrenalin in setting your energy levels. Proper functioning of Noradrenalin in the brain is essential for you to feel energized. Without enough brain Noradrenalin you feel exhausted, tired, droopy and without energy. You just don’t feel like doing anything. You just wantto sit.
People with Noradrenalin failure become progressively more and more lethargic. They do not seem to have any energy to do anything. Running your brain with low Noradrenalin is akin to running your car with a failing battery. Sooner or later, it just won’t start.
Dopamine: Your Pleasure and Your Pain
As you probably know, morphine and heroin are the most potent pain relieving and pleasure producing medications known to man. They are so potent in fact, that they were long believed to mimic some unknown, but naturally occurring, body chemical. A recent technological advance has led to the remarkable uncovering of natural morphine-like molecules that are, indeed, made in each of our brains. Collectively, these substances are known as ENDORPHINS, and they are responsible for regulating our moment to moment awareness of pain.
It appears that in the discovery of Endorphins we have found our body’s naturally occurring mechanism for regulating pain. It is likely that a certain baseline secretion of Endorphin occurs at all times in the body. Under certain conditions, this Endorphin secretion may rise, making the person relatively insensitive to pain. Under other conditions, the Endorphin levels may drop, making a person more sensitive than usual to pain.
Individual variations of Endorphin level would explain the observation that people may react with differing levels of perceived pain when suffering the same painful stimulus. In medical practice it is quite common to see one person with an injury have very little discomfort, while another person with a very similar injury has terrible discomfort. In the past we have said that such unusual suffering was “all in the person’s head”.
Now we may speculate that what is different in that person’s head is the Endorphin level. Hence, the person who seems to have an unusual amount of discomfort from what appears to be a trivial injury, probably is feeling more pain. For some reason, his body’s own pain control mechanism has been depleted of Endorphins.
Now, our third Happy Messenger, Dopamine, seems to be concentrated in areas of the brain immediately adjacent to where the major Endorphin releasing mechanisms lie. When Dopamine function declines, Endorphin function also declines. Hence, when too much stress causes failure of Dopamine function, it also causes loss of your body’s natural “pain killer”.
Dopamine also runs your body’s “Pleasure Center”. This is the area of your brain that allows you to enjoy life. When stress interferes with your Dopamine function, the Pleasure Center becomes inoperative. Normally pleasureful activities no longer give any pleasure. With severe Dopamine/Endorphin malfunction, life becomes painful and devoid of any pleasure.
WHAT OVERSTRESS FEELS LIKE
When your stress level is high enough to cause failure of your Happy Messengers, what is going to happen to you? What will you feel like?
If your total stress load is high enough to interfere with your brain’s Happy Messengers, then your Body Clock is going to stop working. You will find yourself having difficulty falling asleep, and frequent awakenings during the night, perhaps with vivid dreams. When morning rolls around, you will not feel at all rested.
Next, you will note lack of energy, lack of desire to get out and do things, lack of interest in the outside world.
Next, you will have aches and pains. Particularly common are chest, shoulder, back and neck pains. But, it will seem like you are aware of vague, uncomfortable feelings from all over your body. Along with increased sensitivity to aches and pains, there is a decreased sense of pleasure in life. Things that used to be fun or pleasurable do not seem enjoyable anymore.
When all of these symptoms coincide–lack of sleep, fatigue, aches and pains–you feel that life is not enjoyable anymore. You feel overwhelmed by life. Now you may cry easily, and feelthat you are “depressed”.
You may also feel quite anxious. All these strange changes in your body. Why can’t I sleep? Why do I ache all the time? Am I having a heart attack? What is happening to me? It is not uncommon for persons who are experiencing the strange changes in their body caused by Happy Messenger failure to have periods of panic. It is during these so-called “panic attacks” that you feel as if you can not catch your breath. The heart races in panic, the muscles ache and pain all over the chest. You may even get light-headed. You may have stomach upset and diarrhea. Stress has caused your body to behave in strange and difficult ways. Under these circumstances, anxiety and fear are not at all unexpected.
All of us have experienced some periods of OVERSTRESS in our lives. Usually they will be of short duration. We live in such a high stress society, however, that at least TEN PERCENT OF OUR POPULATION IS IN OVERSTRESS ALL THE TIME! These people, who have inherited a Low Stress Tolerance, are fighting against Happy Messenger failure every day of their lives. It rarely stops; and they are sorely afflicted.
In the past, we did not know the cause of this suffering. Such persons were often said to have a “mental illness”. The medical world now recognizes these symptoms to arise from a brain Happy Messenger malfunction. THIS MALFUNCTION IS CAUSED BY TOO MUCH STRESS.
What was once regarded as a mental illness has emerged from that shadowy realm to reside in the world of biochemistry and physical illness.
What are the common causes of Lower Back Pain
May 7th, 2009Common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.
A lumbar strain is a stretching injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as “acute” if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as “chronic.”
Lumbar strain most often occurs in people in their forties, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back.
The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, x-ray testing is only helpful to exclude bone abnormalities.
The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found helpful in some patients that do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.
The nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths—from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.
Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration (“wear and tear”) of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized “sciatica” pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a “popping” sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.
Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.
Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.
Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking poor circulation). Treatment of these afflictions varies, depending on their severity, and range from rest to surgical decompression by removing the bone that is compressing the nervous tissue.
Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are from inflammation of the joints (arthritis).
Congenital bone conditions—Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal design of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing.
Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
Degenerative bone and joint conditions—As we age, the water and protein content of the body’s cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on x-rays of the spine as a narrowing of the normal “disc space” between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain (“lumbago”) in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain x-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.
Injury to the bones and joints—Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a “cement” (methymethacrylate) is injected into the balloon and remains to retain the structure.
Arthritis—The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter’s disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping the progression.
What are other causes of low back pain?
Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.
What are uncommon causes of low back pain?
Uncommon causes of low back pain include Paget’s disease of bone, bleeding or infection in the pelvis, infection of the cartilage and/or bone of the spine, aneurysm of the aorta, and shingles.
Paget’s disease can be diagnosed on plain x-rays. However, a bone biopsy is occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is helpful to determine the extent of the disease, which can involve more than one bone area. A blood test, alkaline phosphatase, is useful for diagnosis and monitoring response to therapy. Treatment options include aspirin, other anti-inflammatory medicines, pain medications, and medications that slow the rate of bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel), alendronate (Fosamax), risedronate (Actonel), and pamidronate (Aredia).
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