CAUSES OF CHRONIC HEAD & BACK PAIN

A 1994 Harris poll estimated that 17% of adult Americans suffer from chronic pain. The major causes, other than cancer, are headaches, back pain, and arthritis. Some 25 million Americans suffer migraines, while another 15 million have other kinds of chronic recurrent headaches. Arthritis afflicts about 40 million Americans. Low back pain disables 7 million. Other causes of chronic pain include angina (the painful spasms associated with coronary artery disease), shingles, tic disorders, amputations, and paralysis. Since many of these causes are associated with age, most chronic pain sufferers are middle-aged or older. As our population ages, the problem of chronic pain will only grow worse.

Headache

The National Headache Foundation distinguishes 21 kinds of head pain. The most common are tension headaches and migraines. Tension headache, typically brought on by emotional stress or muscle tension, involves the contraction of the head and neck muscles. The dull, steady pain can feel like a vice tightening around the head. It may come and go or last for hours. Aspirin, acetaminophen, and other painkillers are useful in relieving the pain, as are muscle relaxants. Biofeedback, massage, and applications of heat and cold may also help reduce muscle tension.

Migraines differ from tension headaches in that the pain is throbbing or pulsating rather than steady, is typically located on just one side of the head, behind or around the eye, and can last for days. Nausea and sensitivity to light and noise usually accompany them. Only about 15% of patients experience the so-called warning aura of flashing lights, weakness, or slurred speech that doctors traditionally use to diagnose migraines. That's one reason why many migraine sufferers are not diagnosed properly.

Migraines are vascular headaches, which means they involve blood vessels. The excruciatingly painful cluster headaches as well as the more ordinary headaches due to caffeine withdrawal are also vascular in nature. Migraines result from an interplay between the blood vessels and nerves in the head, including the nerves around the eyes and the forehead. Something - it's not known exactly what - triggers these nerves to release chemicals that cause blood vessels around the brain to dilate. The expanding vessels press against nearby nerves, further irritating them and increasing the inflammation.

Until recently, treatment relied on drugs that cause blood vessels to constrict. They work for some patients, but for others they are ineffective or cause too many side effects. Newer drugs, called triptans, act directly on the nerve, reducing the inflammation and stopping the transmission of pain signals. Imitrex was introduced in 1993; Zomig, Amerge, and Maxalt became available in the past year. As promising as they are, they too do not work for everyone, and many migraine sufferers continue the round of doctor visits seeking a combination of drugs and therapies that will give them some relief.

Low back pain

The back is a complex mechanism consisting of a stack of 24 bones (the vertebrae) connected by dozens of short and long ligaments and muscles. Shock-absorbing discs and lubricating synovial fluid protect the joints between the vertebrae. Running through a canal made by openings in the vertebrae is the spinal cord, the main link between your brain and the rest of the nervous system. Nerves to your arms, legs, back, and other parts of your body branch off the spinal cord like branches off a tree trunk. Anything that puts pressure on the spinal cord or other nerves can cause back pain, the simplest being a tight muscle due to strain. Causes of chronic back pain include a damaged vertebral joint due to arthritis, a fracture in a vertebra due to osteoporosis, a herniated disc, or a narrowing of the spinal canal (called spinal stenosis). Emotional stress, poor posture, lack of exercise, and obesity all add to the problem.

Most patients with lower back pain improve with a combination of mild painkiller, muscle relaxant, and rest - usually within days. In others the underlying condition can frequently be treated. For example, surgery can repair herniated discs and spinal stenosis. For the remaining patients, back pain all too often becomes chronic, and relief is harder to come by. Analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and muscle relaxants are the most commonly prescribed drugs, although specialists have linked long-term use of muscle relaxant tranquilizers to depression and increased pain. Also proven helpful is transcutaneous electrical nerve stimulation (TENS), certain exercises that stretch back muscles and strengthen abdominal muscles, posture training, and weight loss. Individual patients swear by acupuncture, massage, heat and cold, spinal manipulation, stress management, and relaxation techniques.