Back pain can be caused by abnormalities in the vertebral column which are present since birth. But they may also be produced by bad posture or by injuries such as whiplash.

More often, they are associated with simple degenerative processes which occur in virtually everyone. For most of us, such changes are either without symptoms or cause no problem.

But for many people the onset of degenerative processes is often associated with increased stresses and strains both at work and at home. This may lead to further weakening or the degeneration of the supporting structures of the vertebral column and can lead to disc problems.

Lower back pain, occurring in the small of the back or in the muscles supporting the spine, is an extremely common complaint.

To some extent this problem is caused by weakened muscles which can be helped by an appropriate exercise program. In fact, just being physically unfit can lead to lower back pain.

Everyday tensions which generate muscle spasms are another source. Lower back muscle spasms sometimes start with a strain or an injury to the region, such as lifting a heavy load with a bent back.

They are then further aggravated by concern about the pain or by other stress conditions. These spasms are sometimes associated with very little X-ray evidence, making it difficult for doctors to find evidence that tension, or spasms, cause the pain. The spasms may in fact may not be present at the exact moment the doctor examines you.

A full and complete history needs to be taken to ascertain stressful events which may be causing the tension in the muscles, which in turn is associated with the muscle pain.

One of the major results of anxiety or stress is muscle tension, which occurs when muscles are contracted for overly long periods. The usual consequences of prolonged muscle activity include a buildup of toxic waste products within the muscle tissue.

This in turn leads to pain which causes further spasms. Along with the build-up of waste products, there is a decreased availability of oxygen to the muscle tissue because of the relative decreased blood flow to the area.

It is therefore easy to see that such situations lead to pain which can be continuous and difficult to treat without a multi-disciplinary approach.

*71\37\8*

Some may be urged by well-meaning family or friends, or even the doctor, not to ‘overdo’ it — which they sometimes carry out so zealously as to become so physically weakened that they have no choice but to take things easy! The traditional game, pointed out by Eric Beme in his excellent book The Games People Play, includes: ‘Try to cure me if you can!’ This is very common among pain patients, who actually challenge the doctor to cure them. If patients have too often been encouraged to take things easy, it then becomes very difficult to convince them that physical activity may be increased without risking physical harm!

*48\37\8*

Sleep disturbance is common. So are appetite changes and a decreased interest in sex. These occur along with increased irritability, the withdrawal of interest and the weakening of relationships. There is also increased preoccupation with everything about the body.

*26\37\8*

It is a commonly held belief that RSI sprang upon an unsuspecting Australian public in the early 1980’s as a result of an industrial campaign by concerned unionists. In fact, RSI dates back to the Middle Ages when people in occupations such as spinning, cobbling and violin-making were said to be afflicted by painful hands and arms.

Other common conditions now brought under the umbrella of RSI include tenosynovitis, cervico-brachial syndrome, shoulder-hand syndrome and occupational overusage syndromes.

*4\37\8*

What else could it be?

Quite a number of conditions causing headache can also give eye symptoms. These have all been covered in other areas of this book.

Pain radiating from one eye can occur as a result of migraine or cluster headache.

Herpes zoster, (shingles),’in a painful skin infection which can attack both the eye, and the skin of the forehead above the eye.

Cervical spondylosis and arthritis of the neck can in certain circumstances cause severe spasm in the muscles of the neck, which creates pain that appears to radiate out of one eye.

Pain behind the eyes or just above the eyes in the forehead is often associated with muscle spasm in the neck, particularly the upper part of the neck. ‘Pension headaches caused in this way often cause eye pain.

Although flashing lights in the eye tend to be associated with migraine, in pregnant women they can also be associated with pre-eclampsia.

Blurred vision can be associated with focusing problems that require spectacles. It can also be a symptom of high blood pressure, acute glaucoma, and uraemia.

A tumour of the pituitary gland can ‘pinch’ the visual field to produce ‘tunnel vision’, in which there is loss of peripheral vision. Sometimes a brain tumour stops the patient seeing one sector of his visual field.

Permanent blindness can occur in temporal arteritis and glaucoma (see above); and brain and pituitary tumours can each cause progressive blindness as a result of pressure on the nerves. Usually the loss of vision is progressive, but sometimes can be halted or reversed by prompt treatment. Temporary loss of vision with a headache is usually caused by migraine

*81\20\2*