Chronic Back Pain: Causes and Treatment Options - Internal Medicine

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Chronic back pain can be a complex and frustrating condition, especially when it persists for months without relief. Your symptoms, including shoulder and back pain that worsens with pressure and is exacerbated by coughing, suggest that there may be multiple factors at play.

Causes of Chronic Back Pain
1. Muscle Strain or Ligament Sprain: One of the most common causes of back pain is muscle strain or ligament sprain, often resulting from heavy lifting, awkward movements, or prolonged poor posture. Even minor injuries can lead to chronic pain if not properly managed.

2. Degenerative Disc Disease: As we age, the discs that cushion our vertebrae can degenerate, leading to pain and discomfort. This condition can also cause nerve compression, resulting in pain that radiates to other areas, including the shoulders.

3. Herniated Discs: A herniated disc occurs when the soft material inside a spinal disc pushes out, potentially pressing on nearby nerves. This can cause localized pain as well as referred pain in other areas, such as the shoulders.

4. Osteoarthritis: This degenerative joint disease can affect the spine, leading to pain and stiffness. The wear and tear of cartilage can result in bone spurs, which may further compress nerves.

5. Skeletal Irregularities: Conditions like scoliosis or kyphosis can lead to chronic back pain due to abnormal curvature of the spine, which places additional stress on muscles and ligaments.

6. Infections or Tumors: Though less common, infections of the spine or tumors can cause significant back pain. If there are accompanying symptoms such as fever, unexplained weight loss, or neurological deficits, these conditions should be ruled out.

7. Referred Pain: Sometimes, pain in the back can be referred from other areas of the body, such as the lungs or abdominal organs. Given that you mentioned experiencing pain during coughing, it’s essential to consider whether there might be a respiratory issue contributing to your discomfort.


Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your back, improve flexibility, and promote better posture. A physical therapist can tailor exercises to your specific needs and monitor your progress.

2. Medications: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen) can help alleviate pain and reduce inflammation. In some cases, your doctor may prescribe stronger medications or muscle relaxants.

3. Heat and Cold Therapy: Applying heat can help relax tense muscles, while cold therapy can reduce inflammation. Alternating between the two may provide relief.

4. Chiropractic Care: Chiropractic adjustments may help realign the spine and relieve pressure on nerves. However, it’s essential to consult with a healthcare provider to ensure this is a suitable option for your condition.

5. Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and provide temporary relief from pain.

6. Lifestyle Modifications: Maintaining a healthy weight, practicing good posture, and incorporating regular low-impact exercise (like walking or swimming) can significantly impact your overall back health.

7. Alternative Therapies: Techniques such as acupuncture, massage therapy, or yoga may provide additional relief for some individuals.

8. Surgery: If conservative treatments fail and there is significant nerve compression or structural issues, surgical options may be considered. This is typically a last resort after other treatments have been exhausted.


Conclusion
Given that your pain has persisted for over three months and has not responded to various treatments, it may be beneficial to seek a comprehensive evaluation from a specialist, such as an orthopedic surgeon or a pain management specialist. They may recommend advanced imaging studies, such as an MRI, to better understand the underlying causes of your pain. Additionally, addressing any respiratory issues related to your cough could also be crucial in managing your back pain effectively. Remember, chronic pain often requires a multifaceted approach, and persistence in seeking the right treatment is key to finding relief.