Whats New In This Article
Fourteen updates have been logged for this article since publication . All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. moreWhens the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are fine print, but more meaningful than most of the comments that most Internet pages waste pixels on. I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.See the Whats New? page for updates to all recent site updates.
2020 Minor science update, added a citation to a cancer case study.
2020 Added information about back pain as a symptom of COVID-19.
2018 Cited Premkumar et al on red flag reliability .
You Can Fix This Chronic Problem Once And For All
Although it may seem easy to fix , many of us assume that the solution is also simple. We subsequently look for easy solutions only to feel disappointed or to believe that our particular solution is not possible.
This is simply not the case. Back pain is complex, with many factors and the process to overcome it should be viewed as a step-by-step and multifaceted one.
To be able to address it, first, begin with what is required to keep your lumbar spine healthy and what causes it to suffer chronic pain.
The lumbar spine consists of your lumbar vertebrae, vertebral discs, interconnecting facet joints, a complex nervous supply that travels in between each vertebra, soft tissue, ligaments, tendons, and muscles.
Can Sleeping On My Stomach Cause Back Pain
The simple answer is yes. Stomach sleeping is infamous for causing back pain problems, which makes sense when you think about it.
Most of your body weight will be dispersed around your middle so the natural curve of your spine will be flattened and placed under unnecessary strain in an awkward position. Since the spine is a hub for your nerves this pain can spread throughout your entire body, not just your lower back!
Then theres your neck to consider. Unless youve miraculously developed the ability to breath with a pillow stuffed in your face, the chances are that you have to turn your neck to the side in order to breathe peacefully through the night.
This can cause problems because its not a natural angle for your neck to be twisted at imagine sitting all day with your head turned to the side! It puts your head out of alignment with your spine which eventually will cause you some discomfort and in a worst case scenario it can cause some real health problems such as a herniated disk!
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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.
Complete Guide To Low Back Pain
This article might ease your mind, but what about your back pain? If your pain is becoming chronic , or if you just keep having flare-ups, you may want to dive much deeper into the topic. There arent any easy answers for stubborn back pain, but there is evidence-based hope, and the PainScience.com back pain tutorial explores the topic extremely thoroughly. The main text is written for patients, but its also extensively referenced for keen readers and healthcare professionals. Read the introduction.
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More Advanced Care Options
Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:
Implanted nerve stimulators
- Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
- Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
- Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.
What About Nocturnal Intervertebral Disc Swelling
This is one of the classic theories about why people seem to be more vulnerable to back pain in the morning.
Between every pair of vertebrae is a bit of padding, the infamous disc. They probably swell up a wee bit overnight. There are two studies that suggest this2930 . A 2016 paper speculates that disc swelling is why astronauts probably suffer from more disc herniations than they should.31 Weightlessness is undoubtedly like resting your spine, but its another long-term effect, so Im not sure how relevant the astronaut angle is its just a fun angle on the topic.
I saved this idea for last because its too speculative to be really satisfying.
Discs may swell, but that doesnt mean swelling discs hurt. Mild swelling is hardly a concern in itself, and most people dont wake up in pain, so its unlikely that swelling alone is a problem. Swollen discs may hurt more in the morning if theres already something wrong with them, such as annular tears,32 but such discs might well be uncomfortable regardless. Mildly herniated discs might swell and effectively be more herniated in the morning but many herniations are painless, so thats hardly a smoking gun.
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When To Call A Professional
Contact your doctor if:
- Severe back pain makes it impossible for you to do your normal daily activities.
- Your back pain follows significant trauma.
- Mild back pain gets worse after a few days or persists more than a week or two.
- Back pain is accompanied by weight loss, fever, chills or urinary symptoms.
- You develop sudden weakness, numbness or tingling in a leg.
- You develop numbness in the groin or rectum or difficulty controlling bladder or bowel function.
- You have had cancer previously and you develop persistent back pain.
What Are Some Less Invasive Or Noninvasive Back Pain Treatments
Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.
Medications. When over-the-counter pills and topicals dont do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:
- Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
- Muscle relaxants, such as baclofen or carisoprodol
- Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
- Opioids, such as oxycodone or hydrocodone, on a short-term basis.
Physical therapy . PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:
- Exercise
- Transcutaneous electrical nerve stimulation
- Ultrasound
Injections. An epidural steroid injection or a selective nerve block may provide short-term pain relief when lower back pain causes sciatica symptoms, such as leg pain.
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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.
Imaging And Blood Tests
Most people do not need additional testing however, sometimes doctors order tests to rule out a specific cause for your pain or to confirm a cause for your back pain. Your doctor may order the following.
- X-rays only show bones and can help diagnose:
- Broken bones or fractures.
- Changes due to aging.
- Changes in the alignment of the spine.
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Persistent And Unremitting Back Pain
Unremitting pain typically raises the same fear in patients and care-givers a concern for cancer. Back pain is the presenting symptom in most patients with cancer that has moved into the spine. Patients who already know they have a cancerous condition should alert their doctors to order specific imaging studies without delay.
Patients with spinal cancer usually experience a different kind of pain from that in common back and neck injuries. Ordinary back pain is usually related to activity, relieved by rest and is often associated with a recognized lifting or physical injury. It may seem to linger forever, but in reality, it typically begins to get better after about four to six weeks of rest.
Instead of getting better with rest, pain caused by a spinal tumor is persistent, progressively getting more intense over time, and is not relieved by rest. Pain may actually feel worse at night, and feel a bit better when you are up and around. Thoracic back pain may be associated with belt-like burning pain around the torso, and lower back pain may be accompanied by symptoms of pain or weakness in the legs similar to what we see in a disc herniation.
Since the most common cause of a spinal cancer is a metastasis from cancers of the lungs, breasts, prostate, kidneys, colon and thyroid, these organs should be thoroughly checked by your doctor when cancer is suspected.
Activity And Back Pain
Back pain is one of the most common reasons for time off work, but staying at work has been shown to improve recovery, although you may need to modify some tasks. When you have back pain, keep as active as you can. Avoid bed rest this does not help and can make symptoms worse. Although you may feel some pain when you are active, it is safe to exercise while you have back pain.
| Benefits of keeping active |
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You’re Having Problems With Your Bowels Or Urination
If your back pain is paired with a loss of control over your bowels or urination, then it’s time to seek help immediately at a local emergency room. These symptoms point to cauda equina syndrome, where the nerves in the lower spine have become paralyzed. While rare, this syndrome can be permanently damaging to the nerves if left untreated. If you experience these symptoms, especially accompanied by numbness in the legs, then you may need surgery to decompress the nerves and preserve their overall function.
What Are Some Other Causes Of Lower Back Pain
The shape of your spine, and well as spinal diseases, are other culprits in lower back pain. Depending on a range of factors, your doctor may look for:
Abnormal spinal curvature. A normal spine resembles a gently curved letter S when seen from the side. Abnormal curves include:
- Lordosis, in which the spine curves too far inward at the lower back
- Kyphosis, in which the spine is abnormally rounded in the upper back
- Scoliosis, in which the spine curves from side to side, often in a C shape
Normal and abnormal curves of the spineArthritis. There are more than 100 types of arthritis, many of which can cause lower back pain. The most common types include osteoarthritis , rheumatoid arthritis, and ankylosing spondylitis.
Cauda equina syndrome . Compression of the bundle of nerves that forms below the spinal cord in the lumbar spine. It is a rare but serious disorder that requires immediate medical attention and possibly emergency surgery. CES got its name from the fact that the fanned-out bundle of nerves resembles the base of a horses tail.
Discitis or osteomyelitis.Both infections of discs and bone can cause severe pain and require prompt medical attention.
Spinal tumors. When cells divide and multiply unchecked, the result is a tumor. Both benign and malignant tumors can cause lower back pain. They can either originate in the spine or metastasize there, meaning theyve spread from somewhere else in the body.
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Other Reading On Painsciencecom About Back Pain
- 6 Main Causes of Morning Back Pain Why is back pain worst first thing in the morning, and what can you do about it?
- 34 Surprising Causes of Pain Trying to understand pain when there is no obvious explanation.
- Dont Worry About Lifting Technique The importance of lift with your legs, not your back to prevent back pain has been exaggerated.
- Chronic Low Back Pain Is Not So Chronic The prognosis for chronic low back pain is better than most people realize especially for Australians in Australia!
- Spinal Subluxation Can your spine be out of alignment? Chiropractics big idea has been misleading patients for more than a century.
- Back Pain & Trigger Points A quick introduction to the role of trigger points in back pain
And the big one
- Complete Guide to Low Back Pain Everything on one mighty page: an extremely detailed guide to the myths, controversies, the nature of the beast and the highlight dozens of detailed, evidence-based reviews of treatment and therapy options. This huge tutorial also focusses on a topic I think is neglected: the role of muscle in back pain.
Two Back Pain Situations You Should Take Seriously Right Away No Delay
These two back pain scenarios might be medical emergencies. They do not necessarily mean something horrible is wrong, but its important to make sure.
Isnt it rather obvious that a potential spinal fracture is an emergency?
Youd think so. But consider this story of a motorcycle accident: many years ago, a friend hit a car that had pulled out from a side street. He flew over the car & landed on his head. Bystanders showed their ignorance of spinal fracture by, yikes, carelessly moving him. In fact, his thoracic spine was significantly fractured yet the hospital actually refused to do an X-ray because he had no obvious symptoms of a spinal fracture. Incredible! The next day, a horrified orthopedic surgeon ordered an X-ray immediately, confirming the fracture & quite possibly saved him from paralysis.
Pain + weakness in both legs as symptoms of cauda equina syndrome or not
That said, obviously you should be checked out if you are experiencing true saddle numbness.17 Even if its not CES, any significant malfunction of your plumbing should be taken seriously.
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Medical And Family History
Your doctor will ask questions about your medical and family history to help determine if an injury or underlying medical condition is the source for the back pain. Some questions your doctor may ask:
- Can you describe your pain?
- Where is the exact location of your back pain?
- When did the pain start and how long have you had the pain?
- What were you doing when you first noticed the pain?
- How severe or bad is the pain?
- What makes the pain worse or better?
Your doctor may ask you to rate your pain on a scale from 1 to 10 to gauge the severity of the pain and talk to you about your ability to perform activities of daily living.