Back pain (also known as dorsalgia) is one of the most common medical problems -- an estimated 8 out of 10 people suffer from it. Symptoms can range from a muscle ache to shooting pain, limited range of motion, and an inability to stand up straight. It can come on suddenly -- from an accident, a fall, or lifting something too heavy -- or it can develop slowly, perhaps as the result of age-related changes to the spine. Regardless of how back pain happens or how it feels, you will know it when you have it. And chances are, if you don't have back pain now, you will eventually. The goal of treatment is to restore proper function and strength to the back and prevent recurrence of the injury.
Acute or short-term low back pain generally lasts from a few days to a few weeks. Acute back pain is usually the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by:
A sports injury
Work around the house or in the garden
A sudden jolt, such as a car accident
Other stress on spinal bones and tissues.
Chronic back pain is pain that persists for more than 3 months; it is often progressive; and the cause can be difficult to determine.
Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks. Disks are the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found.
Strains
Back
pain most often occurs:
From strained muscles and ligaments
From improper or heavy lifting
After a sudden awkward movement
Sometimes a muscle spasm can cause or be associated with back pain.
Structural
problems
In some cases, back
pain may be caused by structural problems, such as:
Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But even so, many people who have bulging or herniated disks experience no pain from the condition.
Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg.
Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.
Osteoporosis. Compression fractures of your spine's vertebrae can occur if your bones become porous and brittle.
Rare
but serious conditions
In rare
cases, back pain may be related to:
Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.
Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain.
Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.
Factors that increase your risk of developing low back pain include:
Smoking
Obesity
Older age
Being female
Physically strenuous work
Sedentary work
Stressful job
Anxiety
Depression
Back pain is most commonly felt as soreness, tension or stiffness in the lower back (the area between the bottom of the ribs and the top of the legs) but it can also be felt in the neck, shoulders, buttocks and thighs.
The pain sometimes develops suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture.
Sometimes the pain develops for no apparent reason. Some people just wake up one day with a sore back. Typically, the pain eases when you lie down flat, whereas moving, coughing or sneezing makes it worse.
When to get medical help
Most cases of back pain usually improve without you having to get medical help, but if your condition does not get any better within three days see your doctor. You should also see your doctor if you suffer regular episodes of back pain for more than six weeks.
There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:
a fever of 38ºC (100.4ºF) or above
unexplained weight loss
swelling of the back
constant back pain that does not ease after lying down
pain in your chest or high up in your back
pain down your legs and below the knees
pain caused by a recent trauma or injury to your back
loss of bladder control
inability to pass urine
loss of bowel control
numbness around your genitals, buttocks or back passage
pain that is worse at night
If you have any of these signs, see your doctor straight away.
Other types of back pain
Pain in the upper back, legs, neck and shoulders can also be felt as back pain but it may be caused by another condition:
pain in the lower back that moves down the buttocks into one or both of the legs may be a symptom of sciatica
soreness in the lower back, muscle weakness, tight muscles and loss of bladder control may be the result of a slipped disc
back pain, buttock pain, swollen joints and tendons and extreme tiredness are common symptoms of ankylosing spondylitis
pain in the joints (including the back) when walking and stiffness first thing in the morning are symptoms of arthritis
painful stiffness of the shoulder, which makes it very difficult to dress, drive or sleep, may be a sign of frozen shoulder
neck pain and stiffness, headaches and lower back pain following an accident are common symptoms of whiplash
Treatment for back pain is usually only necessary for chronic back pain, which is pain that lasts for more than 3 months. Acute back pain, which is pain that lasts no longer than 6 weeks, usually gets better on its own, without any treatment. Chronic back pain can be treated with or without surgery, although doctors usually recommend non-surgical forms of back pain treatment first.
The type of back pain treatment that your healthcare provider recommends will generally depend on whether you are experiencing acute or chronic back pain.
Acute pain is pain that hits you suddenly, for example, after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy. Acute pain comes on quickly and leaves quickly. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.
Chronic pain may appear quickly or slowly, and it will linger for a long time. In general, pain that lasts more than 3 months is considered chronic. Chronic pain is much less common than acute pain.
Treatment for Acute Back Pain
Acute back pain usually gets better on its own, without treatment, although acetaminophen, aspirin, or ibuprofen may help to ease the pain. Getting up and moving around can help ease stiffness and relieve pain. Exercise and surgery are not recommended as treatment for people with acute back pain.
Treatment for Chronic Back Pain
Chronic back pain can be
treated with or without surgery. In the vast majority of cases,
treatment does not require surgery. Doctors will almost always try
non-surgical treatment before recommending back surgery. In a very
small percentage of cases -- when back pain is caused by a tumor, an
infection, or a nerve root problem called cauda equina syndrome --
prompt surgery is necessary to ease the pain and prevent further
problems.
There are a number of non-surgical chronic treatment options for back pain, which include:
Hot or cold packs
Exercise
Medications
Devices
Behavioral modification
Injections
Complementary and alternative therapy.
Hot or cold packs -- or sometimes a combination of the two -- can be soothing to chronically sore, stiff backs. Heat can:
Reduce muscle spasms
Alter the sensation of pain
Dilate the blood vessels, which will improve the supply of oxygen that the blood takes to the back.
Cold may reduce inflammation by decreasing the size of the blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it will numb deep pain. Applying heat or cold may relieve pain, but it will not cure the cause of chronic back pain.
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning. Exercises that may be helpful for specific causes of back pain include flexion, extension, stretching, and aerobic.
Flexion
The purpose of flexion (exercises in which you bend over) exercises is to:
Widen the spaces between the vertebrae, thereby reducing pressure on the nerves
Stretch the muscles of the back and hips
Strengthen abdominal and buttock muscles.
Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. However, if a herniated disc is causing your back pain, performing flexion exercises may increase pressure within the discs, making the problem worse.
Extension
Extension exercises are exercises in which you bend backward. Extension exercises may minimize radiating pain, which is pain that you can feel in other parts of the body other than where it originates. Examples of extension exercises are leg lifts while lying prone and raising the trunk while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
Stretching
The goal of stretching exercises is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.
Aerobic
Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated. It is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include:
Brisk walking
Jogging
Swimming.
People with back problems should avoid exercises that require twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, people with disc disease should avoid high-impact activities. People who are unable to exercise for 30 minutes at a time due to back pain should try three 10-minute sessions and work up to their goal. However, people who have back pain should talk to their doctor or physical therapist about the safest aerobic exercise for them.
There are many medications that are used for the treatment of chronic back pain. While some types of back pain medication are available over-the-counter, others are available only with a doctor's prescription. Types of medications that are used for back pain include:
Analgesics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Other medications.
Analgesics
Analgesic medications are specifically designed to relieve pain. Analgesics include:
Over-the-counter acetaminophen (Tylenol) and aspirin.
Prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin).
Topical analgesics include Zostrix, Icy Hot, and Ben Gay.
Aspirin and acetaminophen are the most commonly used analgesics, and narcotics should only be used for a short time for severe pain or pain after surgery. People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics to be helpful. These creams, ointments, and salves are rubbed directly onto the skin over the site of the pain.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that are used to relieve both pain and inflammation. NSAIDs include nonprescription products such as:
Ibuprofen (Motrin and Advil)
Ketoprofen (Actron and Orudis KT)
Naproxen sodium (Aleve).
More than a dozen other NSAIDs, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription. Some examples include:
Naproxen (Naprosyn, Anaprox, Naprelan)
Celocoxib (Celebrex).
All NSAIDs work by blocking substances called prostaglandins, which contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body. Side effects of all NSAIDs can include:
Upset stomach
Stomach ulcers
Heartburn
Diarrhea
Fluid retention.
However, COX-2 inhibitors are designed to cause fewer stomach ulcers. For unknown reasons, some people seem to respond better to one NSAID than another. It is important to work with your doctor to choose the NSAID that is safest and most effective for you.
Key information about NSAIDs includes:
NSAIDs can cause stomach irritation or, less often, they can affect kidney function.
The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious.
Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your healthcare provider or pharmacist before taking NSAIDs.
NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People over age 65 and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.
Other Medications
Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.
Some
herbal supplements with anti-inflammatory properties may ease back
pain. Although more research is needed to reliably determine their
safety and efficacy, some studies suggest that the following herbs
may be helpful:
Willow bark (Salix alba), taken orally
Devil's claw (Harpagophytum procumbens), taken orally
Capsicum (Capsicum frutescens), applied as a topical plaster
Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disc to slip back into place. While some people experience pain relief while in traction, the relief is usually temporary. Once traction is released, the stretch is not sustained and back pain is likely to return. There is no scientific evidence that traction provides any long-term benefits for people with back pain.
Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays. These devices are designed to:
Limit the motion of the lumbar spine
Provide abdominal support
Correct posture.
While corsets and braces may be appropriate after certain kinds of surgery, there is little, if any, evidence that they help treat chronic lower back pain. In fact, by keeping you from using your back muscles, they may actually cause more problems than they solve by causing lower back muscles to weaken from lack of use.
Developing a healthy attitude and learning how to move your body properly while you do daily activities -- particularly those involving heavy lifting, pushing, or pulling -- are sometimes part of the back pain treatment plan. Other behavioral changes that might help with back pain include adopting healthy habits, such as exercise, relaxation, and regular sleep, and dropping bad habits, such as smoking and eating poorly.
When medications and other non-surgical treatments fail to relieve chronic back pain, doctors may recommend injections as part of back pain treatment for pain relief. Types of injections can include:
Nerve root blocks
Facet joint injections
Trigger point injections
Prolotherapy.
Nerve Root Blocks
If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, an injection called a nerve root block may be used to help ease the resulting back and leg pain. Nerve root block injections contain a steroid medication and/or anesthetic, and the injection is administered to the affected part of the nerve. Whether the procedure helps or not will depend on finding and injecting precisely the right nerve.
Facet Joint Injections
The facet joints are those where the vertebrae connect to one another, keeping the spine aligned. Although arthritis in the facet joints themselves is rarely the source of back pain, the injection of anesthetics or steroid medications into facet joints is sometimes tried as a way to relieve pain. The effectiveness of these injections is questionable, and one study has suggested that this treatment is overused and ineffective.
Trigger Point Injections
In this procedure, an anesthetic (or a steroid medication) is injected into specific areas in the back that are painful when the doctor applies pressure to them. Although trigger point injections are commonly used, researchers have found that injecting anesthetics and/or steroids into trigger points provides no more relief than "dry needling," or inserting a needle and not injecting a medication.
Prolotherapy
Prolotherapy is one of most talked-about procedures for back pain. Prolotherapy is a treatment in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (the tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain. However, studies have not verified the effectiveness of prolotherapy, and only chiropractors and physicians primarily use this procedure.
When back pain becomes chronic, or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. While such therapies won't cure diseases or repair the injuries that cause pain, some people find these therapies to be useful for managing or relieving pain. Complementary therapies include:
Manipulation
Transcutaneous electrical nerve stimulation (TENS)
Acupuncture
Acupressure
Rolfing
Cognitive behavioral therapy
Progressive relaxation
Manipulation
Spinal manipulation refers to procedures in which professionals use their hands to mobilize, adjust, massage, or stimulate the spine or surrounding tissues. Osteopathic doctors and chiropractors usually perform this type of therapy, and it tends to be most effective in people with uncomplicated pain and when used with other therapies. Spinal manipulation is not appropriate if you have a medical problem such as osteoporosis, spinal cord compression, or inflammatory arthritis (such as rheumatoid arthritis), or if you are taking blood-thinning medications such as warfarin (Coumadin) or heparin (Calciparine or Liquaemin).
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) involves wearing a small box over the painful area that directs mild electrical impulses to the nerves. The theory behind TENS is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested it could elevate the levels of endorphins (the body's natural pain-numbing chemicals) in the spinal fluid. However, subsequent studies of its effectiveness against pain have produced mixed results.
Acupuncture
Some people with low back pain report that acupuncture helps relieve their symptoms. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts sterilized stainless steel needles into the skin at specific points on the body.
A consensus panel convened by the National Institutes of Health (NIH) in 1997 concluded that there is clear evidence that this treatment is effective for some pain conditions, including postoperative dental pain. Although there is less convincing evidence to support using acupuncture for back pain and other pain conditions, the panel concluded that acupuncture may be effective when used as part of a comprehensive treatment plan for low back pain, fibromyalgia, and several other conditions.
Acupressure
The difference between acupuncture and acupressure is that no needles are used in acupressure. Instead, a therapist applies pressure to points along the channels with his or her hands, elbows, or even feet. In some cases, patients are taught to do their own acupressure. However, it is important to note that acupressure has not been well studied as a treatment for back pain.
Rolfing
Rolfing is a type of massage that involves using strong pressure on deep tissues in the back to relieve tightness of the fascia, a sheath of tissue that covers the muscles, which can cause or contribute to back pain. The theory behind rolfing is that releasing muscles and tissues from the fascia enables the back to properly align itself. So far, the usefulness of rolfing as a back pain treatment has not been scientifically proven.
Cognitive Behavioral Therapy
Chronic back pain is commonly associated with emotional stress and mental health conditions, such as depression. In cognitive behavioral therapy, you learn to identify and change negative thought patterns that have a damaging impact on your mental and physical health. Research has found that this type of therapy may significantly relieve chronic low back pain.
Progressive Relaxation
This relaxation technique involves systematically tensing and relaxing different muscle groups in your body. Progressive muscle relaxation boosts your ability to recognize and counteract muscle tension as soon as it starts. Evidence suggests this technique helps ease back pain.
If non-surgical back pain treatment has failed, back surgery may be an option.
Few
people ever need surgery for back pain. If you have unrelenting pain
associated with radiating leg pain or progressive muscle weakness
caused by nerve compression, you may benefit from surgical
intervention. Otherwise, surgery usually is reserved for pain related
to structural anatomical problems that haven't responded to intensive
conservative therapy measures.
Types of back surgery include:
Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.
Partial removal of disk. If disk material is pressing or squeezing a nerve, your doctor may be able to remove just the portion of the disk that's causing the problem.
Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage.