AGONY MEDIC

Dr. Lutful Aziz, FCPS, PHD, Consultant "analgesia", Pain relief centre

What Causes Back Pain?
The back is a complex mechanical device, and one of the single most studied areas of the body. However, a great deal of the time, a clear cause to back pain is never found. Basically, anything that puts pressure on your back muscles or nerves can cause pain. Any illness or damage to your spine also can cause pain. The cause of most acute back pain is unknown, but probably is due to minor strains, sprains and overuse. Emotional stress may add to the pain, especially since it slows the rate of recovery. Other possible causes of back pain are ruptured discs, spinal stenosis, osteoarthritis, ankylosing spondylitis, injury, osteoporosis, rheumatoid arthritis, fibromyalgia, pagets disease, cancers, and referred pain form other locations. This by no means is a complete list.

What causes acute low back pain?
There are many reasons for acute back pain, from muscles pulls, strains, a disk problem in your spine, pinched nerves, arthritis or depression.
Acute low back symptoms can then be classified into one of three working categories:
1. Potentially serious spinal condition-tumor, infection or spinal fracture, or a major neurologic compromise, such as cauda equina syndrome
2. Sciatica-back-related lower limb symptoms suggesting lumbosacral nerve root compromise.
3. Nonspecific back symptoms-occurring primarily in the back that do not suggest nerve root compromise or a serious underlying condition.
Due to the back's complexity, even with modern technology, doctors aren't always able to arrive at a simple diagnosis.

How common is low back pain?
Low back problems affect virtually everyone at some time. Surveys indicate a yearly prevalence of symptoms in 50 percent of working-age adults; 15 to 20 percent of these persons seek medical care. Low back problems rank high among the reasons for physician office visits and are costly in terms of medical treatment, lost productivity and other factors such as diminished ability to perform or enjoy usual activities. In fact, for persons under age 45, low back problems are the most common cause of disability. Acute low back problems are defined as activity intolerance due to lower back or back-related leg symptoms of less than three months' duration.

How can I prevent low back pain?
General physical fitness is the best way to prevent low back pain. However, if you have had a problem with your back in the past, you are more likely to have problems in the future. It is important to learn to lift heavy objects by bending your knees instead of bending over to lift the object. You should also try to avoid repeated heavy lifting, and working with vibratory objects suck as impact wrenches, avoid sitting on the floor, use high commodes in toilet etc.

When should I call my doctor?
In most cases, low back pain goes away within a few days. You should call your primary doctor if:
Your back pain continues for longer than a month.
Your back pain starts after you are over 60 years old or before age 20.
Your pain is worse when you lie down.
Your pain causes weakness in your leg or numbness in your genital area.
You have difficulty with your bowels or bladder.
You have a fever at the same time as the pain.
You have a history of cancer.
You have had progressive weight loss.
Your back pain is caused by a serious injury, such as falling off a ladder.
Your pain prevents you from walking.
Your pain or symptoms are getting worse.

When should I have an x-ray, CT scan or MRI?
These examinations are usually not necessary when you first develop pain. Because in most people acute back pain will go away on its own, most physicians will not order radiological studies unless the pain persists. However, even with tests, it can be difficult to pinpoint the exact reason for the pain.

What can my family doctor do for my low back pain?
Your family doctor will first do a careful physical examination. If your doctor does not find a serious problem causing your low back pain, he or she may tell you to rest for a few days, do certain exercises and take medication for pain. Your doctor may also refer you to a pain clinician who knows about treating back problems. Sometimes specialized injections are helpful for easing back pain. Injections are usually used only for severe back pain or for back pain that continues for a long time.

What is my chance of recovery?
About 90 percent of patients with acute low back problems spontaneously recover tolerance to activity within one month.

What can I do for my low back pain?
If you develop low back pain, the first thing to do is to avoid any heavy lifting or bending. Bed rest is usually not necessary, although your doctor may recommend resting for a day or two. Your doctor can give you information about exercises you can do at home to strengthen your back.

Will I need surgery?
Very few people with low back pain ever need surgery. However, if you have a severely damaged disk with weakness in your leg or numbness in your groin, you are more likely to need surgery. Your primary doctor will refer you for surgical opinion to help you decide if surgery is right for you.

What is Chronic Back Pain?
Chronic back problems are generally defined as back-related activity limitations of greater than three months duration.

Interpreter of Maladies
Dr. Nighat Ara, Psychiatrist

Q. The last issue of LS was really interesting. I would really like to know some thing about fear from your expert Nighat Ara. After the grenade incident I am always scared when I am out. Even a tyre puncture scares me. I am always tensed, which is effecting my perforamace in the prefessional life. I would like to know what is fear and why is this happeing to me? Thank you.

Fear is a primary emotion that can be perceived as a mild sense of uneasiness (e.g. facing an interview) to an extreme sense of terror (e.g: bomb blast in a peaceful rally). Fear is a negative emotion and can be potentially harmful to both the body and the mind. It decreases the sense of well being and seriously interferes with the performance and productivity of a person (when we are afraid, our rational thinking is impaired and we can do silly things). In fear, a particular pattern of physiological response takes place as a result of Autonomic nervous system (ANS) arousal and release of stress hormone "adrenaline". The ANS arousal is responsible for butterfly sensation in stomach, racing heart, cold clammy extremities etc. The abundance of adrenaline in our system leads to "fight or flight response" to the source of threat (some people flee and others turn around to fight back). This hormone is also responsible for wear and tear of the body. Our ancestors had to use it quite often for their survival. It however seems that we are back to that stage of human civilisation and need to guard our safety and security above all. Any emotion has three main components in it- A physical component (the internal body state that accompanies the emotion. e.g. pounding heart), cognitive component ( how you interpret the situation will determine the response. Response to a loud noise if interpreted as tire burst will definitely differ from that interpreted as bomb blast) and a behavioural component (facial expression, body posture, tone of voice like screaming etc.). An environment that persistently triggers the ANS and causes release of stress hormone is quite damaging to health and may lead to many psychosomatic illnesses. In this present political and social situation of the country, albeit we all understand the impact of fear on our health and quality of life. Never the less, the impact will be automatically multiplied several times if you have to "fight or flight" against/from unidentified source of threat.

BY THE WAY

To be a mum or a friend

To be a friend or to go all parenty and stern-that is the dilemma most parents face all through their lives. Usually, people fluctuate between being too nice and over friendly, and being a stern disciplinarian and a voice of no reason. The answer always lies in being a combination of gentle and firm. Being a best friend and a parent means listening, communicating, sharing information, trusting and being supportive. It also means being authoritative when necessary and teaching children about values. Now you decide whether you want to be a strict mum or a friendly mum.

 

UNDER A DIFFERENT SKY

From the world of offerings

The other day while I was having a moment of pure slackery I decided to indulge myself with some good "deals" over the internet through free classified list serves. These sites play quite a huge role in our semi-American, no-time-to-waste-but-enough-time-to-surf lives than you can imagine. Like many I usually find these sites extremely useful and often quite entertaining. They allow people to connect in a one to one basis. From selling or giving away your broken car to pencil sharpener, finding pets to boyfriends and one-night-stands to ink cartridges. You name it, they have it all.

From the moment my cursor steps into the crowded screen full of options, I find myself clicking away, often without an agenda just to suffice my shopaholic tendencies, and sometimes just to pry into other peoples' lives, and I strongly believe I am not alone in this, I trust many working men and women in America spends a few minutes of their mid-week mid-day doing the same. Reading through descriptions of 8'x12' rooms or a perfect lesbian match, whatever it might be, it's eye opening, representing the true face, the true needs, the desires and true supplies and demands of the metro-culture in America.

I remember when I first bumped into such sites, I was almost startled, different boxes with different titles, Jobs (both need and want sections), Partners (women seeking men, men seeking women, men seeking men, women seeking women, strictly platonic, missed connection and Miscellaneous romance), For Rent, For Sale, Forums (from Haiku to Self-employment), Gigs, Services, Community and personals, it's all there, neatly compartmentalized and advertised, humans to machines to pure rhythmic words.

The best thing about these sites is the fact that they unlike most media based mediums still consume the power to amaze you. In a world where we are constantly running out of amusements, few strange words written by strangers are often precious. Especially when it's found in an unexpected place, provoking unanticipated thoughts, ideas and questions.

For example, just the other day while I browsed through the advertised apartments for rent section I came upon this particular posting, it went:

Date: 2004-08-24, 10:15AM EDT
26 year old single male looking for full time live in female slave to share 2 bed room apartment in DC. Your rent will depend on which tasks you're willing to perform, how often, and how well you do them. I do not yet have an apartment, so part of your duties will be helping me find a place in Georgetown, Dupont, Foggy Bottom, or possibly Rosslyn. Even better if you already have a place. Please be N/S, D&D free, and under 30. Inexperienced OK. Contact me to tell me what you're interested in.
As you assumed this particular one definitely was a shocker. First I was thinking the audacity of this individual to ask for someone to be his female slave, but that's not really an issue here I guess, everyone is free to express their opinions and search for what they fancy. In a bizarre way it was kind of reassuring to see this kind of ignorant needs do exist in America, we are constantly blaming our Bangladeshi men for their sexist, chauvinist comments, actions and thought patterns, but some fellow Americans share similar or worse ideas. I guess the difference would be the man who advertised is valuing willingness and freedom of choice, as in the person who would reply would knowingly agree to be his female slave, and he has every right therefore to advertise what he did…
I did ponder if a female who is under 30 and drama and disease free replied back to him. As they say anything is possible in America, the land where your dreams (no matter how twisted) can come true.

My intention was not to highlight this particular posting by the female slave-sleeker in this column, but I am afraid I have already done so. My real objective was to show the liberty, freedom and convenience these kinds of sites offer. I would say this is a great way to peak into the lives of the Americans, but that would not be fair. Although this sites represent a large population, it does not represent all who are out there; plus the list serve lingo is often confusing if one is not use to the cyber-metro-culture of America, so even though I am very tempted to list a few good list serves from the web for you I am going to resist myself.

So for now you will just have to be happy with my biased highlights and observations. But seriously, in this selfish world when everything seems out of context, these postings are often the only true connection, between me, you and the world of offerings, a place to call home to a home to call space.

By Iffat Nawaz