Back pain

Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide.

Fortunately, you can take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional. Surgery is rarely needed to treat back pain.

Symptoms

Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking.

When to see a doctor

Most back pain gradually improves with home treatment and self-care, usually within a few weeks. Contact your doctor if your back pain:

• Persists past a few weeks
• Is severe and doesn't improve with rest
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness or tingling in one or both legs
• Is accompanied by unexplained weight loss

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

• Causes new bowel or bladder problems
• Is accompanied by a fever
• Follows a fall, blow to your back or other injury

Causes

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:

• Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you're in poor physical condition, constant strain on your back can cause painful muscle spasms.
• Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
• Arthritis. Osteoarthritis can affect the 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.
• Osteoporosis. Your spine's vertebrae can develop painful fractures if your bones become porous and brittle.

Risk factors

Anyone can develop back pain, even children and teens. These factors might put you at greater risk of developing back pain:

• Age. Back pain is more common as you get older, starting around age 30 or 40.
• Lack of exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
• Excess weight. Excess body weight puts extra stress on your back.
• Diseases. Some types of arthritis and cancer can contribute to back pain.
• Improper lifting. Using your back instead of your legs can lead to back pain.
• Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
• Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.

Prevention

You might avoid back pain or prevent its recurrence 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 you might try.
• Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
• Maintain a healthy weight. Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.
• Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

Avoid movements that twist or strain your back. Use your body properly:

• Stand smart. Don't slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
• Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
• Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Buyer beware

Because back pain is so common, numerous products promise prevention or relief. But there's no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs can help.

In addition, there doesn't appear to be one type of mattress that's best for people with back pain. It's probably a matter of what feels most comfortable to you.

Diagnosis

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. Your doctor might also ask you to rate your pain on a scale of zero to 10 and talk to you about how well you're functioning with your pain.

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 can also help rule out more-serious causes of back pain.

If there is reason to suspect that a specific condition is causing your back pain, your doctor might order one or more tests:

• X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won't show problems with your spinal cord, muscles, nerves or disks.
• MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
• Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
• Bone scan. In rare cases, your doctor might use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
• Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment

Most back pain gets better within a month of home treatment. However, everyone is different, and back pain is a complex condition. For many, the pain doesn't go away for a few months, but only a few have persistent, severe pain.

Over-the-counter pain relievers and the use of heat might be all you need. Bed rest isn't recommended.

Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don't avoid activity out of fear of pain. If home treatments aren't working after several weeks, your doctor might suggest stronger medications or other therapies.

Medications

Depending on the type of back pain you have, your doctor might recommend the following:

• Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), may help relieve back pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects. If OTC pain relievers don't relieve your pain, your doctor might suggest prescription NSAIDs.
• Muscle relaxants. If mild to moderate back pain doesn't improve with OTC pain relievers, your doctor might also prescribe a muscle relaxant. Muscle relaxants can make you dizzy and sleepy.
• Topical pain relievers. These products deliver pain relieving substances through your skin via creams, salves, ointments or patches.
• Narcotics. Drugs containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don't work well for chronic pain, so your prescription will usually provide less than a week's worth of pills.
• Antidepressants. Some types of antidepressants — particularly duloxetine (Cymbalta) and tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain independent of their effect on depression.

Physical therapy

A physical therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help keep pain from returning. Physical therapists will also provide education about how to modify your movements during an episode of back pain to avoid flaring pain symptoms while continuing to be active.

Surgical and other procedures

Procedures used to treat back pain may include:

• Cortisone injections. If other measures don't relieve your pain, and if your pain radiates down your leg, your doctor may inject cortisone — a strong anti-inflammatory drug — plus a numbing 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 only a month or two.
• Radiofrequency neurotomy. In this procedure, a fine needle is inserted through your skin so the tip is near the area causing your pain. Radio waves are passed through the needle to damage the nearby nerves, which interferes with the delivery of pain signals to the brain.
• Implanted nerve stimulators. Devices implanted under your skin can deliver electrical impulses to certain nerves to block pain signals.
• Surgery. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. These procedures are usually reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn't responded to other therapy.

Alternative medicine

A number of alternative treatments might ease symptoms of back pain. Always discuss the benefits and risks with your doctor before starting a new alternative therapy.

• Chiropractic care. A chiropractor manipulates your spine to ease your pain.
• Acupuncture. A practitioner of acupuncture inserts thin sterilized needles into the skin at specific points on the body. A growing body of scientific evidence indicates acupuncture can be helpful in treating back pain.
• Transcutaneous electrical nerve stimulation (TENS). A battery-powered device placed on the skin delivers electrical impulses to the painful area. Studies have shown mixed results as to TENS' effectiveness.
• Massage. If your back pain is caused by tense or overworked muscles, massage might help.
• Yoga. There are several types of yoga, a broad discipline that involves practicing specific postures or poses, breathing exercises, and relaxation techniques. Yoga can stretch and strengthen muscles and improve posture, although you might need to modify some poses if they aggravate your symptoms.

Preparing for an appointment

If your back pain persists despite home treatment, see your doctor. Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Key personal information, including mental or emotional stressors in your life
• Your symptoms, and when they began
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you receive.

For back pain, questions to ask your doctor include:

• What is the most likely cause of my back pain?
• Do I need diagnostic tests?
• What treatment approach do you recommend?
• If you're recommending medications, what are the possible side effects?
• I have other medical conditions. How can I best manage them together?
• How long will I need treatment?
• What self-care measures should I try?
• What can I do to prevent a recurrence of back pain?

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• When did your back pain begin?
• Have you ever injured your back?
• Is the pain constant?
• Does the pain affect your ability to function? If so, how much?
• Do you have other signs or symptoms besides back pain?
• Do you do heavy physical work?
• Do you exercise regularly? What types of activities do you do?
• How often do you feel depressed or anxious?
• Do you sleep well?
• What treatments or self-care measures have you tried so far? Has anything helped?

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