What Causes Back Pain
Your spine or backbone is a complex structure that is made up of 24 small bones called vertebrae that are stacked on top of each other. Discs sit between each vertebra to act as cushions or shock absorbers and give your spine flexibility. Vertebrae are joined together by small joints called facet joints. These joints allow you to move and bend your back. A mesh of ligaments and muscles hold the spine together and provide structural support, which allows you to move.
Back pain can originate from any of these structures, but in most cases, this pain doesnt result from any significant damage to your spine. This pain usually stems from surrounding muscles, ligaments or joints and occasionally spinal disc problems.
For at least 9 in 10 people, back pain is not caused by any particular condition and is referred to as non-specific back pain.
This type of back pain results from a range of different factors such as:
- poor posture
- an unhealthy weight
Less than 1 in 100 people have back pain that is related to a serious medical problem such as cancer, infection, a spinal fracture or specific conditions such as ankylosing spondylitis. Research has also shown that you actually dont need to know the cause of back pain to treat it successfully.
Chronic Back Pain What Options Are Available
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If you are struggling with back pain in Central Pennsylvania, youre part of a vast group. Around 80 percent of adults, at some point in their lives, experience back pain. Its one of the most common contributors to missed work days and job-related disability, according to the National Institute of Neurological Disorders and Stroke . The Orthopedic Institute of Pennsylvania provides chronic pain treatment options at our eight locations, including conservative methods and surgical procedures if needed.
Should You Even Visit A Doctor
Knowing what the AHRQ says, should you visit your doctor when you experience back pain? Generally speaking, back pain is not serious, and it is only very rarely life-threatening. That said, it can and often does disrupt the quality of life.
For your first experience with back pain, checking with your doctor is probably a good idea. Figure out who the best back doctor to go to is. He or she will ask you some basic questions as a way of narrowing your symptoms down to a diagnosis.
These questions may include: What were you doing when the pain started? Did the pain come on gradually or suddenly? Where do you feel the pain and does it radiate out? What does it feel like? A number of terms for describing your symptoms exist, so have at it. You might feel electrical symptoms such as pins and needles, burning, shock and the like, or you may have a dull ache. The more you can thoroughly and accurately describe your pain symptoms, the better. Your description gives the doctor something to go on when making a diagnosis and subsequent treatment recommendations.
Other things your doctor will likely want to know are the timing of the pain. In other words, when does it come on and when is it relieved, what you physically do at work, and more.
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What About Oral Steroids
If youâre nervous about getting an epidural steroid injection, you may wonder if you can take oral steroids instead. In some cases, oral steroids can be an option, but theyâre generally not as helpful as injected steroids.
Thereâs some evidence that shows oral steroids can be effective in treating low back pain. One study showed that oral steroids caused a dramatic improvement in patients with lumbar radiating pain however, the authors of that study admit that thereâs not currently a large body of scientific evidence supporting the use of oral corticosteroids for treating lower back pain. In addition, thereâs also evidence in the opposite direction which indicates that while oral steroids can improve function in patients with low back pain, they donât provide a measurable amount of pain relief .
Because they target the entire body and not just one specific nerve or joint, oral steroids may be a better option for patients whose pain arises from inflammatory arthritis as opposed to nerve issues.
Oral steroids also exhibit more severe side effect profiles than local steroid injections. Side effects of oral steroids can include weight gain, irritability and mood swings, insomnia, stomach irritation and bleeding, high blood pressure, muscle weakness, and worsening of diabetes .
Summary
Steroid injections may result in a brief temporary increase in pain, but overall are relatively safe and allow patients to resume normal activities within a day.
Clarification Of Prescribing Guidelines
Its important to know that it is not recommended for your doctor to refuse to prescribe opioids if you have already been taking them for the long term. The Department of Health and Human Services has recommending a highly deliberate approach to reducing opioid intake for patients who have been undergoing long-term treatment with these medications.
Adm. Brett P. Giroir, MD, assistant secretary of health at the HHS remarked, If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way.
If your doctor abruptly discontinues your pain medication, you are in danger of going into opioid withdrawal. The signs and symptoms of opioid withdrawal include:
- Anxiety or agitation
- Hallucinations
- Seizures
Although these symptoms are not usually life-threatening, experiencing them alongside the resurgence of your chronic pain can be debilitating. The new guidelines from the HHS emphasize that focusing too hard on reducing opioid intake in people with chronic pain may produce unintended and unwanted results. A careful taper of opioid pain medication usually involves the physician:
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Ways To Treat Chronic Back Pain Without Surgery
Back pain is considered chronic if it lasts three months or longer. It cancome and go, often bringing temporary relief, followed by frustration.Dealing with chronic back pain can be especially trying if you dont knowthe cause.
Back pain rehabilitationspecialistAndrew Nava, M.D., offers insights into common chronic back pain causes and nonsurgicaltreatment optionsand advises not to give up hope.
Heat And Ice For Back Pain
A hot water bottle or heat pad may help ease muscle spasm and pain. Make sure your skin is protected dont put heat pads directly on your skin. You can buy pads that you put over your clothing on the area that hurts. These are available from pharmacies and last for several hours.
Ice packs may also be helpful, especially in the first few days of any injury. Make sure you wrap the ice pack in a towel to protect your skin. You can apply the pack to the area that hurts for 15 minutes at a time.
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How Is Lower Back Pain Diagnosed
The most common cause of low back pain is a mechanical back injury. This means an injury that occurs to the spine, back muscles, nerves, or bones near the back that may cause you to become unbalanced. Common causes for back injuries can include bad posture, improper lifting, arthritis, a ruptured or herniated disc, fractures, falls, and more.
Typically, back pain of any kind is self-diagnosed. Low back pain is especially easy to diagnose because its an easily recognizable location. However, you should still see your primary care physician or another back pain specialist for a thorough review of your medical history and a physical exam to identify any serious conditions that may be causing the pain and to assist you in seeking treatment.
Patients should know that lower back pain can be caused by many different things and that they should have a proper evaluation by a physician before going off on their own to find someone to treat them, said Amy Sedgwick, MD of Yoga Medicine.
What Are The Best Home Remedies For Lower Back Pain
Depending on the severity and cause, you may be able to reduce or eliminate your lower back pain at home. Many of these remedies are short-term solutions, but can help you avoid medications while you wait for your next doctors appointment. After consulting a healthcare professional, you may be able to rely on these solutions entirely for minor pain.
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Eight Risk Factors Of Lower Back Pain
There are eight risk factors that can increase a persons chances of developing lower back pain. These factors include:
- Age Most patients experience lower back pain as they age. Osteoporosis can develop, leading to fractures. Additionally, spinal stenosis increases with age due to lost cushioning and reduced muscle elasticity in the vertebrae.
- Fitness Out-of-shape people are more likely to develop back pain. Weak abdominal muscles create lack of support for the spine.
- Pregnancy Pelvic changes caused by increased pregnancy weight gain can cause lower back injuries. This does not always resolve after childbirth.
- Obesity Excess weight can cause back aches and pains.
- Genes Inherited conditions can cause lower back pain. Ankylosing spondylitis, a genetic form of arthritis, can cause lower back pain as spinal joints fuse together.
- Job-related risks Lifting and pushing heavy objects can cause injuries. Sedentary desk jobs can trigger back pain due to poor posture or back support.
- Mental illness Anxiety and depression can alter how a person perceives pain. Chronic pain can also lead to the development of psychological issues that affect the body in several ways.
- Backpack overload Heavy backpacks can strain younger childrens back muscles. Backpacks shouldnt weigh more than 20 percent of the childs body weight.
Remedies Less Likely To Help
Cleveland Clinic spine specialists generally do not support the use of passive treatments for low back pain.
Chronic use of low-level laser therapy, ultrasound, transcutaneous electrical nerve stimulation and spinal manipulation may only help in the short term, Dr. Mayer points out. We dont want you to waste your money on treatments unlikely to provide more than a day of benefit.
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Current Rules For Opioid Prescriptions
There are currently no nationwide federal laws regarding opioid prescription regulations. The Centers for Disease Control and Prevention has released prescribing guidelines for opioids, but they are just that: guidelines. Enforceable laws about opioid prescriptions are down to individual states, and many of the laws enacted are incredibly restrictive.
For instance, New Jerseys new law on opioids prohibits authorized prescribers from issuing an initial prescription for more than five days. There are no exceptions to the rule, including for the management of post-operative pain. Additionally, the prescription for acute pain must be for the lowest effective dose. The next prescription can only be written no less than four days after the initial five-day prescription, so if the initial dose was not enough to be effective the person must wait for several days until they can get an updated prescription.
Laws like these too often make doctors afraid to prescribe opioids at all and cause them to write prescriptions that may not be effective against a persons level of pain. Refusal to prescribe pain medication leads to unnecessary suffering and can in some cases drive patients to seek other, illicit forms of opioids to keep withdrawal at bay.
Related Resources For Lower Back Pain
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
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Lower Back Pain Medications
Medications are often used to treat low back pain. Due to the range of causes and levels of pain in the lumbar area, medications used to treat this pain will vary as well. For some, using anti-inflammatory medications called NSAIDs, which include aspirin, can help. For others, stronger medications like narcotics are needed. As always, you should discuss your medication options with your doctor as narcotic medications have a higher risk of dependence, abuse, or addiction when used long-term.
Answers To Common Back Pain Questions
More than eight in 10 people will experience upper, mid, or low back pain at some point in their lives. Low back pain is the most common back pain. In most cases, the pain goes away over time. If your back pain is severe or does not improve, you may need medical care. Here are answers to some common questions about back pain and tips on when to seek help.
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When Do You Need A Doctor For Back Pain
if you have any of the following symptoms along with your back pain, see a doctor immediately:
- Numbness in an arm or leg
- Trouble with bowel or bladder control
- Weakness in an arm or leg
When the team assesses patients with severe back pain, we often recommend physical therapy and pain medication then we dont see the patients again because their back pain got better on its own. Staying or getting active with guidance from your doctor can provide ample relief for severe back pain.
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
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Lower Back Pain Treatment Options
Back pain treatment will vary depending on the cause and severity of your pain. There are many different options for managing your back pain so your chances of finding pain relief are high. First, you can always try at-home, or self-care, treatments. These could include heating pads such as disposable self-heaters, microwavable bags, electric heating pads, or cold packs if the pain is due to inflammation. They may ease pain enough to allow for greater mobility. You could also try physical exercise at home including light aerobic activity focused on stretching or strengthening your injured area. However, you should use caution when attempting this. Its always a good idea to consult a physician before attempting physical activity as you could worsen your injuries.
There are a variety of medications available for managing your back pain as well. These can be a great way to eliminate pain while recovering from a severe injury that prevents movement, but typically are not the best long-term solution. A few common types include muscle relaxants, narcotics, anti-inflammatories, and analgesics.
Massages and joint manipulation are both treatment options for low back pain. Massages are sometimes used when muscle pain or strain is the main issue. Joint manipulation is used to restore movement to the joints while reducing pain in the area, in this case, the lower back. Stretching can also allow for further movement without pain in the future.
Get Back Pain Treatment Online
Speak to a board certified doctor, securely from your phone or computer and get back pain treatment online in 15 minutes. There are many home remedies and prescription medications a doctor can recommend to help you recover faster.
We accept these insurance plans and many more. Without insurance, appointments are $119.
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When Opioids Are Appropriate
If you have moderate to severe back pain or neck pain, have exhausted all other viable medication options, an opioid may be an effective treatment for you. Before your doctor prescribes an opioid pain reliever, he/she will likely evaluate your current medical condition by performing a physical and neurological examination. The assessment focuses on your painincluding the location, intensity, frequency, and treatments youve tried.
Pain Relief For Lower Back Pain With Sciatica
Sciatica is when you have pain in your lower back, buttocks and down one or both legs. If you have sciatica and the above treatments havent controlled the pain, your doctor may prescribe a medicine for treating what is called neuropathic pain. This is pain that is thought to be caused by nerve damage or by your nerves becoming more sensitive to pain.
These medicines include amitriptyline, duloxetine, gabapentin and pregabalin. If youre not able to take tablets, your doctor may suggest using a cream called capsaicin instead.
Youll have a follow-up appointment with your doctor to see how well your medicine is working and to talk about any problems or side-effects. It can take a little while to find the dose that works for you.
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