60 year old male from Ecuador presenting with chronic back pain for over 40 years, most recently the back pain has worsened. He describes shooting pain down both legs all the way down to posterior calf area, right worse than left, tingling (pins and needles ) mostly on the right side. Most lately at times patient can not even walk less than half of a block before stopping. He has difficulty falling sleep because of pain, And then when he wakes up in the morning the pain is still there, not as bad but always there. Pain gets worse with stress. Past medical history except for back surgery in 1990 otherwise is unremarkable, Medications; Patient says "nothing works, nothing touches the pain." Despite the pain patient has remained active and have been working, denying disability. Patient describes himself as type B and Definitely not a perfectionist. But a real good hearted person. A type of person who can't say no and at times bends backward and goes out of his way to accommodate others.
Discussion: Dr. John Sarno M.D. from NYC, the man who described mind-body disorders states that two types of personalities are more prone to back pain, 1.Perfectionist . 2.Generously responsive (kind and open-hearted people). I concur with the guru, I have observed the above matter too many times in my practice. Unfortunately for these people although they are typically successful in their work and business, their personalities works against them thru sympathetic and parasympathetic nervous system and worsening their symptoms. Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma . Pain from trauma may be caused by a sports injuries, or sudden jolt such as a car accident or other stress on spinal bones and tissues. Chronic back pain is pain that persists for more than 3 months. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain. Their Effectiveness however is uncertain by some authorities. Hot compresses may help reduce pain and inflammation and allow greater mobility for some individuals. Bed rest is recommended for no more than 1~2 days . Acupuncture as well as physical therapy, Rolfing, deep tissue massage and Tai Chi could help (anything with the goal of producing increased blood flow). Patients with back pain should resume activities as soon as possible. Correction of human gait and applying ergonomic principles can greatly help to maintain a healthy back. Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 2 weeks of self-care. Recent data suggests prevalence of back pain in 50% of working population, with 15-20% of them looking for medical help, the cost per year of back pain ranges from 20 to 50 billion dollars in U.S.A alone. The cost includes medical treatment and loss of productivity. Osteoarthritis of Cervical spine, Neck Pain.