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Back pain is one of the most common painful and non-life-threatening conditions. It affects four in five Americans at some point in their lives. The good news is that back pain need not govern how you live your life.
If you have back pain, medication, exercise, and changes in your lifestyle are likely to offer the most relief. Surgery is useful in a minority of people
Other self-care steps you can take to mend your back include different types of exercise and complementary therapies such as chiropractic care, acupuncture, and massage, as well as choosing the right mattress.
When a person says I have back pain, we usually interpret that to mean low back pain. For good reason, the pain and tightness most often hit the lower part of the back.
Back pain can be a symptom of many different illnesses and conditions.The main cause of the pain can be a problem with the back itself or by a problem in another part of the body. In many cases, doctors can't find a cause for the pain. When a cause is found, common explanations include:
Rarer causes include:
Back pain varies widely. Some symptoms (often called “red flag” symptoms) may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer and neurological symptoms, such as numbness, weakness or incontinence (involuntary loss of urine or stool). If any of these symptoms occur, contact your doctor immediately.
Back pain is often accompanied by other symptoms that may help point to its cause. For example:
Your doctor will ask about your symptoms and your medical history. He or she will examine your back muscles and spine and will move you certain ways to check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg.
Your symptoms and the physical examination may give your doctor enough information to diagnose the problem. However, with back pain, your doctor may only be able to tell you that the problem is not serious. If your doctor determines that your back pain is caused by muscle strain, obesity, pregnancy or another cause that is not urgent, you may not need any additional tests. However, if he or she suspects a more serious problem involving your vertebrae or spinal nerves, especially if your back pain has lasted longer than 12 weeks, you may need one or more of the following tests:
How long back pain lasts depends on its cause. For example, if your pain is caused by strain from overexertion, symptoms usually subside over days or weeks and you may be able to return gradually to your normal activities. However, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back gets better.
Women who have back pain caused by the added weight of pregnancy almost always will get better after delivery. People who are obese may need to lose weight before back pain eases.
People with back pain caused by pyelonephritis often begin to feel better within days after they start taking antibiotics, although they usually need to continue taking antibiotics for up to two weeks.
People with more serious forms of back pain caused by problems with the vertebrae or spinal nerves may have more persistent back pain that lasts for months and may last for years.
You can help prevent some forms of back pain by strengthening your back with exercises and by avoiding activities that lead to back injury.
Movement is the best way to ward off back pain. Regular physical activity can make the back stronger to reduce future episodes of pain. Exercises should focus on increasing strength and improving range of motion — as well as ensuring balance on both sides of the body, as some back pain can start when one side of the body is stronger than the other.
In addition, whenever possible, avoid prolonged sitting. If you sit at a desk in the office all day, get up periodically — at least every 30 minutes — and walk around. Walk to get a drink of water or to pick up your mail. Take breaks throughout the course of the day to prevent future bouts of pain.
Other measures that may help prevent back pain include:
To help prevent osteoporosis, make sure you get enough calcium and vitamin D daily to meet the dietary requirements for your age group. Follow a routine program of weight-bearing exercise. Avoid smoking and limit the amount of alcohol you drink. If you are a woman who has entered menopause, speak with your doctor about testing for osteoporosis and medications that can help to prevent or reverse it.
Medications tend to have only temporary and modest benefits, so it makes sense to try something other than a pill for back pain relief. The specifics depend on the type and duration of back pain.
For new low back pain relief (lasting less than 12 weeks), try:
If these don’t work, an NSAID such as ibuprofen or naproxen or a muscle relaxant are reasonable options. But given their potential to cause side effects and their modest benefit, they aren’t the first choice.
For chronic low back pain relief (lasting 12 weeks or more), try:
Other approaches, such as tai chi, yoga, or progressive relaxation techniques may also be helpful.
If these don’t work, treatment with an NSAID or duloxetine is worth consideration. However, opioids should be avoided for chronic low back pain in most cases.
It’s important to emphasize these suggestions are for low back pain that might begin after an unusually strenuous workout or shoveling snow. It’s not for serious causes of back pain such as a major injury, cancer, infection, or fractures.
The decision to consider back surgery should always come after trying nonsurgical or "conservative" options. There are exceptions. For example, if a person has back pain and progressive weakening in one or both legs or loses control of bladder or bowel function, prompt surgical intervention may be necessary.
Most often acute back pain will resolve after 6 to 8 weeks. So, it’s usually best to be patient and give nonsurgical options time to work. Even if the discomfort persists, surgery is most likely to be successful when the person’s pain clearly correlates to abnormal findings on an imaging test like an MRI.
However, imaging tests often show abnormal changes that have nothing to do with the pain. That’s when surgery is unlikely to help and perhaps offers no relief, as well as risking complications.
When conservative measures have not provided sufficient pain relief for a herniated disc causing persistent sciatica or spinal stenosis, you and your doctor might consider surgery. The procedures back surgeons perform most often are discectomy and laminectomy.
In a discectomy, the surgeon removes part of a herniated disc, which occurs when a disc ruptures and its jelly-like center leaks, irritating nearby nerves.
Back surgeons perform laminectomy for spinal stenosis (narrowing of spaces in the spine), causing pressure on a nerve going into the legs. The surgeon removes the bony plate (lamina) on the back of the vertebra where the stenosis is located. This opens up more space for the spinal nerves. Laminectomy can be performed through a tiny incision and guided by video from a miniature camera.
Sometimes there is so much narrowing that a simple laminectomy won’t do the job. In such cases, a laminectomy with spinal fusion may be needed. In addition to removing one or more bony plates, the surgeon removes discs and other tissues, and then stabilizes the spine with cement or hardware.
Laminectomy alone is usually just as effective as spinal fusion, and so is the preferred option when possible to help relieve lower back pain.
A bird flu primer: What to know and do
New urine test may help some men with elevated PSA avoid biopsy
Dupuytren’s contracture of the hand
Why play? Early games build bonds and brain
Moving from couch to 5K
How — and why — to fit more fiber and fermented food into your meals
Tick season is expanding: Protect yourself against Lyme disease
What? Another medical form to fill out?
How do trees and green spaces enhance our health?
A muscle-building obsession in boys: What to know and do
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