The 3 classes of Pain that can affect your backAxial PainAxial spinal pain is a condition that affects the spine and causes pain in the neck, back, or shoulders. This condition can be caused by injury or disease and may cause numbness, weakness, or muscle spasms. Axial spinal pain can be caused by an injury to the spine, such as a herniated disc or pinched nerve, which can happen when there is damage to the soft tissue surrounding the spine. Other causes include arthritis of the spine (degenerative joint disease), spinal stenosis (narrowing of the spine), spondylolisthesis (slippage of vertebrae), osteoarthritis, tumor growths and infections within the bones of the spine. | The 3 classes of Pain that can affect your back Axial Pain Referred Pain Radicular Pain The 5 Types of Back Pain Flexion Dominant Back Pain Extension Dominant Back Pain Neurogenic Claudication Inflammatory Back Pain Chronic Back Pain Why Do Veterans Suffer From Back Pain? VA Ratings for Back Problems Common in Veterans Lumbosacral and Cervical Strain Intervertebral Disc Syndrome Sciatic Nerve Pain Degenerative Disc Disease |
Referred pain is a type of pain that is felt in one part of the body, but its source is somewhere else. The location of referred pain may be difficult to pinpoint. For example, when you have a stomachache and you feel it in your back, this is an example of referred pain. This is because the actual cause of your stomachache—perhaps a gallbladder attack or some other digestive problem—is actually happening in your abdomen (not in your back). Referred pain can occur for many reasons. Sometimes it can be caused by nerve endings that run from the site where the pain originates to another part of the body (such as from your arm to your chest). This happens because those nerve endings send signals related to pain to your brain. The brain then interprets these signals as coming from the area where they originated instead of where they actually do originate.
Radicular Pain
Radicular spinal pain is a type of nerve pain that can be caused by a herniated disc, spinal stenosis, or other causes. The term “radicular” refers to the nerve root(s) — the area where nerves exit the spine and travel to the rest of the body. Radicular spinal pain is often described as radiating from one side of the back down into one leg or foot, but it can also radiate from other areas of your body. If you have radicular spinal pain, it may feel like pins and needles (tingling), burning, stabbing, throbbing, or shooting through your legs and feet. Your leg may feel numb or weak as well as painful. The pain may come on suddenly when you bend over or twist suddenly — for example, when getting out of bed in the morning — or it might develop gradually over time without an apparent cause (such as from sitting too long).
The 5 Types of Back Pain
Flexion Dominant Back PainIf you’re experiencing back pain and have trouble bending forward, it’s likely that you have a flexion dominant back pain pattern. Flexion dominant back pain is caused by overuse of the muscles in the front of your body and stiffness in the muscles of your back, causing them to “overcompensate” by taking on more work than they were intended to do. This can lead to pain in the lower back, hips, and hamstrings. People who are flexion dominant typically experience low back pain during activities that require them to bend forward: picking up something from the floor or reaching for something on a shelf above their head.
Extension Dominant Back Pain
Extension dominant back pain occurs when the muscles in your lower back are tight and overworked. This can cause them to become short, stiff, and easily irritated. Extension dominant back often occurs after long periods of standing or high impact activities such as running. It can include pain or tingling in the legs. Sufferers of this type of back pain often find that bending or sitting provides some relief.
Neurogenic Claudication
Neurogenic claudication is a form of back pain that occurs when there is a decrease in blood flow to the lower limbs due to a narrowing of the arteries. This can be caused by atherosclerosis, which narrows the arteries, or it can be due to an injury to the spinal cord. The pain associated with neurogenic claudication is often described as a cramp-like sensation in the legs and feet.
Inflammatory Back Pain
Inflammatory back pain is a common health problem that can affect people of any age. Inflammatory back pain occurs when your joints, muscles, ligaments or nerves become inflamed. This causes pain and stiffness in the back and arms. Inflammatory back pain is caused by an injury or trauma to the spine or muscles of your lower back. It can occur when you lift heavy objects or when you twist or bend incorrectly, for example when lifting something from the floor or doing an activity like gardening. Inflammation can also be caused by an infection in your bones or joints, such as arthritis.
Chronic Back Pain
Chronic back pain is a condition that lasts for more than 3 months. It can be caused by any number of things, including injury, degenerative disc disease, and spinal stenosis. Your spine is made up of bones called vertebrae. These vertebrae are separated by discs that act as cushions between each bone. When you have chronic back pain, it’s usually because one of these discs has lost its ability to act as a cushion and support your spine. If this happens, you may experience stiffness or pain in your back or neck. You may also experience pain when sitting or standing for long periods of time and difficulty sleeping comfortably at night.
Why Do Veterans Suffer From Back Pain?
Back pain is a common problem for veterans, and it can have a devastating effect on your life. From being unable to work and support yourself to simply being unable to enjoy the activities you love, back pain can make life extremely difficult. The rigors of military service put veterans at high risk of developing back pain from direct injury to the spine during training or in combat, trauma and stress from carrying heavy packs for long distances, and regular bending and lifting. Back pain can also develop in veterans experiencing post-traumatic stress disorder (PTSD). PTSD can cause increased muscle tightness and reduced flexibility in the back region resulting in spinal problems and physical pain.VA Ratings for Back Problems Common in Veterans
Lumbosacral and Cervical Strain (Diagnostic Code 5237)Lumbosacral (lower back) and Cervical (neck) injuries are typically caused by trauma or overuse of the muscles, tendons, and ligaments. These injuries can be acute or chronic and cause pain that is particularly noticeable when bending over or lifting heavy objects. Lumbosacral and Cervical Strain results in a stiffening of the spine and a reduced range of motion – a condition known as ankylosis. The VA determines your disability rating based on the degree of ankylosis that you suffer from.
- Ankylosis to the entire spine – 100%
- Ankylosis to both the thoracic and lumbar spine – 50%
- Ankylosis to the entire cervical region – 40%
- An inability to bend forward any more than 30 degrees in your thoracolumbar region – 40%
- An inability to bend your neck (cervical spine) any more than 15 degrees – 30%
- Forward flexion (bending forward) of the thoracolumbar spine limited to between 31 and 60 degrees – 20%
- Forward flexion of the thoracolumbar spine limited to between 61 and 85 degrees – 10%
Intervertebral Disc Syndrome (Diagnostic Code 5243)
Intervertebral Disc Syndrome (IVDS) is commonly known as a herniated disc or discs. The main symptom of IVDS is sharp constant pain caused by irritation of nerve roots that exit the spine. This pain can be incapacitating and the VA determines disability ratings based on the frequency and duration of incapacitation caused by IVDS over a 12 month period.
- A cumulative total incapacitation of 6 weeks or more – 60%
- A cumulative total incapacitation of 4 or more weeks but less than 6 weeks – 40%
- A cumulative total incapacitation of 2 or more weeks but less than 4 weeks – 20%
- A cumulative total incapacitation of at least 1 week but less than 2 weeks – 10%
Sciatic Nerve Pain (Diagnostic Codes 8520, 8620 & 8720)
Sciatic nerve problems are an example of referred pain (mentioned above). Although the pain if felt in the legs the cause of the problem originates in the back. Sciatic nerve pain is usually caused by compression of the sciatic nerve or herniation of the disc where the sciatic nerve leaves the spine. The VA will determine if your sciatica involves paralysis, neuritis (inflammation of the sciatic nerve causing pain and loss of motor functions) or neuralgia (tingling, numbness, and moderate to severe pain together with some loss of motor function). VA ratings for sciatic nerve conditions are as follows:
- Complete paralysis causing failure in all the muscles below the knee – 80%
- Severe (but not complete) paralysis causing atrophy and poor circulation in the leg – 60%
- Severe neuritis resulting in loss of sensation, limited use of the leg together with some atrophy – 60%
- Moderately severe paralysis or neuritis of the leg – 40%
- Moderate paralysis, neuritis or neuralgia of the leg – 20%
- Mild paralysis, neuritis or neuralgia of the leg – 10%
Degenerative disc disease (DDD) is caused by the stress of everyday movements and minor injuries that accrue over time. DDD causes a sharp and constant pain at the point where these injuries occur. The VA will determine your rating for DDD based on the limitations of movement for your spine described above. However, if the particular part of your body affected is not considered eligible for compensation the VA will apply the following ratings:
- 2 or more major joints or 2 or more minor joint groups – 20%
- 2 or more major joints or 2 or more minor joint groups but with only occasional incapacitation – 10%
