Articles on essential hypertension

Causes of Hypertension and How to Avoid It

Dr. Yogesh Kumar, Ayurveda
Hypertension or high blood pressure is an increase in the blood pressure which is or can be harmful for the body. It is rapidly becoming a devastating disease as there is a patient of hypertension in every family. It could be your grandparents, parents, you or someone you know. Most Patients with hypertension are unaware of its presence as they do not experience any major signs and symptoms till accidently come to know they have hypertension. Hypertension remains undiagnosed in the early stages in half of the people suffering from hypertension.What is hypertension? How can I know I have hypertension?It is very hard to specify the definition of hypertension many factor influence in the diagnosis of hypertension like age, presence of other serious illness, weight, and many more. There is a controversy as what is a normal blood pressure. A normal blood pressure is the range of blood pressure where the person has no chance of getting hypertensive complaints in the long term.In order to make it simple if a person having blood pressure reading more than 140/90 mm Hg and presence of other risk factors is said to have hypertension. Blood pressure is measured by a device called Blood pressure monitoring apparatus or Sphygmomanometer.What causes hypertension?There are a number of reasons that are being linked directly to hypertension.Sedentary life style: With all the comfort of today’s world burn very less calories then required and that can be a precipitating factor for diseases like hypertension and diabetes.Bad eating habits:Fast food: Fast food or junk food is a major cause of hypertension as it is full of fat and other harmful components. This type of food can cause narrowing and blocking of blood vessels and hence cause a subsequent rise in the blood pressure.Smoking: smoking of cigarette bides, cigar, hookah causes hypertension more rapidly than other causes and should be immediately stopped. It causes hardening of blood vessels and ultimately hypertension.Drinking alcohol:  Alcohol consumption increases the risk of hypertension and heart disease.Stress: Stress also plays a part in increasing blood pressure and further can lead to heart diseases, if not managed well.High amount of salt in diet: A diet rich in high sodium found commonly in salt increase the blood pressure.Heredity: Hypertension is found in people whose parents were known hypertensive.Age: People in early forties to 5th decade start to experience hypertension. Although people in early age can also have high blood pressure.Other: Patients suffering from other severe diseases like obesity, kidney disease, and diabetes are at the risk of developing hypertension later.Pregnancy: Some pregnant females can experience high blood pressure in pregnancy.It should be treated like urgency.How can I avoid hypertension?Tips to avoid hypertensionRegular exercise: A brisk walk for 45 minutes every day should be taken. It is the best exercise for a hypertensive patient. Heavy exercises should be avoided.Diet: Patients suffering from hypertension or at the risk of hypertension should switch to diet specially designed to control their blood pressure levels. This includes fat free  and low salt diet.Avoid all saturated oils like coconut oil, butter, ghee and choose olive oil, canola oil, sunflower oilRestrict to use 2 tsp oil per day.Increase fibre rich diet, vegetables and fruits. Fruits with edible covers should be eaten with covers.Low fat diet: Absolute no to cholesterol rich foods like butter ghee unskimmed milk deep fried foods.In non vegetarian diet yellow of egg, red meat, marbled beef, goose, hamburger, deep fried fish.Smoking cessation: smoking doubles the risk of heart diseases in patients suffering from hypertension. In hypertension patients smoking should be strictly stopped as well as passive smoking should be avoided as it has equal amount of risk.Restricted use of alcohol drinks: Alcohol increases the fat level in the blood and should be avoided. If not should be restricted to 2 times per week in small amount.Stress management: Meditation for 15 minutes every day. The aim should be to blank the mind from tension of everyday life. One should think positively about own health, job and family. Try to live life with a relaxed mind. You can take lesson for stress management from an expert tutor.Yoga: Yoga asana to relax the body (Shav asana),Pranayama: A breath control exercise which gives a peaceful feeling to mind and soul. It should be done 10-15 minutes daily, in guidance of an expert.

Are You Indian? Careful About Diabetes and Hypertension

Ms. Swati Kapoor, Dietitian/Nutritionist
Research over the last several years has shown that Indian bodies and genetics are different from their western counterparts. Not in a good way- Indians suffer from abdominal obesity compared to people in the west, whose bodies are uniformly obese. As a result of this, Indians are at a higher risk of diabetes and hypertension.There are currently 41 million diabetic people in India and this number is expected to rise by 170 per cent in the next 20 years. Even today, India has the largest population of diabetics in the world. By 2050, India is projected to be diabetes capital of the world. Today, one in every three Indians has high blood pressure, which is expected to shoot by 60 per cent in the next 20 years.Read to know more about 8 steps to get rid off high blood pressure.Not much can be done about the genetic risk of Indians, but a lot can be done to take measures about reducing your risk. Important Guidelines1. First, get yourself tested for blood sugar and hypertension. Read more about wonder fruits for diabetes.2. Watch your diet and exercise. The Indian diet is very high in carbohydrates. Watch the type of carbohydrates that you put into your body- some carbohydrates promote fat storage. 3. You don't have to cut out fat from your diet. Just eat the healthy fat. Here are snacks that are delicious and healthy- Almonds keep you fitYoghurt reduces fatApple fights cancerGuavas build immunity4. If you have not exercised in a while, then this is your chance to start- start with a walk, and graduate to a jog. There are innumerable benefits of running. The classic pushup exercise also builds muscle and burns fat.You're never too old to get in shape! If you need to lose weight, get on a healthy weight loss plan, with a balanced diet and an effective exercise routine.

High Blood Pressure Is a Silent Killer

Dr. Mubarak Raja, Diabetologist
In medical term Hypertension means HIGH BLOOD PRESSURE·       It is one of the most common cardio-vascular diseases.·       Many people have Hypertension for years without any symptoms.·       Uncontrolled pressure can cause significant damage to the body.·       It is otherwise called as “SILENT KILLER’’.FACTORSWHICH INCREASE BLOOD PRESSURE:LIFESTYLE:Lack of adequate physical exercise and a sedentary lifestyleincreases the risk of high blood pressureSTRESS:Physicaland emotional stress encountered in private life or work place increases Bloodpressure.OBESITY:Therisk of Hypertension increases with obesityAGE:HTmay be encountered at any age, but as one grows older , the chances of Developinghigh BP increases.DIETARY SALT INTAKE:an excessive amount of salt in the diet can cause high BPALCOHOL:  Regular and heavy consumption of alcohol increases BP. Generally there are no symptoms for mild to moderately high BP.The best way to check BP once in every three monthsIn few patients there may be symptoms like :Lack of sleepGiddinessBlurred visionBrain damageEye damageHeart attackKidney failurePatients with Diabetes and Hypertension need to be very careful as the above risks increase even further with Diabetes.§  Do not check BP immediately after taking food§  Do not check BP when you are tense§  Do not check Bp immediatelyafter urination§  Do not check BP immediately after you rush into a clinic. Wait till your breathing becomes normal.ü Drugs alone may not be sufficient to control BP.Lifestyle modifications arevery important to reduce BPAvoid excess strain andstress both in the office and at home.Should have a good sleep of6 - 8 hrs/dayReduce excessive salt indietAvoid pickles, pappads andsalty fish Avoid too spicy foodsAvoid oily and cholesterolrich foodsUse only Safflower,sunflower or refined oilsIncrease green leafyvegetables in foodFresh fruits can be taken inlarge quantitiesAvoid smoking and alcoholRegular aerobic exerciseWalking/Skipping/Jogging/Swimming daily ½ to 1 hr preferably in the morninghoursReduce weight if you areobeseWith all the above measures,Drugs(tablets) are important in controlling BPTake your medicines regularly as prescribed by the doctor

Hypertension in Pregnancy

Dr. Pallavi Vasal, Gynecologist/Obstetrician
                                                                      Hypertension is defined as high blood pressure (B.P). A person has high blood pressure when the systolic pressure (the top number in BP reading) is greater than 140mmHg and the diastolic pressure (the bottom number) is greater than 90mm Hg.Hypertension can lead to many health problems. During pregnancy severe and uncontrolled hypertension can cause complications to both mother and baby.Causes of high blood pressure in pregnancy -1. Chronic hypertension - is high blood pressure that is present before the lady is pregnant or that occurs in first 20 weeks of pregnancy.2. Gestational hypertension – is high blood pressure that occurs during the second half of pregnancy that is after 20 weeks of pregnancy.3. Pre-eclampsia - is high blood pressure after 20 weeks of pregnancy associated with proteinuria (an abnormal amount of protein in the urine) . Pre-eclampsia is a serious BP disorder which can affect all the organs of a lady.The woman can present with complaints of severe headache, swelling over face and hands, changes in vision, vomiting, pain in upper abdomen or decrease urine output.The RISK of developing pre-eclampsia are more in women who -Are pregnant for the first timeHave had pre-eclampsia in previous pregnancy or have family history of pre-eclampsia.Are 40 years or olderHave multiple pregnancy (more than 1 baby in utero)Have history of chronic hypertension, kidney disease or both.Are obese IVF conceptionHave medical conditions such as diabetes, thrombophilias or lupus.RISKS  of high BP for baby -Growth restrictionPreterm deliveryPlacental abruption that is premature detachment of placenta (afterbirth) from the wall of uterusCaesarean deliveryIntra uterine deathHence it is very important for the lady who is planning to conceive or is pregnant to keep her BP within normal limits.PRECAUTIONS TO BE TAKEN FOR HIGH BP DURING PREGNANCY - Before Pregnancy-Keep the blood pressure under control. Reduce salt intake and do physical exercise. Loose weight if overweight .Lady needs to discuss with her doctor that she wants to become pregnant so that the doctor may change the medication to one which are safe in pregnancy or change the dose of medication if she is trying to conceive. 2) During Pregnancy-Take care of your diet that is a diet which is low in salts (avoid processed foods, pickles, pappad etc) and eat food rich in vitamin C, D and antioxidants.Lifestyle modifications that is exercise regularly .Walk and practice yoga if possible and keep weight gain under control.Avoid alcohol and tobaccoGo for antenatal check ups with your obstetrician and make sure that BP and urine are examined in each checkup. If the lady is feeling unwell any time during pregnancy , consult the doctor immediately.Being proactive and taking care of herself, going for regular prenatal and antenatal check ups, the lady with hypertension can deliver a healthy baby.

Understanding Hypertension (High BP)

Dr. Sfurti Mann, General Physician
High Blood Pressure is often called the “the silent killer”, because it has no symptoms, so you may not be aware that it’s damaging your blood vessels, heart and other vital organs of the body.Do not make the mistake of assuming that symptoms will alert you to the problem of high BP. Everybody needs to know their BP numbers. If left untreated, high blood pressure also called Hypertension – can lead to a range of serious health problems, including Heart disease and Stroke.As per WHO (World Health Organization), high BP affects every 3rd person above the age of 18. The proposition increases with age, from 1 in 10 people in their 20s & 30s to 5 in 10 people in their 50s.Both sexes are at equal risk of developing hypertension. In India, 23.10% men and 22.6 % women above 25 years suffer from Hypertension.Single reading of high BP is not the basis for diagnosing Hypertension. You should have consecutive high readings over time. Likewise, one normal reading does not mean you don’t have Hypertension.Criteria for Hypertension is as under:BP ClassificationValue of BP(mm Hg)Optimal <120/80Pre Hypertension 120/80- 139/89Grade 1 Hypertension 140/90- 159/99Grade 2 Hypertension > Or = 160/100“Isolated Systolic Hypertension” is when systolic BP is more than 140 mm Hg but diastolic BP remains normal. It is seen especially in elderly, due to stiffening of arteries.“Accelerated Hypertension”- A rapid, sudden increase in BP.Lifestyle modifications we all must undertake to tackle Hypertension are as follows:Weight Reduction : Attain and maintain a BMI OF < 25 kg/m2.Dietary Salt Restriction to less than 5gram per day from all sources.DASH (Dietary Approaches to Stop Hypertension) type dietary plan- Rich in fruits, vegetables, low fat dairy products, reduced saturated and total fat.Moderation of Alcohol Consumption- consume less than 2 drinks/day in men and less than 1 drink per day in women.Physical Activity- Regular aerobic activity e.g., brisk walking for at-least 30min/day.Quit SmokingControl blood glucose, cholesterol levels by following a healthy lifestyle and medications as prescribed by your doctor.Try and take steps to reduce your stress levels by meditation, pranayama techniques and Yoga.I will soon share with you all the common misconceptions about Blood Pressure.Wish everyone a healthy living!

Decoding Hypertension

Dr. Kshamashree Madle, Yoga and Naturopathy
Hypertension is defined as repeatedly elevated blood pressure exceeding 140/90 mm Hg i.e. above 140 mm Hg Systolic Pressure and above 90 mm Hg Diastolic pressure. The point to note here is that, for elevated blood pressure to fall under ‘Hypertension’ category, it needs to be consistently high in 3 readings taken in a single visit. The following chart gives a brief understanding of stages of Hypertension.DECODING HYPERTENSIONNow let us look at Hypertension in a different way. Physics defines:Pressure = Force/AreaNow we know thatForce = Mass * AccelerationMass = Density * VolumeSo according to this formula:Pressure = (Density * Volume * Acceleration)/AreaIn other words, if Density, Volume or Velocity of any object increases and the area in which the object is, decreases, then the pressure increases.  Now, if we look at Blood Pressure, then we can easily deduce that anything which:Increases the Density of Blood such as increased fat contentIncreases the Volume of Blood such as water retentionIncreases the Velocity of Blood in Arteries such as elevated heart rateDecreases the Area of Arteries such as blockage in arteriesWill in fact increase the blood pressureCauses of HypertensionALLOPATHIC MANAGEMENT OF HYPERTENSIONDiuretics – Promotes elimination of water in urine thereby reducing volume of blood and reducing pressureBeta Blockers – Reduces force of Heart rate thereby reducing velocity of blood in Arteries and enhances reduction in BPVasodilators – Relaxes the walls of arteries for smooth passage of blood or in other words increases Arterial area thereby reducing BP.However, these drugs and are not without side effects. Once started they have to be continuously taken because they are not formed within the body .They work until they are in the system. They do not work on specific areas only and would have the same effect on Blood or Arteries all over the body. NATURAL WAYS TO MANAGE HYPERTENSIONYoga - Relaxes the entire system and helps deal with Stress induced HypertensionNutrition - Reducing the sodium in your diet and eat a variety of foods rich in particular nutrients that help lower blood pressure and reduce the blockages in arteriesAyurveda - Medications as well as therapies to balance the Tri Doshas which has led to HypertensionThe Natural interventions which help in management of Hypertension areCondition Specific Yoga TherapyHealthy NutritionYoga based Stress Management TechniquesLifestyle ModificationA combination of 2 or more of these will help in managing hypertension in a healthy way.

Understanding Hypertension- Bust the Myths!

Dr. Sfurti Mann, General Physician
Bust the myths, know the facts.In my previous article 'Understanding Hypertension(high BP)', I talked about what is Hypertension and what measures can be taken to prevent it. Now, I'll be talking about the common misconceptions and myths associated with Hypertension and help you know the facts.Common misconceptions about Hypertension are as follows:I feel normal, I do not have to worry about BP- It is estimated that every 3rd individual above the age of 25 years has high BP and most of them do not know it or do not experience any symptoms. Know your BP numbers.I use sea salt or Sendha namak instead of regular salt, I don’t need to restrict my intake-Chemically table salt and sea salt are the same- 40% Sodium-and count the same towards total Sodium consumption. Alternative salt options contain as much sodium.I do not use table salt in my food, my BP can not rise- 75% of Sodium we consume is hidden in processed foods like tomato sauce, soups, pickles, canned and prepared mixes. Watch labels for sodium content in the form of Sodium chloride, Sodium bicarb. (Baking soda) or MSG(Mono Sod. Glutamate)Watch for added salt.I was diagnosed with high BP and I have normal BP after taking medications, so I can discontinue the medications and do not need regular BP check ups- Hypertension is a chronic condition. Follow your doctor’s recommendations for regular BP management. By your co-operation you can successfully reach your treatment goals and enjoy the benefits of a healthy life. Make sure, you  know about your BP medications & follow your physician's instructions.Wine is supposed to be good for the heart, so I can consume as much as I want- If you drink alcohol, including wine, do so in moderation. Regular use of alcohol can dramatically increase BP. It also has deleterious effects on your heart, brain, cholesterol levels and liver.  Have alcohol in moderation.There is nothing I can do, it runs in my family and I too will get it-  Hypertension can be prevented by following a healthy lifestyle and awareness about factors which are risk factors for high BP.Medications cause side effects, so I should not have any- There are various classes of anti- Hypertensive medications. It may take some time to regularize your BP medications, nonetheless, you need to take medications as per your doctor’s recommendations, because untreated Hypertension can be very dangerous for your health.Once I begin BP medications, I will have to continue same medicine forever- There can be BP fluctuations, and medicines also need to be changed, added or reduced depending on your BP and other factors. Grade 1 Hypertension may even be reversed back to normal with lifestyle modifications and medications may not be needed. But only your doctor is the right person to decide on that.KEEP BLOOD PRESSURE AT BAY AND ENJOY A HEALTHY LIFE. I will soon follow up with another article on BP medications, things you must know about.

7 Essential Nutrient Checklist

Ms. Swati Kapoor, Dietitian/Nutritionist
Some nutrients are important for healthy living and play a important role in daily body metabolism. We eat nutritious food most of the time, but are you meeting your daily requirement? Most of the health problems are due to the imbalance of the nutrients.Here is a check list of 7 of these important nutrients and food sources rich in them.Iron assists in the transportation of oxygen throughout the body and is an essential  component of red blood cells and the muscles that . Deficiency in iron can make you feel tired and can decrease your performance. Women lose twice as much iron as men and are more likely to be deficient, particularly during the child bearing years. Lentils, kidney beans, dried fruits, green vegetables and cereals are rich source of iron.Vitamin D primarily helps to strengthen your skeleton as well as keeps you away from heart attacks. Some Research says that people deficient of vitamin d are more likely to develop heart attack. Sunlight is the biggest and the important source of Vitamin D. Therefore it is important to take time out of your busy schedule and get outdoors to soak some sun. Some other options for vitamin D in your diet are eggs and in small amounts in calcium rich products.Magnesium is a multi-tasker and involves in more than 300 bodily functions. Some how we are inefficient in meeting the 400 milligram daily requirement of it. Helps to convert carbohydrates, protein, and fats into energy. The body has to struggle to generate energy when there is a deficiency of calcium in the body. Eat  almonds, spinach, navy beans, lima beans, peanuts and black eyes peas are a few options of magnesium rich food you can choose from. Magnesium helps to regulate nerve signaling, muscle contraction and relaxation, and the rhythm of your heart.Vitamin B12. Apart from creating red blood cells and keeping our nervous system healthy, we also need vitamin B12 in order to be able to absorb folic acid. Vitamin B12 also helps to release energy.  A daily requirement of 2.4 micrograms is needed by our body. Good source of casino online B12 vitamins are salmon, lamb and fortified cereals.Zinc is an essential mineral that stimulates the activity of many enzymes in the body. It supports your healthy immune system and supports the healthy growth and development of the body during adolescence, childhood and pregnancy. Good sources of zinc are red meat, poultry, seafood, whole grains, beans, nuts and dairy products.Potassium helps your cells convert glucose for energy, without potassium your heart couldn't beat, your muscles wouldn't contract, and your brain couldn't comprehend this sentence. It also helps lower blood pressure and keeps your stress levels at bay. A recent survey says that in a research it was found that people are consuming just 60-70 % of your daily requirement of potassium. To meet your daily requirement of 4500 mg some of good sources of potassium are potatoes, banana, coconut water, coconut and avocados.Iodine. Yoghurt, eggs, milk and animal feed are some of good sources of iodine for your nutrition.Thyroid glands require iodine to produce the hormones which helps control how efficiently you burn calories. Insufficient iodine can cause you gain weight and feel fatigued. Table salt might not be the best source as a research suggests that most common salts don"t meet the FDA recommended amount of salt.

Why Hypertension Patients Need to Visit an Eye Surgeon?

Dr. Manoj Rai Mehta, Ophthalmologist
Eye is the only organ in the human body where blood vessels of all calibres can be seen clearly. Right from arteries to capillary network to veins.  This provides a unique opportunity to an eye specialist to evaluate changes in the blood vessels and convey their implications to other specialist. Cardiologists, Obstetricians and Internal Medicine specialists especially seek such information from their ophthalmic colleagues.A patient with hypertension should be seen by an ophthalmologist to record changes in the blood vessels of retina as well as the retinal grounds.  This information is shared with the treating doctor who selects appropriate medicines and adjusts their dose.  At times an ophthalmologist suspects hypertension and sends the patient to an internist for evaluation.  Hypertensive Retinopathy is an important indicator of life prognosis as well as adequacy of control of blood pressure.    Spasm of blood vessels (angiospasm).  Excessive spasm in the vessels indicates inadequate controlReactive Sclerosis.  Blood vessel walls thicken and make their walls opaque.  This indicates a chronically raised blood pressure.  Vessel walls turn copper to silver hue in due course if the pressure is not controlled.  Some sclerosis comes with age as well- arteriosclerosis, which an experienced ophthalmologist can differentiate from reactive sclerosis.       Hard Exudates.  These are residual deposits of fat and protein that leak out of blood vessels when the pressure is very high.  They can at times cause irreversible damage to the retina leading to poor vision.Soft Exudates. These represent areas of infarction in the superficial retinal layers implying a lack of oxygen supply to an area.Haemorrhages.  They can be different in shape and present at different depths in the retina. Flame shaped superficial haemorrhages are typically seen in hypertensive retinopathy.Papilloedema. This is a serious condition in which swelling in the brain occurs an dis picked up during eye examination.  Patient should be hospitalised immediately when such an observation is made.Needless to say a detailed examination of eyes is an integral part of "hypertension management" as it gives important information to an internist. Adequacy of BP control, t iteration of dose, speed with which pressure is to be brought down as well as selection of drugs are guided by the ophthalmic examination.An eye surgeon is an important stake holder in hypertension management and regular exchange of clinical information with treating doctors enhances quality of life and longevity of a patient.      

3 Essential Tips to Prevent Back Pain

Dr. Sidharth Verma, Pain Management Specialist
Back pain is one of the most common debilitating disorder in the world today. The pain affects 90% of people at some point of their lives. Human back comprises of various structures (see figure) which are nerves, bones, muscles, ligaments, and tendons, any or all of which can be a source of pain. Once back pain occurs, it may become chronic (more than 4 weeks) and you shall need to consult a pain physician for relief and accurate diagnosis.Figure showing back muscles and their attachmentsSince prevention is always better than cure,  you can save yourself from having back pain if you follow these basic tips.Regular Exercise in Correct Form: Regular exercise is important to maintain proper muscular strength of the back. Human back is supported by several big muscle groups (see figure). They serve two functions - one is to facilitate the posture and movements of the back itself and the other is to help movements of the rest of the body appendages (arms, head, pelvis and legs).The health of these muscle group is important to take stress off the spinal bones and maintain proper function. Most of these muscles are red muscle fibers as they need to maintain their activity for prolonged periods of time. Just to give you an idea - your biceps (arm muscles) have to work only when you bend your arm. But your back muscles have to function all the time - whether you sit, walk, stand or even sleep. But the point is what kind of exercises are good for your back? The best exercises for back include body weight low impact aerobics like brisk walking, swimming, stationary bicycling, extension exercises and yoga. What is important to remember while doing these exercises if that you need to be gentle in your movements and achieve correct "form" - this is possible if you can ask someone (preferably a trainer) to observe and point out whether the back stays straight during the exercise. It has been seen that arching and excessive bending is associated with injury to the back while exercising.Stay Hydrated and Eat Natural Nutritious diet:The inter vertebral discs contain 70 - 80% water. The muscles and tissues have 60% water content. Therefore, it is important to stay hydrated. In addition, you must eat a nutritious diet consisting of green leafy vegetables, good protein source and just enough carbohydrates. Deficiencies of essential nutrients like Vitamin D can result in diseases like osteoporosis. Another important aspect is to maintain body weight within healthy limits. This is very important as increased belly fat is linked to increased back pain due to mechanical factors.Lift objects correctly and maintain proper posture:While lifting objects, keep them as close to body as possible. Do not slouch or bend excessively while lifting. Just keep your back straight at all times. You may bend your knees a little if required (see figure). Think before you lift and get help if needed. While working, you must not sit for more than 45 minutes at a stretch. Walk for two minutes, go to a colleague's desk and say hi or even just drink some water or visit the washroom. Humans evolved as hunter - gatherers and our bodies are more adapted to walking / standing than to sitting for prolonged periods. Those of you who travel more and have to sit for long periods of time also need to follow above tips - avoid prolonged sitting in same posture.While exercising, improper position can do more harm than good. Therefore, proper form and posture is a must.Bonus tip: Avoid cigarette smoking and those who smoke cigarettes to decrease your chances of having degenerative disc diseases leading to chronic back pain early in life.Word of caution to prevent permanent damage: In case of back pain, which is not responding to home remedies or over the counter painkillers, please contact a Pain Physician to pin point the diagnosis and appropriate management.