如何處理背痛 How to deal with Back Pain

 - 由Grace Tom姊妹(已退休的註冊護士)撰寫  

 - Written by Grace Tom (Retired RN) 

 

 

 

 

文章使用中英對照  Article is in both Chinese & English


如何處理背痛

許多疾病及其他的情况都會引致背痛。 導致背痛的原因可能是背脊骨有問題, 或身體其他部位有問題而引致背痛 。很多時醫生都找不到背痛的起因。

常見的起因

  • 背肌肉受損傷, 因扭傷或拉傷; 因肥胖而背肌肉受到長期性的負苛; 有時因舉重或抬重東西或懷孕後期使到背肌肉有短暫的不沈常的負苛而使到有背痛。 
  • 脊骨的疾病及損傷, 包括因意外或因骨質疏鬆症影響骨折或骨裂。
  • 因年長, 受傷及有遺傳傾向的疾病而使到有脊骨退化症, 及風濕影響到有背痛。 
  • 因脊骨神經線疾病, 如椎間盤突出或脊椎骨狹窄, 壓着神經線而使到有背痛。
  • 急性/慢性腎石症及腎炎都可引致背痛。

少見的起因

  • 脊骨風濕發炎症如强直性脊骨炎及有關的情況。 
  • 脊骨發炎會在椎間盤發炎;骨髓炎; 脊骨有膿腫;肚腹, 盆骨發炎; 或血內有 菌都可引至背痛. 這些都是緊急情況, 應立刻求醫。   

症狀

背痛的症狀有很多樣化,包括發燒, 最近創傷, 背部受損, 減磅, 因有癌症歷史而擴散到脊骨, 腦神経線症狀, 如痲痺, 手腳軟弱, 或更嚴重的情況會使到失禁 。 由於背痛會引發其他不適的症狀,可幫助知道背痛的起因, 例如:-

1. 背脊扭傷或拉傷

  • 因抬重, 用力過度去推或拉重。
  • 背肌肉, 屁股, 大腿很多時都感覺疼痛及僵硬。背肌肉輕輕觸摸也會很痛 。

2. 脊骨退化性關節炎

  • 長時間的勞損而引致的關節炎會導致背痛僵硬, 及不可能彎腰。

3.  椎間盤突出

  • 椎間盤破裂或向外脫出,會壓着脊骨神經線, 導致有劇烈的背痛, 彎腰或扭腰會更痛, 痛可散至到整隻脚。

4. 骨質疏鬆症

  • 脊骨會疏鬆及弱, 很容易折烈-----普遍發生在收經後的女士們, 年老的女人及男人 。 若胸椎下半及腰椎有壓縮骨折, 除了有背痛還不可彎腰。  除非有骨折斷, 否則骨質疏鬆症是不會引致背痛, 及有任何痛楚。

5. 脊骨及附近的內臟有癌症

  • 背部會時常感到痛楚, 及躺平會更痛.  雙腳痲痺, 軟弱及有針剌感覺,疼痛還會持續的加劇。若癌症擴散到脊骨神經線,或會影響大小便失禁。

6. 纖維肌痛綜合症

  • 除了有背痛, 身, 頸部, 肩膊, 膝頭, 手肘都會感到全身痛, 及早上感覺特別僵硬。早上睡醒,通常會感到有異常的疲倦。   就算一夜睡得好都感覺到很疲倦;  及有特別位置輕輕觸摸都很痛。

7. 關節發炎

  • 如强直性脊柱炎及有關的情況 。常有背痛,  盤骨部, 頸, 胸及雙腳也會  有痛及僵硬, 及非常疲倦。

診斷

  1. 病歷及症狀描述。
  2. 身體檢查, 醫生會檢查您的背肌肉及脊骨, 他須要您做一些動作, 檢查您有没有痛, 有沒有肌肉觸摸痛及軟弱, 僵硬, 痲痺, 及反應異常。
  3. 檢查後,您的醫生才會決定您的背痛是否嚴重及痛的因素是肌肉扭傷, 或因肥胖所引起,  懷孕或任何不緊急的因素 。您便不須 要任何試驗。 但是若您的醫生懷疑您有更嚴重的脊骨或脊骨神經線問題, 或有急性損傷, 例如車禍,跌倒, 或任何意外, 或您的背痛持續多過12個星期, 用了所有家庭的藥物及治療都沒有進展, 您或須要進行以下更進一步的檢查:
  • 背部X-光鏡
  • 驗血
  • 檢驗小便
  • 脊骨磁力共振MRI
  • 電腦掃描CT Scan
  • 神經線傳導測驗nerve conduction studies, 及肌肉電圖electro-myography 去診斷您的肌肉或/及神經線有沒有受損。
  • 骨掃描bone scan, 特別是您有癌症的病歷, 去診斷癌細胞是否擴散到脊骨。

 

預計背痛期限

視乎背痛的起因:

  1. 若因用力過度而扭傷----數天或數星期, 少過6-12星期及您可逐漸回復正常運作。  在這段時期, 您應避免攜重物件, 長時間坐着, 或突然間彎腰或扭腰, 直至到您的背痛有好轉及復元。
  2. 孕婦的背痛通常產後會有好轉。
  3. 肥胖的人或須要减體重才感背痛舒緩。
  4. 若因有腎石及腎發炎而使到有背痛, 服完一兩星期的特效消炎藥會消炎, 或腎石自然排出或須動手術才可取出腎石。 在一兩天或數天後背痛通常便會有好轉。
  5. 較嚴重的脊骨問題會影響到骨及神經線, 背痛或會持續數年或數月。

預防

  • 每日做增強背部的運動, 記着做背部運動之前及後要做伸展的舒緩運動。
  • 防止做任何引致背部損傷的活動。
  • 行走坐卧, 要保持良好姿勢。
  • 若側面睡, 可放小枕頭在兩膝頭中間, 若背睡, 可放枕頭在膝下。 
  • 練習仰卧起坐運動去堅強腹部肌肉,可幫助強化脊骨。經常步行或游水令腰骨會更強壯。
  • 學習舉起物件時先蹲下的動作, 然後用盤骨部及雙腳幫助抬重。避免彎腰或扭腰從地上拿起重物。
  • 防止長時間坐立, 及彎頸或背部。
  • 平時應穿著低過一吋半的軟底結實鞋。女士們應避免長時間穿著高跟鞋。
  • 防止有骨質疏鬆症---------每日從飲食或保充劑吸取足夠的鈣及維他命D, 不要吸煙, 飲少量酒, 每天做運動, 曬太陽。

治療

          很多時背痛都不是很嚴重的, 及可以用以下的方法去處理:-

  • 限卧床休息一至兩天。 
  • 有痛可服Acetaminophen (Tylenol 及其他牌子) 或任何消炎薬, 如Aspirin, Ibuprofen (Advil, Motrin 及其他同一功效的藥物), 或 Naproxen( Aleve) 可減痛及消炎。
  • 如有須要, 可短期服肌肉鬆弛劑或醫生寫的更強的治痛藥方。 
  • 用熱敷。
  • 按摩, 針炙, 指壓, 脊骨推拿或會有幫助, 要預先請教您的醫生才好去做以上治療。
  • 慢慢逐漸回復正常活動; 之後應防止抬重物件; 避免久坐及突然彎腰或扭身。每天去散步可堅固脊骨肌肉。
  • 慢性背痛(超過12個星期 ) 嘗試太極或瑜珈等運動。
  • 慢性背痛也可因抑鬱症等心理問題而影響,須 請教心理科醫生。

何時須要打電話向專業人士求助?

要致電您的醫生, 若有以下情況:-

  • 有劇烈的背痛而影響正常生活。
  • 跌倒, 有車禍或任何急性受傷 。
  • 幾日輕微背痛變嚴重或持續多過一兩星期。
  • 除了背痛還有其他症狀, 如突然減磅, 發燒, 發冷, 或小便時有灼熱感。
  • 突然感覺軟弱, 雙腳或雙手感覺痲痺及針刺。
  • 腹股溝或直腸感到麻木及有困難控制大小便。
  • 有腫瘤病歷而突然有持續的背痛而又與受傷無關。

預測

多過百份之九十有背痛的人都會經過内科治療而復元。只有小部份, 百份之五有背痛的人有其他的症狀維持多過12個星期, 很多時不很嚴重。 若慢性背痛沒有新或急性症狀, 而又可做日常運作, 而沒有很大痛楚, 許多人都可忍受的。

 結論

保持健康的脊骨須要時常有良好的姿勢,日常多做些強健肌肉的運動, 進食健康飲食去預防骨質疏鬆症, 不吸煙, 飲着量的酒, 保持健康體重,可幫助防止有背痛。 

 

 

Back Pain – how to deal with it

Back pain can be a symptom of many different illnesses and conditions.

The main cause of the pain can be a problem with the back itself or by a problem in another part of the body.  In many cases, doctors cannot find the cause for the pain.

Common causes

-Stress or injury involving back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; short term overload of back muscles caused by any unusual stress, such as lifting or pregnancy.

-Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the osteoporosis.

-Degenerative diseases and arthritis, a “wear and tear” process that maybe related to aging, injury and genetic disposition.

-Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disk (fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal column).

-Kidney stones or a kidney infection (pyelonephritis).

Rare causes

-Inflammatory arthritis, including ankylosing spondylitis and related conditions.

-Infection, which may be in the disk space, bone (osteomyelitis), abdomen, pelvis or bloodstream, and abscess in the spine. These are more acute situations, and needs immediate medical attention.

Symptoms

Back pain symptoms varies, this may include fever, recent trauma, injury to back, weight loss, a history of cancer with metastasis to the spine, neurological symptoms such as numbness, weakness of arms or legs, or more severe condition can cause incontinence.

Back pain usually is accompanied by other symptoms that may help to pinpoint to its cause, for example:-

1. Back sprain or strain 

-After heavy exertion; lifting, pushing and pulling.

-Muscles in the back, buttocks and thighs are often sore and stiff. Back muscles maybe tender to touch.

2. Degenerative arthritis of the spine

-Besides back pain, there is stiffness and trouble bending over, which usually develops over many years.

3. Protruding disk (Herniated disk)

-The bulging or herniated disk compress on the spinal nerve causing severe back pain. Pain gets worse during bending and twisting, pain may spread down to one leg.

4. Osteoporosis

-The spinal bones got thinned and weakened and easily get fractured. Most commonly happened in postmenopausal women or elderly women. It can also happen in elderly men with osteoporosis. When there is compressed fracture of the mid and lower spine, people may have a crooked back and stooped over together with back pain.  Osteoporosis does not cause back pain, unless there is a bone fracture in the spine.

5. Cancer 

-Cancer in the spinal bones or nearby structures may cause back pain. It is consistent and may become worse when lying down. Numbness, weakness or tingling of the legs that continues to get worse. If the cancer spreads to the spinal nerves that control the bladder and bowels, there may be bowel or bladder incontinent.

6. Fibromyalgia

-Besides back pain, one will experience stiffness in the trunk, neck, shoulders, knees and elbows. Pain maybe generalized soreness, and stiffness is often worse in the morning. People usually complain of feeling abnormally tired even after a good night sleep, and there are specific areas that are painful to touch, called tender points.

7. Inflammatory arthritis

-It includes ankylosing spondylitis and related conditions. There is pain in the lower back, with morning stiffness in the back, hips or both. Also can have pain and stiffness in the neck or chest and feeling extreme tired.                                               

Diagnosis

1. Medical history and description of symptoms.

2. Physical exam-your doctor check on your back muscle and spine, move you in certain ways to check for pain, muscle tenderness, or weakness, stiffness, numbness or any abnormal reflexes.

3. Your doctor will determine your back pain is serious or not, or the causes are by muscle strain, obesity, pregnant or any other causes are not urgent, then you may not need any tests.  However if your doctor suspects serious problem involving your vertebrae or spinal nerves or you have an acute injury e.g. car accidents, falls, or any accidents, and if your back pain lasted longer than 12 weeks with no improvements after initial home remedy treatment, you may need one or more of the following tests:-

1. X-rays of your spine.

2. Blood tests.

3. Urine test.

4. Spinal magnetic resonance imaging (MRI).

5. Computed tomography (CT) scan.

6. Nerve conduction studies and electromyography to determine   whether nerves, muscle or both maybe injured.

7. Bone scan, especially if you have previous history of cancer, to rule out metastasis to the spine.

Expected Duration

It depends on the causes:-

-Strain from over exertion, days or weeks, less than 6-12 weeks and you may be able to return to gradual normal activities. During this time, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back pain gets better or resolved.

-Pregnant women’s back pain almost always will get better after delivery.

-Obese individuals may need to lose weight before back pain eases.

-When pyelonephritis or kidney stones causing back pain, once starting antibiotics for one to two weeks for kidney infection and when kidney stones passed out of the body, medically or surgically, back pain will resolve in one or two days.

-More serious spinal vertebral problems affecting the bones and nerves, back pain may last for months or years.

Prevention

-Do back strengthening exercise daily- but remember to do stretching before and after.

-Prevent any activities that may injure your back.

-Maintain a good posture, sitting and standing at all times.

-Sleeping on your side, with a pillow between knees, or lying flat on back with a pillow under your knees if you can, to relax your back while sleeping.                                 

-Practicing abdominal crunches to strengthen abdominal muscles, which support your lower back.  Walk or swim regularly to strengthen your lower back.

- Learn to lift objects from a squatting position, using your hips and your legs to do heavy work.  Avoid bending and twisting your back to lift any objects from the floor.

-Avoid sitting or standing and bending your neck and back for extended period of time.

- Wear soft sole shoes with heels less than 1 and one-half inches high. Women avoid wearing high heels for extended time.

- Prevent osteoporosis by getting enough calcium, Vit.D, avoid smoking and moderate consumption of alcohol, and do regular exercises and get enough sunshine.

Treatment

Most episodes of back pain are not serious and may be treated with:-

-Limited bed rest (no more than 2 days)

-Acetaminophen (Tylenol and others) for pain or any oral anti-inflammatory drugs such as aspirin, ibuprofen (Advil, Motrin and others)  or Naproxen(Aleve, Naprosyn), for pain and inflammation.

-Muscle relaxants or prescription pain relievers (may be more stronger ) if necessary for a short period of time.

- Hot compresses, massage therapy, acupuncture, chiropractor’s treatment, and acupressure may help.

-Return to normal activities gradually and avoid heavy lifting, prolonged sitting or sudden bending and twisting temporarily.

-Chronic back pain(more than 12 weeks) can try practising Tai Chi or Yoga exercise.

-Chronic back pain maybe due to psychological problem, like depression-may need to consult psychiatrist for assessment.

-If your back pain is related to more serious disorders of the vertebrae or spinal nerves, or it has not improved over a few weeks, you may need to consult a neurologist, orthopedic surgeon, rheumatologist, endocrinologist, and pain specialist, and if you have cancer history, refer to the oncologist.

When to call a professional?

Contact your doctor if:-

-Severe back pain hinders you to perform normal daily activities.

-You have a fall, auto accident or acute trauma of any kind to your back.

-Mild back pain gets worse after a few days or persists more than a week or two.

-Back pain is accompanied by weight loss, fever, chills or urinary symptoms, like burning on urination.

-You develop sudden weakness, numbness or tingling in your upper or lower extremities.

-You develop numbness in the groin or rectum or difficulty controlling bladder or bowel functions.

-You have had cancer history and you develop persistent back pain not related to any acute injury or trauma.

Prognosis

More than 90% of people with back pain get better after conservative medical treatment. Only 5% of people with back pain will have symptoms for more than 12 weeks and for most of these people the cause is not serious. As long as chronic back pain has no new or acute symptoms, and one can perform daily activities with no distress, many can live with it. 

Conclusion

Maintaining a healthy spine needs constant good posture, regular back strengthening exercise, eat a healthy diet to prevent osteoporosis, no smoking, and limit alcohol consumption, maintain a desired healthy body weight, you will help to have a healthy spine without back pain.

 


預防勝於治療  wink

Prevention is better than cure  wink

 

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