The Worst Back Pain Is Rarely The Scariest
People understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain ominousness,10 and some of the worst causes are actually the least painful . For instance, someone could experience the symptoms of cauda equinae syndrome, and be in real danger of a serious and permanent injury to their spine, but have surprisingly little pain even none at all in some cases!
Meanwhile, many non-dangerous problems can cause amazingly severe back pain. A muscle cramp is a good analogy just think about how painful a Charley horse is! Regardless of whats actually going on in there, muscle pain is probably the main thing that back pain patients are feeling. The phenomenon of trigger points tiny muscle cramps, basically11 could be the entire problem, or a complication thats more painful and persistent than the original problem. Its hard to overstate how painful trigger points can be, but they are not dangerous to anything but your comfort.
How Is Low Back Pain Diagnosed
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Tests include:
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
Ix Referred Pain To The Lumbar Spine
Pain in the area of the lumbar spine may be due to important problems that are actually unrelated to the back.Referred pain occurs when a problem in one place in the body causes pain in another place. The pain travels down a nerve. For example, a pinched nerve in the neck may cause pain that is felt in the arm or hand. Sources of referred pain may include abdominal aneurysm , tubal pregnancy, kidney stones, pancreatitis, and colon cancer. Clues to these maladies include pain that waxes and wanes over a short period, with frequent peaks of intense pain, weight loss, abnormalities found during abdominal exam, and trace amounts of blood in the urine.
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How Is It Treated
Most low back pain will improve with basic first aid, which includes continuing to do light activity such as walking, and taking over-the-counter pain medicine as needed.
Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong.
Your doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called . Strengthening the muscles in your can improve your posture, keep your body in better balance, and lower your chance of injury.
If your symptoms are severe or you still have symptoms after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from .
Each of the various treatments for back pain work for some people but not for others. You may need to try different things to see which work best for you, such as:
- Spinal manipulation.
- Massage.
- Acupuncture.
Having ongoing back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both antidepressant medicines and counseling. Counseling can help you learn stress management and pain control skills.
Arthritis Of The Spine
Arthritis of the spine the slow degeneration of the spinal joints is the most frequent cause of lower back pain. All of us experience wear and tear as we age, and it is normal for your lower back to start acting up as you get older. As the cartilage breaks down between the spinal joints, surrounding tissues may become inflamed. The inflammation and the thinning of cartilage increase friction in the joints, which may cause pain in the lower back.
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Medicines For Back Pain
Acute back pain often goes away on its own over several weeks. In some people, back pain persists. It may not go away completely or it may get more painful at times.
Medicines can also help with your back pain.
OVER-THE-COUNTER PAIN RELIEVERS
Over-the-counter means you can buy them without a prescription.
Most health care providers recommend acetaminophen first because it has fewer side effects than other drugs. Do not take more than 3 grams on any one day, or over 24 hours. Overdosing on acetaminophen can cause severe damage to your liver. If you already have liver disease, ask your doctor if acetaminophen is OK for you to take.
If your pain continues, your provider may suggest nonsteroidal anti-inflammatory drugs . You can buy some NSAIDs, such as ibuprofen and naproxen, without a prescription. NSAIDs help reduce the swelling around the swollen disk or arthritis in the back.
NSAIDs and acetaminophen in high doses, or if taken for a long time, can cause serious side effects. Side effects include stomach pain, ulcers or bleeding, and kidney or liver damage. If side effects occur, stop taking the drug right away and tell your provider.
If you are taking pain relievers for more than a week, tell your provider. You may need to be watched for side effects.
NARCOTIC PAIN RELIEVERS
Examples of narcotics include:
- Fentanyl — available as a patch
- Hydrocodone
Possible side effects of these drugs include:
- Drowsiness
Xv Useful Links And References
, Hospital for Special Surgery, Hector Lozada, PT, DPT, OCS, Robert Turner, PT, OCS, MS, Theodore R. Fields, MD, FACP, January 19, 2017.
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.
1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
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What Is The Outlook
Most of us will have a bout of nonspecific low back pain at some point in our lives. The severity can vary. However, it is difficult to quote exact figures as to outlook . This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:
- Most nonspecific back pains ease and go quickly, usually within a few weeks.
- In about 4 in 10 cases, the pain has completely gone within four weeks.
- In about 7 in 10 cases the pain has completely gone within one year.
However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.
When Surgery Is Necessary
When conservative treatment for low back pain does not provide relief or neurologic symptoms are worsening or severe, surgery may be needed. Candidates for surgery present any of the following:
- Reasonably good health
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurologic deficits develop, such as leg weakness, numbness or both
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If several nerve roots and discs are causing the pain or if degeneration and instability exist in the spinal column, the neurosurgeon may choose: a minimally invasive approach a more open decompression or fusing the vertebrae together with bone grafts and stabilizing them with instrumentation, including metal plates, screws, rods and cages, depending on the extent of disease. After such surgery, patients may gain restored mobility in the back, including the ability to bend over. In addition, patients may require postoperative physical therapy.
The benefits of surgery should always be weighed carefully against the risks. Although a large percentage of patients with low back pain report significant pain relief after surgery, it is not guaranteed that surgery will help.
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What Is A Back And Spine Pain Doctor Called
The decision to seek treatment for your chronic lower back pain will alleviate the stiffness, soreness, and lack of mobility that affects your daily life. At Pain Treatment Specialists, a back and spine pain doctor is called an interventional pain specialist. Our team works with patients to explore minimally-invasive, yet highly effective cutting-edge treatments designed to avoid surgery and return them to the activities they love.
Where To Start With Back Pain
Low back pain is one of the most common complaints on the planet.
And when someone starts experiencing back pain it can be so frightening that we immediately want an expert that will somehow magically get rid of it.
Unfortunately, there’s just no unicorns and rainbows when it comes to solving back pain.
Realize that most back pain will resolve on its own. What I’m saying here is that your major ache or tweaked out back doesn’t require a specialist in most cases.
Some of the most common causes of acute or sudden back pain include an injury:
- to a muscle or tendon
- to a back ligament
- to a bulging disc .
And the reality is, many of these issues will eventually resolve on their own.
In my personal opinion, the first time someone starts to experience back pain, they should immediately start doing back extension exercises.
I would continue to do back extensions every 3-4 hours throughout the day for at least 3 days.
And if you notice that you’re feeling better, continue for another 1-2 weeks.
But if your low back pain doesn’t improve, then maybe there is something more serious happening.
More serious causes of back pain include:
- a narrowing of the spinal canal
- disc tears or herniations
- severe degenerative disc disease
- spinal infections
So if your back pain doesn’t improve with back extensions and modified activities, then you’d want to consider someone who is qualified to properly assess the situation.
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What Else Do I Need To Know
Braces are a relatively low-risk treatment method for several musculoskeletal conditions. They can provide short-term back pain relief, lumbar support, posture improvement, and muscle spasm relief, and can help alleviate lower back pain. Your doctor may offer medical advice such as pairing back brace usage with physical therapy, considering orthosis for other parts of your body, or specific exercises to strengthen your back muscles.
Summary
If you choose to use a back brace, take care to find the best fit, design, and style for your needs. Keep in mind that overuse of your brace can lead to muscle weakness, which could ultimately compound your pain, so be sure to use the brace as directed by your healthcare provider.
When Should I See My Healthcare Provider About Lower Back Pain
Lower back pain usually gets better with rest and pain relievers. Back pain that doesnt go away may be a sign of a more serious condition.
See your provider if you have:
- Pain that doesnt get better after about a week of at-home care.
- Tingling, numbness, weakness or pain in your buttocks or legs.
- Severe pain or muscle spasms that interfere with your normal activities.
- Fever, weight loss, bowel or bladder problems or other unexplained symptoms.
A note from Cleveland Clinic
Millions of people live with low back pain. Stiffness, pain and limited movement can have a major impact on quality of life. But you may be able to avoid lower back pain by maintaining a healthy weight and staying active. Talk to your provider if back pain doesnt go away or if youre unable to do the activities you enjoy. Several treatments can relieve pain, help you move better and get more out of life.
Last reviewed by a Cleveland Clinic medical professional on 01/18/2021.
References
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How Can You Prevent Low Back Pain From Returning
After you’ve had low back pain, you’re likely to have it again. But there are some things you can do to help prevent it. And they can help you get better faster if you do have low back pain again.
To help keep your back healthy and avoid further pain:
- Practice good posture when you sit, stand, and walk. “Good posture” generally means your ears, shoulders, and hips are in a straight line.
- Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
- Sleep on your side.
- Watch your weight.
- Don’t try to lift things that are too heavy for you. When you must lift, learn .
If you sit or stand for long periods at work:
- Sit or stand up straight, with your shoulders back.
- Make sure your chair fits you and has good back support.
- Take regular breaks to walk around.
If your work involves a lot of bending, reaching, or lifting:
- Talk to your human resources department to see if there are other ways you can do your work.
- Don’t depend on a “back belt” to protect your back.
Lower Back Pain: Medical Assistance From A Doctor Specialist
Doctor of Osteopathic Medicine: This doctor specialist for lower back pain concentrates on the neuro-musculoskeletal system. . If your primary care physician has requested that you visit them, they will first of all work on an accurate diagnosis of the problem before recommending any medical care. Treatments often involve osteopathic manipulative therapy. Diagnosis and treatment go hand in hand.
Physical Therapist: Often back pain is caused by a muscle pulling on the spine. One way to relieve the pressure is through the right exercises. Your physical therapist will consult with your doctor specialists about your lower back pain and then teach you the exercises to reduce the tension. It is advisable to continue these exercises at home. In addition the therapists can perform deep massage, ultrasound, and electrical stimulation to relax tense muscles. Your therapist will also advise you about ways to perform everyday activities without straining your back muscles.
Chiropractor: A chiropractor can be your primary care doctor specialist to treat your back pain. He or she will manipulate your spine to make sure that all of the bones are aligned correctly.
Acupuncturist: This is an ancient medical art in which small thin needles are inserted into specific areas of the body. It is believed that these needles stimulate chemicals to block pain. There is relatively no pain in this procedure.
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Tips To Strengthen Your Back
Flexion and extension exercises are commonly used to prevent low back pain. Be sure to review with the doctor any program you are considering.
Easy Low Back Exercises
- Ankle Pumps: Lie on your back and move ankles up and down.
- Heel Slides: Lie on your back and bend then straighten the knees one at a time.
- Wall Squats: With your back flat against a wall, sit like you would in a chair with your knees lined up over your ankles. Gently press against the wall, keeping your abdominal muscles tight. Hold for five seconds.
- Single Knee to Chest Stretch: Lying down with back flat, pull your knee into the chest.
Iii Importance Of An Accurate Diagnosis
The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI , or CT scan is unnecessary.
There may also be certain clues in a patients medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to sciatica, a condition in which a bulging disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.
A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.
When tumor or infection are suspected, the doctor may order blood tests, including a CBC and sedimentation rate .
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