Back pain and other forms of chronic pain affect millions of American adults every year. Pain from arthritis, back problems, musculoskeletal conditions and headaches costs US businesses more than $61 billion a year in lost worker productivity. In a three-month period, about one fourth of US adults experience one day of back pain. It is one of the biggest medical problems affecting people today.
Back pain can be divided into two different forms: acute and chronic back pain. Acute back pain often results from injury and comes on quickly while leaving just as quickly. This type of pain may result from falling from a ladder, being tackled on the football field or lifting a load that is too heavy and should last no longer than six weeks.
Chronic back pain may arrive quickly or slowly and remains for a long period of time. Pain that lasts longer than three months is considered chronic. While chronic back pain is less common than acute back pain, it can be more debilitating.
Causes of back pain can range from various injuries and accidents to genetics or even some diseases like fibromyalgia and conditions like scoliosis.
A trip to the doctor is not often needed for acute back pain, as it will usually go away on its own. However, more severe symptoms may be signs that a doctor visit is needed.
See a physician if you experience the following symptoms:
- numbness or tingling
- severe pain that does not show improvement with rest
- pain after a fall or injury
- pain with the addition of any of the following:
- trouble urinating
- numbness in the legs
- weight loss when not on a diet
These symptoms could signal a larger problem that is developing or has already developed. If you are experiencing pain that you suspect goes beyond normal soreness, seek medical attention. Your doctor may be able to provide detailed answers and treatment information for something that has been reoccurring. If pain affects your daily life or you notice symptoms never before present, schedule an appointment for a physical examination.
There are many different types of doctors who can treat back pain, ranging from family physicians to doctors who specialize in disorders affecting the nerves and musculoskeletal system. In most cases, it is best to see your primary physician first. He or she can then redirect you to another specialist if your condition needs specialized care.
Properly diagnosing back pain requires a medical history and a physical examination by a doctor. If necessary, additional tests, such as an x-ray, may be ordered. Your doctor will begin by asking you questions about your back pain, such as if you have fallen recently and if there are certain activities or times of the day when the pain is worse. Make sure to tell your doctor if you or any close family members have experienced any health problems or conditions, as these may help your doctor pinpoint the cause of the pain.
Your doctor may follow these questions by asking you to stand or walk and then checking your reflexes to look for slowed or heightened reflexes, as these may be a sign for nerve problems. Your doctor may check for fibromyalgia by looking for tender points on your back. Your doctor also will likely check your muscle strength and sensation as well as signs of nerve root irritation.
Additional tests used for diagnosis of back pain may include the following:
- X-rays. Your doctor may order an x-ray if he or she suspects that you have a fracture, osteoarthritis or an unaligned spine.
- MRI scan. Your doctor may order an MRI scan if he or she suspects a problem such as an infection, a tumor, inflammation or pressure on a nerve. An MRI scan is needed if your pain lasts longer than three to six weeks or if your doctor feels there may be a need for surgical consultation. Unlike an x-ray, which shows only bony structures throughout the body, an MRI scan produces clear pictures of soft tissues such as ligaments, tendons and blood vessels.
- CT scan. A CT scan allows your doctor a clearer and cleaner view of spinal structures that cannot be seen through a generic x-ray. A computer creates a three-dimensional image and can identify problems such as herniated disks, tumors or spinal stenosis (narrowing of the open spaces in the spine).
- Blood tests. Although blood tests are not common in the diagnosis of back pain, they may be used in specialty cases. A complete blood count (CBC) could be used to point to problems such as infection or inflammation. An erythrocyte sedimentation rate (sed rate) could measure inflammation and infection, which could point to types of arthritis or tumors. A C-reactive protein (CRP) test is another blood test used to measure inflammation and the possibility of arthritis. HLA-B27 is a test to identify a genetic marker in the blood more common in people with ankylosing spondylitis — a form of arthritis affecting the spine and sacroiliac joints.
Treatment for back pain differs depending on whether the pain is acute or chronic. In acute back pain, the pain usually goes away on its own and without medical treatment (although you may wish to use aspirin or ibuprofen to ease pain). Getting up and continuing your normal activities can reduce pain and ease stiffness.
Chronic back pain treatment falls into two categories: the kind involving an operation or surgical procedure and the kind that does not. Usually, back pain does not require surgery.
Some non-surgical treatments include the following:
- Hot or cold packs. Either a hot or cold pack, or sometimes a combination of the two, can be incredibly soothing to irritating pain and stiffness. Heat dilates blood vessels, both improving the supply of oxygen the blood takes to the back region and reducing muscle spasms. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to a specific area. It also works to numb deep pain.
- Exercise. Proper exercise can ease chronic back pain, although it might not be safe for acute pain. Flexion exercises (exercises which help you bend forward), extension exercises (bending backward), stretching and aerobic exercises, which get your heart pumping faster, can all help. But speak with your doctor before beginning an exercise regimen to be sure that its safe and will work for you.
- Traction. Traction involves using pulleys and weights to stretch out the back. The idea behind traction is to pull the vertebrae apart to allow a bulging disk to slip back into its appropriate place.
- Corsets and braces. Corsets and braces include multiple devices such as elastic bands and stiff supports with metal stays designed to limit the motion of the lumbar spine and provide support to the abdomen. These devices can also assist in the correction of posture.
- Behavioral modification. A healthy attitude can help in treating back pain. It can be beneficial to learn to move your body properly while you do daily activities, particularly those involving heavy lifting, pushing or pulling. Pick up other healthy habits such as regular exercise, relaxation and a steady sleep pattern.
- Medication. There are numerous medications used to treat chronic back pain. Some of these medications are available over-the-counter, while others require a doctor's prescription. The following are common medications used in the treatment of back pain:
- Analgesics. Analgesic medications are those designed specifically to relieve pain. Tylenol and aspirin are analgesics, and so are prescription narcotics like oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Topical analgesics are also available in the forms of creams, ointments and salves rubbed directly onto the skin over the site of pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medications that relieve pain and inflammation. These include ibuprofen (Motrin, Advil), ketoprofen and naproxen sodium (Aleve). These medications work by blocking substances called prostaglandins that contribute to inflammation and pain.
- Muscle relaxants and certain antidepressants have also been prescribed for the treatment of back pain.
- Injections. When medications and other nonsurgical treatments fail, doctors may recommend injections for pain relief. The most commonly used injections include the following:
- Nerve root blocks. If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, a nerve root block injection may be used to help ease the resulting back and leg pain.
- Facet joint injections. The facet joints are those where the vertebrae connect to one another, keeping the spine straight and aligned. An injection of anesthetics or steroid medications into facet joints is sometimes used to try to relieve pain.
- Trigger point injections. An anesthetic is injected into specific areas in the back that are painful when pressure is applied.
- Manipulation. Spinal manipulation refers to procedures in which health care professionals use their hands to mobilize, massage or stimulate the spine and surrounding tissue.
- Transcutaneous electrical nerve stimulation (TENS). TENS involves wearing a small box over the site of pain. This box directs mild electrical impulses to nerves in that area. Some experts suggest that stimulating the nervous system could modify the patient's perception of pain.
- Acupuncture. Acupuncture is based on the theory that a life force Qi flows through the body along certain channels, which if blocked, can cause illness. Insertion of thin needles at precise locations along these channels can supposedly unblock the flow of Qi, relieving pain and restoring health. Although few Western-trained doctors would agree with the concept of blocked Qi, some believe this insertion of needles may spark production of the body's natural pain-numbing chemicals such as endorphins, serotonin and acetylcholine.
- Rolfing. Rolfing is a type of massage involving strong pressure on deep tissues in the back to relieve tightness.
Besides these nonsurgical treatments, there are surgical remedies for back pain, but such procedures are not always necessary. Depending on the diagnosis, surgery may be the first treatment of choice or might be reserved for chronic back pain for which other treatment avenues have failed. Herniated disks, spinal stenosis, spondylolisthesis, vertebral fractures and degenerative disk disease are some diagnoses that may require surgery.
Surgical procedures that may be used for back pain include the following:
- Laminectomy/discectomy. In this procedure, which is used in the treatment of herniated disks and spinal stenosis, part of the lamina (a portion of the bone on the back of the vertebrae) and a portion of the ligament are removed. Then, the herniated disk is taken out through the incision.
- Microdiscectomy. This procedure is similar to a traditional discectomy and involves the removal of a herniated disk through an incision in the back. In microdiscectomy however, the incision is much smaller than it is in discectomy and the doctor uses a magnifying microscope or lenses to locate the disk through the incision.
- Laser surgery. In laser surgery, which is also used for herniated disks, the surgeon inserts a needle that delivers a few bursts of laser energy to vaporize tissue in the disk. This procedure reduces the size of the disk and relieves pressure on the nerves.
- Spinal fusion. Spinal fusion is used to treat spondylolisthesis — a condition in which a vertebra in the spine slips out of the proper position onto the bone below it. In a spinal fusion, two or more vertebrae are joined together using bone grafts, screws and rods to stop the affected vertebrae from slipping. The grafted bone usually comes from another area of the body, most commonly the hip or pelvis, but can also come from a donor.
- Vertebroplasty. Both trauma and osteoporosis can cause a compression fracture (broken vertebra). If this happens, your doctor may cut a small opening in the skin over the affected part of the spine and inject a cement-like mixture called polymethylacrylate into the fracture. The goal of this procedure is to relieve pain and stabilize the spine.
- Kyphoplasty. The procedure begins with the doctor inserting a balloon device to help restore the height and shape of the spine. The doctor then injects polymethylacrylate (the cement-like mixture) to repair the fracture.
- Intradiscal electrothermal therapy (IDET). In this procedure, a heat wire is inserted through a small incision in the back and into a disk. An electrical current is then sent down the wire to strengthen the collagen fibers that hold the disk together.
- Disk replacement. This procedure is used to treat a herniated disk. Instead of just removing the disk (discectomy), the disk is removed and replaced with a synthetic disk. This artificial disk restores height and mobility between vertebrae.
It is important to remember that back pain is a symptom, not a complete diagnosis. In other words, back pain is a sign of another condition.
One possible cause of back pain is mechanical problems, or issues with the way the spine moves or the way a person feels when moving the spine in certain wasy. One of the most common mechanical causes of back pain is intervertebral disk degeneration. Simply put, intervertebral disk degeneration means that the disks between the vertebrae of the spine are wearing down with age. As these disks slowly break down, they lose the cushioning they once relied on.
Other possible mechanical causes of back pain include spasms, muscle tension and ruptured or herniated disks.
Injuries are a common cause of acute or short-lasting back pain, but they can also lead to chronic pain. Spine injuries such as sprains and fractures can cause back pain. Sprains are tears in the ligaments that support the spine and can occur from twisting or lifting with haste and improperly. Fractured vertebrae can result from osteoporosis.
Certain medical conditions and diseases can cause back pain. Scoliosis, a curving of the spine, may cause back pain in middle age. Spondylolisthesis, varying forms of arthritis and spinal stenosis, which is a narrowing of the spinal column that puts pressure on the spinal cord and nerves, could also cause back pain. Pregnancy, kidney stones, infection and endometriosis, which is the buildup of uterine tissue in places outside of the uterus, are other potential causes back pain. Fibromyalgia is also a cause of such pain and is a condition of widespread muscle pain and fatigue.
Infections of the vertebrae and tumors are additional sources of back pain. So too is emotional stress, which can play a role in how severe the pain is and how long it lingers. Stress can negatively affect the body in many ways, including causing back muscles to become tense and painful.
Back pain, especially chronic or long-lasting back pain, can be debilitating and disabling for many Americans. And if the cause of back pain is unknown, it can be very difficult to treat.
If your back pain lasts longer than six weeks, you should schedule an appointment to see your doctor for a full physical examination. Don't assume this pain is soreness. Many of the causes of back pain are impossible to detect or diagnose alone, and you will need a medical diagnosis in order to receive proper treatment. If you have been injured or had an accident that resulted in back pain, you should not hesitate to visit your doctor.
Remember that with acute back pain, you may be able to go about your daily activities knowing the pain will cease and eventually go away. Ask your doctor about returning to your exercise regimen and about ways to speed your recovery. He or she may suggest strengthening exercises like stretching or bending forwards and backwards.
What are the risk factors for back pain?
Anyone can have back pain. However, there are a number of factors that can increase your risk. These factors include age, fitness level, diet, genetics, race, cigarette smoking, the presence of other diseases and occupational risk factors.
Typically, low back pain first attacks between the ages of 30 and 40 and becomes more common with age. Back pain is also more common among people who are not physically fit. The spine may not have proper support in people with weak back and abdominal muscles.
A diet high in calories and fat potentially can lead to obesity, which can add stress to the back.
Some conditions that cause back pain, such as ankylosing spondylitis, a form of arthritis, are caused by genetics and are therefore hereditary.
Race may be a factor in back problems. For example, African American women are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine slips out of place.
Osteoarthritis, rheumatoid arthritis and cancer may cause or contribute to back pain.
Having a job that carries risk factors such as heavy lifting, pushing and pulling can increase the risks for developing back pain. Smoking increases back pain risk as well.
What can I do to help my acute back pain?
Acute back pain is back pain that lasts less than six weeks. Injury or accidents, like getting tackled on the football field or falling from a ladder, are common causes of acute back pain.
If you develop back pain after a serious injury, it is important to see a doctor as soon as possible so that he or she can evaluate the damage and provide prompt treatment. However, if it is mild, try an aspirin or ibuprofen. Although you may be tempted, don't try and immobilize yourself until the pain ceases. Staying active will keep up blood flow and not allow you to grow stiff. A hot or cold pack can be used to treat sore and stiff backs and can be found at the pharmacy or drug store. Do not exercise vigorously with acute back pain as you may cause further damage to your back. Ask your doctor what is safe.
Living with back pain can be difficult and uncomfortable, but there are proactive steps you can take to reduce that pain or prevent it altogether.
Regular exercise is one of the best ways to keep your back strong and prevent back pain, especially as you age. Exercises that boost balance and strength can lower your risk of falling and injuring your back or breaking bones. Any weight-bearing exercise that challenges your balance, such as tai chi or yoga, are options you can try.
A healthy diet also plays a key role in back pain treatment and prevention. If you're overweight, a healthy diet can help you lose weight that puts unnecessary and injury-causing stress and strain on your back.
It's also important to have enough calcium and vitamin D in your diet to keep your bones strong and to help prevent osteoporosis. Calcium is found in dairy products like milk and cheese, green leafy vegetables and fortified products like orange juice. The body naturally produces vitamin D through exposure to the sun. But if you don't go outside much, you can get your vitamin D through supplements and/or your diet. Products such as milk and other fortified products contain vitamin D.
Practicing good posture and avoiding heavy lifting are also good ways to prevent injury and back pain.