Loma Linda University Medical Center

Request More Information

Let us find the right doctor for you. Fill out the form below, and a member of our referral staff will contact you soon to complete the appointment process.

* indicates required field













 

Learn About Neurosurgery

Aneurysm

Aneurysm

Definition

An aneurysm is an abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel. Some common locations for aneurysms include:

  • Aorta (the major artery from the heart) -- see abdominal aortic aneurysm and thoracic aortic aneurysm)
  • Brain (cerebral aneurysm)
  • Leg (popliteal artery aneurysm)
  • Intestine (mesenteric artery aneurysm)
  • Splenic artery aneurysm

Causes

It is not clear exactly what causes aneurysms. Defects in some of the parts of the artery wall may be responsible. In certain cases (abdominal aortic aneurysms), high blood pressure is thought to be a contributing factor. Some aneurysms are congenital (present at birth).

Atherosclerotic disease (cholesterol buildup in arteries) may contribute to the formation of certain types of aneurysms. Pregnancy is often associated with the formation and rupture of aneurysms of the splenic artery (an artery leading to the spleen).

Symptoms

The symptoms vary depending on the location of the aneurysm. Swelling with a throbbing mass at the site of an aneurysm is often seen if it occurs near the body surface. Aneurysms within the body or brain often have no symptoms

In the case of rupture, low blood pressure, high heart rate, and lightheadedness may occur. The risk of death after a rupture is high.

Exams and Tests

Physical exam, ultrasound examination, and CT scan are used to evaluate aneurysms.

Treatment

Surgery is generally recommended. The timing and indications for surgery differ depending on the type of aneurysm.

Some people are candidates for endovascular stent repair. A stent is a tiny tube used to prop open a vessel. This procedure can be done with a major cut, so you recover faster than you would with open surgery. Not all patients with aneurysms are candidates for stenting, however.

Outlook (Prognosis)

With successful surgical repair, the outlook is often excellent.

Possible Complications

The main complications of aneurysm include rupture, infection, and compression of local structures. Rupture of some types of aneurysms can cause massive bleeding, which is often fatal. This is commonly seen with abdominal aortic aneurysms, mesenteric artery aneurysms, and splenic artery aneurysms.

Rupture of aneurysms in the brain can cause stroke, disability, and death. Brain surgery for aneurysms can also result in these complications, if the aneurysm ruptures during surgery and bleeding cannot be controlled.

Infection of the aneurysm, which sometimes follows infection at other sites of the body, can lead to systemic illness and rupture. Clotting of the aneurysm occurs when blood stops moving inside the aneurysm, blocking further blood flow past the site of the aneurysm and depriving the tissues beyond of blood.

In certain cases, aneurysms can compress neighboring structures such as nerves, leading to neurologic problems, such as weakness and numbness. This can occur with popliteal artery aneurysms.

When to Contact a Medical Professional

Call your physician for if you develop any new mass on your body, whether or not it is throbbing.

Prevention

Control of high blood pressure may help prevent some aneurysms. Control of all risk factors associated with atherosclerotic disease (diet, exercise, cholesterol control) may help prevent aneurysms or their complications.

Review Date: 7/14/2006
Reviewed By: J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Spinal Stenosis

Spinal stenosis

Definition

Spinal stenosis is a narrowing of the lumbar (back) or cervical (neck) spinal canal, which causes compression of the nerve roots.

Causes

Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by osteoarthritis or Paget's disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

Symptoms

  • Pain in the buttocks, thighs or calves that is worse with walking or exercise
  • Numbness in the buttocks, thighs or calves, that is worse with standing, walking or exercise
  • Back pain that radiates to the legs
  • Weakness of the legs
  • Neck pain
  • Leg pain
  • Difficulty or imbalance when walking

Exams and Tests

An examination of reflexes of lower legs reveals asymmetry. Neurologic examination confirms leg weakness and decreased sensation in the legs.

  • X-ray of the spine shows degenerative changes and narrowed spinal canal.
  • Spinal MRI or spinal CT scan shows spinal stenosis.
  • EMG may show active and chronic neurological changes.

Treatment

Generally, conservative management is encouraged. This involves the use of anti-inflammatory medications, other pain relievers, and possibly steroid injections. If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves.

Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

Outlook (Prognosis)

If the nerve roots can be successfully relieved of pressure, the symptoms will not worsen and may improve.

Possible Complications

Injury can occur to the legs or feet due to lack of sensation; infections may progress because pain related to them may not be felt. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Call your health care provider if symptoms suggestive of spinal stenosis develop.

Review Date: 5/31/2006
Reviewed By: Kevin B. Freedman, MD, MSCE, Sports Medicine, Orthopaedic Specialists, Bryn Mawr, PA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Brain Tumor

Brain tumor - adults

Alternative Names

Glioblastoma multiforme - adults; Ependymoma - adults; Glioma - adults; Astrocytoma - adults; Medulloblastoma - adults; Neuroglioma - adults; Oligodendroglioma - adults; Meningioma - adults; Cancer - brain tumor (adults)

Definition

A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in adults.

See also:

  • Brain tumor - metastatic (cancer that has spread to the brain)
  • Brain tumor - children

Causes

Primary brain tumors include any tumor that starts in the brain. Tumors may be confined to a small area, invasive (spread to nearby areas), benign (not cancerous), or malignant (cancerous).

Tumors can directly destroy brain cells. They can also indirectly damage cells by producing inflammation, compressing other parts of the brain as the tumor grows, causing swelling in the brain, and increasing pressure within the skull.

Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, benign or malignant tendencies of the tumor, and other factors. Primary brain tumors can arise from the brain cells, the meninges (membranes around the brain), nerves, or glands.

The cause of primary brain tumors is unknown. This is because they are rare, there are many types, and there are many possible risk factors that could play a role. Exposure to some types of radiation, head injuries, and hormone replacement therapy may be risk factors, as well as many others. The risk of using cell phones is hotly debated.

Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot's syndrome.

Tumors may occur at any age, but many specific tumors have a particular age group in which they are most common. In adults, gliomas and meningiomas are most common.

SPECIFIC TUMOR TYPES

Gliomas are thought to be derived from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. The gliomas are subdivided into 3 types:
  • Astrocytic tumors include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant). Astrocytomas can progress over time more malignant forms, including glioblastoma.
  • Oligodendroglial tumors also can vary from low grade to very malignant. Some primary brain tumors are composed of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
  • Glioblastomas are the most aggressive type of primary brain tumor. These may or may not arise from a prior lower grade primary brain tumor.

Meningiomas are another type of brain tumor. These tumors:

  • Occur most commonly between the ages of 40-70
  • Much more common in women.
  • While 90% are benign, they still may cause devastating complications and death due to their size or location. Some are cancerous and aggressive.

Other primary brain tumors in adults are rare and include ependymomas, craniopharyngiomas, pituitary tumors, pineal gland tumors, and primary germ cell tumors of the brain.

Symptoms

The specific symptoms depend on the tumor's size, location, degree of invasion, and related swelling. Headaches, seizures, weakness in one part of the body, and changes in the person's mental functions are most common.

Symptoms may include:

  • Headache -- a persistent headache that is new for the person, worse on awakening
  • Vomiting -- possibly accompanied by nausea; more severe in the morning
  • Personality and behavior changes
  • Emotional instability, rapid emotional changes
  • Loss of memory, impaired judgment
  • Seizures that are new for the person
  • Reduced alertness
  • Double vision, decreased vision
  • Hearing loss
  • Decreased sensation of a body area
  • Weakness of a body area
  • Speech difficulties
  • Decreased coordination, clumsiness, falls
  • Fever (sometimes)
  • Weakness, lethargy
  • General ill feeling
  • Positive Babinski's reflex
  • Decerebrate posture
  • Decorticate posture
Additional symptoms that may be associated with primary brain tumors:
  • Tongue problems
  • Swallowing difficulty
  • Impaired sense of smell
  • Obesity
  • Uncontrollable movement
  • Dysfunctional movement
  • Absent menstruation
  • Hiccups
  • Hand tremor
  • Facial paralysis
  • Eye abnormalities
    • pupils different sizes
    • uncontrollable movements
    • eyelid drooping
  • Confusion
  • Breathing, absent temporarily
  • Unusual or strange behavior

Exams and Tests

A doctor can often identify signs and symptoms that are specific to the location of the tumor. Some tumors may not show symptoms until they are very large and cause a rapid decline in the person's mental functions. Other tumors have symptoms that develop slowly.

Most brain tumors increase pressure within the skull and compress brain tissue because of their size and weight.

The following tests may confirm the presence of a brain tumor and identify its location:

  • CT scan of the head
  • MRI of the head
  • EEG
  • Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may confirm the exact type of tumor)
  • Examination of the cerebral spinal fluid (CSF) may reveal cancerous cells

Treatment

Treatment can involve surgery, radiation therapy, and chemotherapy. Brain tumors are best treated by a team involving a neurosurgeon, radiation oncologist, oncologist or neuro-oncologist, and other health care providers, such as neurologists and social workers.

Early treatment often improves the chance of a good outcome. Treatment, however, depends on the size and type of tumor and the general health of the patient. The goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or the person's comfort.

Surgery is necessary for most primary brain tumors. Some tumors may be completely removed. Those that are deep inside the brain or that enter brain tissue may be debulked instead of entirely removed. Debulking is a procedure to reduce the tumor's size.

Tumors can be difficult to remove completely by surgery alone, because the tumor invades surrounding brain tissue much like roots from a plant spread through soil. In cases where the tumor cannot be removed, surgery may still help reduce pressure and relieve symptoms.

Radiation therapy and chemotherapy may be used for certain tumors.

Other medications used to treat primary brain tumors in children may include:

  • Corticosteroids such as dexamethasone to reduce brain swelling
  • Osmotic diuretics such as urea or mannitol to reduce brain swelling and pressure
  • Anti-convulsants such as phenytoin to reduce seizures
  • Pain medications
  • Antacids or histamine blockers to control stress ulcers

Comfort measures, safety measures, physical therapy, occupational therapy and other such steps may be required to improve quality of life. Counseling, support groups, and similar measures may be needed to help in coping with the disorder.

Patients may also consider enrolling in a clinical trial after talking with their treatment team.

Legal advice may be helpful in creating advanced directives such as a power of attorney.

Support Groups

For additional information, see cancer resources.

Possible Complications

  • Brain herniation (often fatal)
    • Uncal herniation
    • Foramen magnum herniation
  • Permanent, progressive, profound neurologic losses
  • Loss of ability to interact or function
  • Side effects of medications, including chemotherapy
  • Side effects of radiation treatments
  • Return of tumor growth

When to Contact a Medical Professional

Call your health care provider if you develop any new, persistent headaches or other symptoms suggestive of a brain tumor.

Call your provider or go to the emergency room if you have seizures that are new, or suddenly develop stupor (reduced alertness), vision changes, or speech changes.

Review Date: 10/31/2006
Reviewed By: Rita Nanda, M.D., Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Spinal Surgery

Spinal surgery - lumbar

Definition

Lumbar spinal surgery is used to correct problems with the spinal bones (vertebrae), disks, or nerves of the lower back (lumbar spine).

See also:

Spinal fusion

Spinal surgery - cervical

Alternative Names

Lumbar spinal surgery

Description

The spine consists of bones (vertebrae) separated by soft cushions (disks). Pressure on the nerves that branch off the spinal cord can produce pain, numbness, tingling, or weakness.

Lumbar spinal surgery is done while you are under general anesthesia (unconscious and pain-free). A surgical cut is made over the area of the problem. The bone that curves around and covers the spinal cord and the tissue that presses on the nerve or spinal cord are removed.

The hole through which the nerve passes may be widened to prevent further pressure on the nerve. Sometimes, spinal fusion is necessary to stabilize the area.

Why the Procedure is Performed

Patients with spinal pain in the neck or back are usually treated conservatively before surgery is considered. This includes bedrest, traction, anti-inflammatory medications (nonsteroid and steroid), physical therapy, braces, and exercise. Maintaining good health, muscle strength, and body posture with appropriate rest and exercise help prevent unnecessary strain on the spine and muscles.

Symptoms of lumbar spine problems that may require surgery at some point include:

  • Pain that extends (radiates) from the back to the buttocks or back of thigh
  • Pain that interferes with daily activities
  • Weakness of legs or feet
  • Numbness of legs, feet, or toes
  • Loss of bowel or bladder control

Immediately call your health care provider or go to the local emergency room if you have numbness in your groin area and problems with urinary or bowel control. This could suggest cauda equina syndrome, which is a medical emergency.

Risks

Risks for any anesthesia include the following:

  • Reactions to medications
  • Problems breathing
Risks for any surgery include the following:
  • Bleeding
  • Infection
Additional risks of spinal surgery include the following:
  • Nerve damage leading to paralysis
  • Blood clots
  • Muscle weakness
  • Loss of bowel or bladder control

Outlook (Prognosis)

The outcome depends on the source of the problem or the extent of the injury but most patients do very well after surgery.

Recovery

How long you must stay in the hospital depends on the type of spinal surgery performed. Some people only say overnight, while others must stay in much longer.

You will be encouraged to walk the first or second day after surgery to reduce the risk of blood clots (deep venous thrombosis).

Complete recovery takes about 5 weeks. Heavy work is not recommended until several months after surgery or not at all.

Review Date: 9/21/2006
Reviewed By: Jeffrey Kauffman, MD, Sacramento Knee and Sports Medicine, Sacramento, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Shunt

Ventriculoperitoneal shunt

Definition

Ventriculoperitoneal shunt is a surgery performed to relieve pressure inside the skull (intracranial pressure) caused by water on the brain (hydrocephalus). The fluid is drawn off (shunted) from the ventricles of the brain into the abdominal cavity or in rare instances, into the pleural space in the chest.

Alternative Names

Shunt - ventriculoperitoneal; VP shunt

Description

This procedure is performed in the operating room under general anesthesia. A flap is cut in the scalp and a small hole is drilled in the skull. A small catheter is passed into a ventricle of the brain.

A valve (pump) that controls the flow of fluid is attached to the catheter to keep the fluid away from the brain. Another catheter is attached to the pump. It is tunneled under the skin, behind the ear, down the neck and chest, and into the abdominal cavity (peritoneal cavity).

Why the Procedure is Performed

In hydrocephalus, the ventricles of the brain become enlarged with fluid of the brain and spinal cord (cerebrospinal fluid). This condition causes the brain tissue to press (become compressed) against the skull, causing serious nervous system (neurological) problems. Shunting is needed to drain the excess fluid and relieve the pressure in the brain. This should be done as soon as hydrocephalus is diagnosed to give the child the best possible neurological outlook.

In some cases hydrocephalus occurs because of another disease that affects the brain. One example is an intracranial hemorrhage where blood gets into the ventricles of the brain and prevents the fluid from draining properly. In cases like this, a shunt is needed to help remove the fluid and to relieve intracranial pressure.

Risks

Risks for any anesthesia are:

  • Reactions to medications
  • Problems breathing
Risks for any surgery are:
  • Bleeding
  • Infection

Other problems include shunt malfunction or blockage, and infection. If the malfunction occurs because the person grows, the shunt will need to be replaced with a longer catheter. Symptoms of shunt malfunction or infection include headache, fever, drowsiness, and convulsions.

As with any other brain surgery there is risk to brain tissue, because the shunt catheter must pass through brain tissue to enter the ventricle. There is a small risk of brain tissue being damaged, resulting in a neurologic deficit.

Outlook (Prognosis)

The outcome for the surgery itself is good. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The degree of hydrocephalus before surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

Recovery

The doctor will closely monitor your vital signs and neurological status. You may get medication for pain. Intravenous fluids and antibiotics are given. You will be checked closely to ensure that the shunt is working properly.

Most people need 2 to 3 days of bedrest in the hospital before they can go home. Often, imaging studies such as CT scans are done after the surgery to confirm that the shunt is in the right place and that the hydrocephalus has gone away.

Review Date: 5/3/2007
Reviewed By: Robert A. Cowles, M.D., Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Back Pain

Back pain - low

Definition

Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.

You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet.

It won't necessarily be one event that actually causes your pain. You may have been doing many things improperly -- like standing, sitting, or lifting -- for a long time. Then suddenly, one simple movement, like reaching for something in the shower or bending from your waist, leads to the feeling of pain.

Alternative Names

Backache; Low back pain; Lumbar pain; Pain - back

Considerations

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body's weight.

Low back pain is the #2 reason that Americans see their doctor -- second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not.

Causes

You'll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain:

  • Small fractures to the spine from osteoporosis
  • Muscle spasm (very tense muscles that remain contracted)
  • Ruptured or herniated disk
  • Degeneration of the disks
  • Poor alignment of the vertebrae
  • Spinal stenosis (narrowing of the spinal canal)
  • Strain or tears to the muscles or ligaments supporting the back
  • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens
  • Other medical conditions like fibromyalgia

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you:

  • Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster)
  • Have bad posture
  • Are pregnant
  • Are over age 30
  • Smoke, don't exercise, or are overweight
  • Have arthritis or osteoporosis
  • Have a low pain threshold
  • Feel stressed or depressed
Back pain from organs in the pelvis or elsewhere include:
  • Bladder infection
  • Kidney stone
  • Endometriosis
  • Ovarian cancer
  • Ovarian cysts
  • Testicular torsion (twisted testicle)

Home Care

Many people will feel better within one week after the start of back pain. After another 4-6 weeks, the back pain will likely be completely gone. To get better quickly, take the right steps when you first get pain.

A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended.

If you have no indication of a serious underlying cause for your back pain (like loss of bowel or bladder control, weakness, weight loss, or fever), then you should reduce physical activity only for the first couple of days. Gradually resume your usual activities after that. Here are some tips for how to handle pain early on:

  • Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
  • Apply heat or ice to the painful area. Try ice for the first 48-72 hours, then use heat after that.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

Do not perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2-3 weeks, you should gradually resume exercise.

Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

AVOID the following exercises during initial recovery unless your doctor or physical therapist says it is okay:

  • Jogging
  • Football
  • Golf
  • Ballet
  • Weight lifting
  • Leg lifts when lying on your stomach
  • Sit-ups with straight legs (rather than bent knees)

When to Contact a Medical Professional

Call 911 if you have lost bowel or bladder control. Otherwise, call your doctor if you have:

  • Unexplained fever with back pain.
  • Back pain after a severe blow or fall.
  • Redness or swelling on the back or spine.
  • Pain traveling down your legs below the knee.
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis.
  • Burning with urination or blood in your urine.
  • Worse pain when you lie down or pain that awakens you at night.
  • Very sharp pain.

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs.
  • You have never had or been evaluated for back pain before.
  • You have had back pain before but this episode is distinctly different.
  • This episode of back pain has lasted longer than four weeks.

If any of these symptoms are present, your doctor will carefully check for any sign of infection (like meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem.

What to Expect at Your Office Visit

When you first see your doctor, you will be asked questions about your back pain, including how often it occurs and how severe it is. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

Questions will include:

  • Is your pain on one side only or both sides?
  • What does the pain feel like? Is it dull, sharp, throbbing, or burning?
  • Is this the first time you have had back pain?
  • When did the pain begin? Did it start suddenly?
  • Did you have a particular injury or accident?
  • What were you doing just before the pain began? Were you lifting or bending? Sitting at your computer? Driving a long distance?
  • If you have had back pain before, is this pain similar or different? In what way is it different?
  • Do you know the cause of previous episodes of back pain?
  • How long does each episode of back pain usually last?
  • Do you feel the pain anywhere other than your back, like your hip, thigh, leg or feet?
  • Do you have any numbness or tingling? Any weakness or loss of function in your leg or elsewhere?
  • What makes the pain worse? Lifting, twisting, standing, or sitting for long periods of time?
  • What makes you feel better?
  • Are there any other symptoms present? Weight loss? Fever? Change in urination? Change in bowel habits?

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

  • Sit, stand, and walk. While walking, your doctor may ask you to try walking on your toes and then your heels.
  • Bend forward, backward, and sideways.
  • Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

Most people with back pain recover within four to six weeks. Therefore, your doctor will probably not order any tests during the first visit. However, if you have any of the symptoms or circumstances below, your doctor may order imaging tests even at this initial exam:

  • Pain that has lasted longer than one month
  • Numbness
  • Muscle weakness
  • Accident or injury
  • Fever
  • If you are over 65
  • You have had cancer or have a strong family history of cancer
  • Weight loss

In these cases, the doctor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present. The presence of a tumor, infection, fracture, or serious nerve disorder change how your back pain is treated.

Tests that might be ordered include an X-ray, a myelogram (an X-ray or CT scan of the spine after dye has been injected into the spinal column), a CT of the lower spine or MRI of the lower spine.

Hospitalization, traction, or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

Many people benefit from physical therapy. Your doctor will determine if you need to see a physical therapist and can refer you to one in your area. The physical therapist will begin by using methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again.

If your pain lasts longer than one month, your primary care doctor may send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist).

Prevention

Exercise is important for preventing future back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

A complete exercise program should include aerobic activity (like walking, swimming, or riding a stationary bicycle) as well as stretching and strength training.

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give a wide base of support.
  • Stand as close to the object you are lifting as possible.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object up or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, DO NOT bend forward.
  • DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to take to prevent back pain include:

  • Avoid standing for long periods of time. If you must for your work, try using a stool. Alternate resting each foot on it.
  • DO NOT wear high heels. Use cushioned soles when walking.
  • When sitting for work, especially if using a computer, make sure that your chair has a straight back with adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
  • If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Learn to relax. Try methods like yoga, tai chi, or massage.

References

Rakel D. Low Back Pain. In:Integrative Medicine. Elsevier; 2003:423-431.

Sierpina VS, Curtis P, Doering J. An Integrative Approach To Low Back Pain. Clin Fam Pract. 2002; 4(4); 817.

US Preventative Services Task Force. Primary Care Interventions to Prevent Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.

Review Date: 5/6/2007
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Map