Non-speci?c back pain is probably the result of mechanical disorders in the muscles, ligaments and joints of the back: torn muscles, sprained LIGAMENTS, and FIBROSITIS. These disorders are not always easy to diagnose, but mild muscular and ligamentous injuries are usually relieved with symptomatic treatment – warmth, gentle massage, analgesics, etc. Sometimes back pain is caused or worsened by muscle spasms, which may call for the use of antispasmodic drugs. STRESS and DEPRESSION (see MENTAL ILLNESS) can sometimes result in chronic backache and should be considered if no clear physical diagnosis can be made.
If back pain is severe and/or recurrent, possibly radiating around to the abdomen or down the back of a leg (sciatica – see below), or is accompanied by weakness or loss of feeling in the leg(s), it may be caused by a prolapsed intervertebral disc (slipped disc) pressing on a nerve. The patient needs prompt investigation, including MRI. Resting on a ?rm bed or board can relieve the symptoms, but the patient may need a surgical operation to remove the disc and relieve pressure on the affected nerve.
The nucleus pulposus – the soft centre of the intervertebral disc – is at risk of prolapse under the age of 40 through an acquired defect in the ?brous cartilage ring surrounding it. Over 40 this nucleus is ?rmer and ‘slipped disc’ is less likely to occur. Once prolapse has taken place, however, that segment of the back is never quite the same again, as OSTEOARTHRITIS develops in the adjacent facet joints. Sti?ness and pain may develop, sometimes many years later. There may be accompanying pain in the legs: SCIATICA is pain in the line of the sciatic nerve, while its rarer analogue at the front of the leg is cruralgia, following the femoral nerve. Leg pain of this sort may not be true nerve pain but referred from arthritis in the spinal facet joints. Only about 5 per cent of patients with back pain have true sciatica, and spinal surgery is most successful (about 85 per cent) in this group.
When the complaint is of pain alone, surgery is much less successful. Manipulation by physiotherapists, doctors, osteopaths or chiropractors can relieve symptoms; it is important ?rst to make sure that there is not a serious disorder such as a fracture or cancer.
Other local causes of back pain are osteoarthritis of the vertebral joints, ankylosing spondylitis (an in?ammatory condition which can severely deform the spine), cancer (usually secondary cancer deposits spreading from a primary tumour elsewhere), osteomyelitis, osteoporosis, and PAGET’S DISEASE OF BONE. Fractures of the spine – compressed fracture of a vertebra or a break in one of its spinous processes – are painful and potentially dangerous. (See BONE, DISORDERS OF.)
Backache can also be caused by disease elsewhere, such as infection of the kidney or gall-bladder (see LIVER), in?ammation of the PANCREAS, disorders in the UTERUS and PELVIS or osteoarthritis of the HIP. Treatment is e?ected by tackling the underlying cause. Among the many known causes of back pain are:
Mechanical and traumatic causes
Congenital anomalies. Fractures of the spine. Muscular tenderness and ligament strain. Osteoarthritis. Prolapsed intervertebral disc. Spondylosis.
In?ammatory causes
Ankylosing spondylitis. Brucellosis. Osteomyelitis. Paravertebral abscess. Psoriatic arthropathy. Reiter’s syndrome. Spondyloarthropathy. Tuberculosis.
Neoplastic causes
Metastatic disease. Primary benign tumours. Primary malignant tumours.
Metabolic bone disease
Osteomalacia. Osteoporosis. Paget’s disease.
Referred pain
Carcinoma of the pancreas. Ovarian in?ammation and tumours. Pelvic disease. Posterior duodenal ulcer. Prolapse of the womb.
Psychogenic causes
Anxiety. Depression.
People with backache can obtain advice from www.backcare.org.uk... backache
The University of Exeter Centre for Complementary Health Studies report, published in 2000, estimated that there are probably more than 60,000 practitioners of complementary and alternative medicine in the UK. In addition there are about 9,300 therapist members of organisations representing practitioners who have statutory quali?cations, including doctors, nurses (see NURSING), midwives, osteopaths and physiotherapists; chiropractors became fully regulated by statute in June 2001. There are likely to be many thousands more health sta? with an active interest or involvement in the practice of complementary medicine – for example, the 10,000 members of the Royal College of Nursing’s Complementary Therapy Forum. It is possible that up to 20,000 statutory health professionals regularly practise some form of complementary medicine including half of all general practices providing access to CAMs – most commonly manipulation therapies. The report from the Centre at Exeter University estimates that up to 5 million patients consulted a practitioner specialising in complementary and alternative medicine in 1999. Surveys of users of complementary and alternative practitioners show a relatively high satisfaction rating and it is likely that many patients will go on to use such therapists over an extended period. The Exeter Centre estimates that, with the increments of the last two years, up to 15–20 million people, possibly 33 per cent of the population of the country, have now sought such treatment.
The 1998 meeting of the British Medical Association (BMA) agreed to ‘investigate the scienti?c basis and e?cacy of acupuncture and the quality of training and standards of con?dence in its practitioners’. In the resulting report (July 2000) the BMA recommended that guidelines on CAM use for general practitioners, complementary medicine practitioners and patients were urgently needed, and that the Department of Health should select key CAM therapies, including acupuncture, for appraisal by the National Institute for Clinical Medicine (NICE). The BMA also reiterated its earlier recommendation that the main CAM therapies, including acupuncture, should be included in familiarisation courses on CAM provided within medical schools, and that accredited postgraduate education should be provided to inform GPs and other clinicians about the possible bene?ts of CAM for patients.... complementary and alternative medicine (cam)
Chiropractors stress the importance of X-raying patients before applying manipulation. “Patients treated by chiropractors,” reported the Medical Research Council in the British Medical Journal, “were not only no worse off than those treated in hospital but almost certainly fared considerably better and maintained their improvement for two years.” ... chiropractic
Symptoms (non-specific). Loss of appetite, anaemia, weight loss; pain in abdomen, especially stomach area. Vomit appears as coffee grounds. Occult blood (tarry stools).
Causes. Alcohol, smoking cigarettes, low intake of fruits and vegetables. Foods rich in salt and nitrites including bacon, pickles, ham and dried fish. (Cancer Researchers in Digestive Diseases and Sciences) Long term therapy with drugs that inhibit gastric acid secretion increase risk of stomach cancer.
Of possible value. Alternatives:– Tea. Mixture. Equal parts: Red Clover, Gotu Kola, Yarrow. Strong infusion (2 or more teaspoons to each cup boiling water; infuse 15 minutes. As many cups daily as tolerated.
Formula. Condurango 2; Bayberry 1; Liquorice 1; Goldenseal quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily in water or honey.
Traditional. Rosebay Willowherb. Star of Bethlehem.
Chinese green tea. Anti-cancer effects have been found in the use of Chinese green tea extracts. Clinical trials on the therapeutic effects against early stomach cancer were promising. (Chinese Journal Preventative Medicines 1990. 24 (2) 80-2)
Chinese Herbalism. Combination. Oldenlandia diffusa 2 liang; Roots of Lu (Phragmites communis) 1 liang; Blackened Ginger 1 ch’ien; Pan-chih-lien (Scutellaria barbarta 5 ch’ein; Chih-tzu (gardenia jasminoides) 3 ch’ien. One concoction/dose daily. Follow with roots of Bulrush tea.
William H. Cook, MD. “Mullein greatly relieves pain, and may be used with Wild Yam and a little Water- Pepper (Polygonum Hydropiper).” The addition of Water-Pepper (or Cayenne) ensures diffusive stimulation and increased arterial force. Burns Lingard, MNIMH. Inoperable cancer of the stomach. Prescribed: Liquid Extract Violet leaves and Red Clover, each 4 drachms; Liquid Extract Cactus grand., 2 drops. Dose every 4 hours. Woman lived 30 years after treatment attaining age of 70.
Arthur Barker, FNIMH. Mullein sometimes helpful for pain.
Wm Boericke MD. American Cranesbill.
George Burford MD. Goldenseal.
Maria Treben. “After returning from a prison camp in 1947 I had stomach cancer. Three doctors told me it was incurable. From sheer necessity I turned to Nature’s herbs and gathered Nettle, Yarrow, Dandelion and Plantain; the juice of which I took hourly. Already after several hours I felt better. In particular I was able to keep down a little food. This was my salvation.” (Health Through God’s Pharmacy – 1981) Essiac: Old Ontario Cancer Remedy. Sheila Snow explored the controversy surrounding the famous cancer formula ‘Essiac’. This was developed by Rene Caisse, a Canadian nurse born in Bracebridge, Ontario, in 1888. Rene noticed that an elderly patient had cured herself of breast cancer with an Indian herbal tea. She asked for the recipe and later modified it. Rene’s aunt, after using the remedy for 2 years, fully recovered from an inoperable stomach cancer with liver involvement, and other terminal patients began to improve.
Rene’s request to be given the opportunity to treat cancer patients in a larger way was turned down by Ottawa’s Department of Health and Welfare. She eventually handed over the recipe to the Resperin Corporation in 1977, for the sum of one dollar, from whom cancer patients may obtain the mixture if their doctors submit a written request. However, records have not been kept up.
In 1988 Dr Gary Glum, a chiropractor in Los Angeles, published a book called ‘Calling of an Angel’: the true story of Rene Caisse. He gives the formula, which consists of 11b of powdered Rumex acetosella
(Sorrel), 1 and a half pounds cut Arctium lappa (Burdock), 4oz powdered Ulmus fulva (Slippery Elm bark), and 1oz Rheum palmatum (Turkey Rhubarb). The dosage Rene recommended was one ounce of Essiac with two ounces of hot water every other day at bedtime; on an empty stomach, 2-3 hours after supper. The treatment should be continued for 32 days, then taken every 3 days. (Canadian Journal of Herbalism, July 1991 Vol XII, No. III)
Diet. See: DIET – CANCER. Slippery Elm gruel.
Note: Anyone over 40 who has recurrent indigestion for more than three weeks should visit his family doctor. Persistent pain and indigestion after eating can be a sign of gastric cancer and no-one over 40 should ignore the symptoms. A patient should be referred to hospital for examination by endoscope which allows the physician to see into the stomach.
Study. Evidence to support the belief that the high incidence of gastric cancer in Japan is due to excessive intake of salt.
Note: A substance found in fish oil has been shown experimentally to prevent cancer of the stomach. Mackerel, herring and sardines are among the fish with the ingredient.
Treatment by or in liaison with hospital oncologist or general medical practitioner. ... cancer – stomach and intestines
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