BACK PAIN

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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. Most people have back pain at least once.

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.

SPINE ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Muscle ache

Shooting or stabbing pain

Pain that radiates down your leg

Pain that worsens with bending, lifting, standing or walking

Pain that improves with reclining

CAUSES

Back pain that comes on suddenly and lasts no more than six weeks (acute) can be caused by a fall or heavy lifting. Back pain that lasts more than three months (chronic) is less common than acute pain.

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.

SKELETAL IRREGULARITIES.
A condition in which your spine curves to the side (scoliosis) also can lead to back pain, but generally not until middle age.

OSTEOPOROSIS.
Your spine's vertebrae can develop compression fractures if your bones become porous and brittle.

TREATMENT

TREATMENT OPTIONS

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

For acute back 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), might relieve acute 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 are creams, salves or ointments you rub into your skin at the site of your pain.

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.
Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline — have been shown to relieve some types of chronic back pain independent of their effect on depression.

INJECTIONS.
If other measures don't relieve your pain, and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — or 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 less than a few months.

EDUCATION
There's no commonly accepted program to teach people with back pain how to manage the condition effectively. So education might involve a class, a talk with your doctor, written material or a video. Education emphasizes the importance of staying active, reducing stress and worry, and learning ways to avoid future injury.

PHYSICAL THERAPY AND EXERCISE
A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain.

As pain improves, the 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.

SURGERY
Few people need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, surgery usually is 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.

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