Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
Treatment Options For Acute Lower Back Pain
Most low back pain is due to muscle strain and spasm and does not require surgery. To treat the pain, medications such as acetaminophen , nonsteroidal anti-inflammatory agents , gabapentin or pregabalin can be used. NSAIDs suppress inflammation, pain and fever by inhibiting certain inflammation-causing chemicals in the body. Acetaminophen reduces pain and fever, but does not inhibit inflammation. Gabapentin and pregabalin, medications that have been used for antiseizure activity, also have the ability to block pain. Opioids provide pain relief and may at times be prescribed to manage severe back pain. However, opioids have many problems, such as habituation, constipation and lightheadedness, and are avoided when possible and used for the shortest possible duration. Epidural injection is an option if the back pain does not respond to these treatments. Each person is different in terms of response to medication.
Other nonsurgical treatments for lower back pain include Intradiscal electrothermal therapy , nucleoplasty, and radiofrequency lesioning.
First A Few Quick Tips
Stretch your lower back with safety and care. Be especially gentle and cautious if you have any type of injury or health concern. Its best to talk with your doctor first before starting any new types of exercise.
You can do these stretches once or twice a day. But if the pain seems to get worse, or youre feeling very sore, take a day off from stretching.
Be mindful of your bodys limits and dont push your body to do too much. Listen to your body and do what feels best for you in each moment.
As you go through these stretches, take your time and pay close attention to your breathing. Use your breath as a guide to make sure you dont strain or overdo it. You should be able to breathe comfortably and smoothly throughout each pose or stretch.
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When Is Not Helpful
Back pain is one of the most common reasons why people visit a health care provider. The good news is that the pain often goes away on its own, and people usually recover in a week or two. Many people want to stay in bed when their back hurts. For many years, getting bed rest was the normal advice. But current studies recommend no bed rest at all and stress that staying in bed longer than 48 hours not only wont help but it may, in fact, actually delay your recovery. Heres why:
Staying in bed wont help you get better faster.If youre in terrible pain, lying down for a day to help ease the distress may seem like a good idea, but moderating your activities and staying active in a limited way is a more effective way to control your symptoms. Research suggests that if you can find comfortable positions and keep moving, you may not need bed rest at all.Research shows that:
- Lying down longer than a day or two day isnt helpful for relieving back pain.
- People can recover more quickly without any bed rest.
- The sooner you start moving, even a little bit, or return to activities such as walking, the faster you are likely to improve.
Types Of Lower Back Pain
There are two primary types of lower back pain: acute and chronic.
- Acute lower back pain is short-term, lasting for just a few days up to a few weeks. It is often connected to an identifiable event or injury. When acute back pain fades, there is no ongoing effect on mobility.
- Chronic lower back pain goes on for three months or longer. In many cases, it occurs without a clear link to an initial injury.
Lower back pain that starts as acute may become chronic. It is estimated that around 20% of cases of acute low back pain persist and become chronic.
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Why Is Lower Back Pain Such A Common Problem
The bottom part of your back typically has just five vertebrae fewer than your neck and mid-back. And these vertebrae do a lot of heavy lifting! Your lower back is where your spine connects to your pelvis, bearing the weight of your upper body. This area experiences a lot of movement and stress, which may lead to wear, tear and injuries.
Who Should I See For Lower Back Pain
Your primary care physician knows you best and should be your first contact for lower back pain. If he or she is unable to diagnose or treat the issue, you may get referred to a specialist, such as a rehabilitation physician . These specialists practice a comprehensive approach to lower back pain, and can diagnose and treat a variety of conditions that have lower back pain as a symptom.
Later, you may get referred to a physical therapist, a chiropractor or another practitioner depending on the nature of your back pain. The good news is that surgery is rarely needed for lower back pain. Only about one in ten patients needs lower back surgery, Chhatre says.
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Look Into Getting A New Mattress
How old is your bed? You may be surprised to learn that the average life span of a mattress is less than 10 years. Theres no hard-and-fast rule, says Sean Mackey, MD, PhD, chief of the division of pain medicine at Stanford University, but if your mattress is sagging significantly or is more than six to eight years old, Id think about getting a new one.
Something else to consider: A firm mattress may not do your back any favors, says Carmen R. Green, MD, a physician at the University of Michigan Back & Pain Center. A number of studies over the years suggest that people with lower back pain who sleep on medium-firm mattresses do better than those with firm beds, she says.
Inflammatory Lower Back Pain
Although comparatively few patients have low back pain due to a systemic inflammatory condition, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.
Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications
People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. Its important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.
syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:
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Looking At Two Kinds Of Back Pain
Lets talk about the most common forms of back pain: acute and subacute . Most of these cases are due to harmless causes. We lump them into the mechanical back pain diagnosis, which includes muscle spasm, ligament strain, and arthritis. A handful will be due to potentially more serious causes such as herniated discs , spondylolisthesis , a compression fracture of the vertebra due to osteoporosis , or spinal stenosis . Rarely, less than 1% of the time, we will see pain due to inflammation , cancer , or infection.
When someone with acute low back pain comes into the office, my main job is to rule out one of these potentially more serious conditions through my interview and exam. It is only when we suspect a cause other than mechanical that we will then order imaging or labs, and then things can go in a different direction.
But most of the time, were dealing with a relatively benign and yet really painful, disabling, and expensive condition. How do we treat this? The sheer number of treatments is dizzying, but truly effective treatment options are few.
Lower Back Pain Causes
Nonspecific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be an over-stretch of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two spinal bones , or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.
To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is nonspecific back pain which means there is no serious problem or disease of the back or spine.
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Does A Lumbar Bulging Disc Heal On Its Own
If you ask almost any doctor, hell probably tell you that theres no easy fix for a bulging disc and that most people feel a significant improvement after about 6 weeks.
However, this prognosis is assessed if you are using conventional treatments, which include pain medication, spinal injections, and maybe physical therapy.
Most conventional treatments usually just mask the symptoms, instead of treating the root cause.
In my experience, natural treatments such as infrared therapy and spinal decompression do a better job of healing the bulging disc, instead of just hiding the pain.
Therefore, natural treatment may bring faster and more effective results, and can prevent future problems, such a herniated disc.
Note: as with any injury, pain, or ache consult your doctor before beginning any treatment or therapy.
To your health and happiness,
Release Your Inner Endorphins
Endorphins are hormones made naturally in your body. What many people dont know is that endorphins may help block pain signals from registering in your brain. Endorphins also help alleviate anxiety, stress, and depression, which are all associated with chronic back pain and often make the pain worse.
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When Is Surgery A Good Idea For Back Pain
These red flags can be indicators for surgery, if theyre found to berelated to your spine condition:
- New or progressing bowel/bladder issues
- Weakness in limbs
- Gait and balance problems
- Evidence of increased reflexes
Surgery can also be an option for chronic back pain if there is a knowncause confirmed by imaging and if other treatments didnt help. Getopinions from at least two surgeons, suggests Nava, as pain can stillcome back after the surgery.
Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
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How Is Lower Back Pain Diagnosed
Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.
Your provider may order:
- Spine X-ray, which uses radiation to produce images of bones.
- MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
- CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain . Urine tests check for kidney stones, which cause pain in the flank .
What Does It Mean If Lower Back Pain Is Shooting Into Legs
Lower back pain can radiate to other parts of the body: up or down from its place of origin. Sometimes lower back pain can be on one side of the back, which is also normal.
If the pain is shooting from the lower back into one or both legs, it could be sciatica , but its not always the case. There are many parts in the lower back that may cause the pain to radiate into the legs, such as facet joints, sacroiliac joints, muscles or inflammation of the bursa.
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Lower Back Pain Caused By Infection
Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.
Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- Discectomy, such as a or removal of a portion of a
- a bone graft that promotes the vertebrae to fuse together
- removal of the lamina to create more space and reduce irritation and inflammation
References and useful links
- 1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
- Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.
- Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.
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Conservative Treatments For Lower Back Pain
Conservative treatment is basically alleviation of lower back pain without any surgical means. Conservative treatments for lower back pain include the following:
- Physical therapy for lower back pain is a type of treatment is administered to strengthen your back muscles. This therapy ranges from water therapies to more specialized massage techniques.
- Medications for lower back pain is the most effective way of reducing inflammation, controlling pain and calming of muscle spasms.
- Injections are whereby the lumbar epidural steroid Injections are administered to help in strengthening of the back to reduce pain. A set of two to three injections will be administered into the Lumbar Spine.