Back pain
Back pain — Comprehensive overview covers causes, treatment, relief for this potentially disabling condition.
Definition
Back
pain is a common complaint. Four out of five people in the United
States will experience low back pain at least once during their lives.
It’s one of the most common reasons people go to the doctor or miss
work.
On the bright side, you can prevent most back pain. If
prevention fails, simple home treatment and proper body mechanics will
often heal your back within a few weeks and keep it functional for the
long haul. Surgery is rarely needed to treat back pain.
Causes
Your
back is an intricate structure composed of bones, muscles, ligaments,
tendons and disks — 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.
StrainsBack pain most often occurs
from strained muscles and ligaments, from improper or heavy lifting, or
after a sudden awkward movement. Sometimes a muscle spasm can cause
back pain.
Structural problemsIn 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 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 conditionsIn 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.
Risk factors
Factors that increase your risk of developing low back pain include:
Smoking
Obesity
Older age
Female gender
Physically strenuous work
Sedentary work
Stressful job
Anxiety
Depression
When to seek medical advice
Most
back pain gradually improves with home treatment and self-care.
Although the pain may take several weeks to disappear completely, you
should notice some improvement within the first 72 hours of self-care.
If not, see your doctor.
In rare cases, back pain can signal a serious medical problem. See a doctor immediately if your back pain:
Is constant or intense, especially at night or when you lie down
Spreads down one or both legs, especially if the pain extends below the knee
Causes weakness, numbness or tingling in one or both legs
Causes new bowel or bladder problems
Is associated with pain or pulsation (throbbing) in the abdomen, or fever
Follows a fall, blow to your back or other injury
Is accompanied by unexplained weight loss
Also,
see your doctor if you start having back pain for the first time after
age 50, or if you have a history of cancer, osteoporosis, steroid use,
or drug or alcohol abuse.
Tests and diagnosis
Diagnostic tests
aren’t usually necessary to confirm the cause of your back pain.
However, if you do see your doctor for back pain, he or she will
examine your back and assess your ability to sit, stand, walk and lift
your legs. He or she may also test your reflexes with a rubber reflex
hammer. These assessments help determine where the pain comes from, how
much you can move before pain forces you to stop and whether you have
muscle spasms. They will also help rule out more serious causes of back
pain.
If there is reason to suspect that you have a tumor, fracture,
infection or other specific condition that may be causing your back
pain, your doctor may order one or more tests:
X-ray. These images
show the alignment of your bones and whether you have arthritis or
broken bones. X-ray images won’t directly show problems with your
spinal cord, muscles, nerves or disks.
Magnetic resonance imaging
(MRI) or computerized tomography (CT) scans. These scans can generate
images that may reveal herniated disks or problems with bones, muscles,
tissue, tendons, nerves, ligaments and blood vessels.
Bone scan. In
rare cases, your doctor may use a bone scan to look for bone tumors or
compression fractures caused by osteoporosis. In this procedure, you’ll
receive an injection of a small amount of a radioactive substance
(tracer) into one of your veins. The substance collects in your bones
and allows your doctor to detect bone problems using a special camera.
Nerve
studies (electromyography, or EMG). This test measures the electrical
impulses produced by the nerves and the responses of your muscles.
Studies of your nerve-conduction pathways can confirm nerve compression
caused by herniated disks or narrowing of your spinal canal (spinal
stenosis).
Treatments and drugs
Most back pain gets better with a
few weeks of home treatment and careful attention. A regular schedule
of over-the-counter pain relievers may be all that you need to improve
your pain. A short period of bed rest is okay, but more than a couple
of days actually does more harm than good. If home treatments aren’t
working, your doctor may suggest stronger medications or other therapy.
MedicationsYour
doctor may prescribe nonsteroidal anti-inflammatory drugs or in some
cases, a muscle relaxant, to relieve mild to moderate back pain that
doesn’t get better with over-the-counter pain relievers. Narcotics,
such as codeine or hydrocodone, may be used for a short period of time
with close supervision by your doctor.
Low doses of certain types of
antidepressants — particularly tricyclic antidepressants, such as
amitriptyline — have been shown to relieve chronic back pain,
independent of their effect on depression.
Physical therapy and
exerciseA physical therapist can apply a variety of treatments, such as
heat, ice, ultrasound, electrical stimulation and muscle-release
techniques, to your back muscles and soft tissues to reduce pain. As
pain improves, the therapist can teach you specific exercises to
increase your flexibility, strengthen your back and abdominal muscles,
and improve your posture. Regular use of these techniques will help
prevent pain from coming back.
InjectionsIf other measures don’t
relieve your pain and if your pain radiates down your leg, your doctor
may inject cortisone — an anti-inflammatory medication — into the space
around your spinal cord (epidural space). A cortisone injection helps
decrease inflammation around the nerve roots, but the pain relief
usually lasts less than six weeks.
In some cases, your doctor may
inject numbing medication into or near the structures believed to be
causing your back pain. Early studies indicate that botulism toxin
(Botox) also may help relieve back pain, perhaps by paralyzing strained
muscles in spasm. Botox injections typically wear off within three to
four months.
SurgeryFew people ever need surgery for back pain.
There are no effective surgical techniques for muscle- and
soft-tissue-related back pain. Surgery is usually reserved for pain
caused by a herniated disk. If you have unrelenting pain or progressive
muscle weakness caused by nerve compression, you may benefit from
surgery. 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.
Disk replacement. An alternative to fusion,
this surgery inserts an artificial disk as a replacement cushion
between two 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.
Prevention
You may be able to avoid back pain by improving your physical condition and learning and practicing proper body mechanics.
To keep your back healthy and strong:
Exercise.
Regular low-impact aerobic activities — those that don’t strain or jolt
your back — can increase strength and endurance in your back and allow
your muscles to function better. Walking and swimming are good choices.
Talk with your doctor about which activities are best for you.
Build
muscle strength and flexibility. Abdominal and back muscle exercises
(core-strengthening exercises) help condition these muscles so that
they work together like a natural corset for your back. Flexibility in
your hips and upper legs aligns your pelvic bones to improve how your
back feels.
Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
Maintain
a healthy weight. Being overweight puts strain on your back muscles. If
you’re overweight, trimming down can prevent back pain.
Use proper body mechanics:
Stand
smart. Maintain a neutral pelvic position. If you must stand for long
periods of time, alternate placing your feet on a low footstool to take
some of the load off your lower back.
Sit smart. Choose a seat with
good lower back support, arm rests and a swivel base. Consider placing
a pillow or rolled towel in the small of your back to maintain its
normal curve. Keep your knees and hips level.
Lift smart. Let your
legs do the work. Move straight up and down. Keep your back straight
and bend only at the knees. Hold the load close to your body. Avoid
lifting and twisting simultaneously. Find a lifting partner if the
object is heavy or awkward.
Alternative medicine
Many people choose hands-on therapies to ease their back pain:
Chiropractic
care. Back pain is one of the most common reasons that people see a
chiropractor. If you’re considering chiropractic care, talk to your
doctor about the most appropriate specialist for your type of problem.
In addition to chiropractors, many osteopathic doctors and some
physical therapists have training in spinal manipulation.
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.
Massage.
If your back pain is caused by tense or overworked muscles, massage
therapy may help loosen knotted muscles and promote relaxation.

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