What is Back Pain?
Back pain is one of the most common types of chronic pain and is only second to the common cold in reasons for why adult Americans visit the doctor. Back pain can be chronic, meaning long-term, or acute, meaning short-term. Acute back pain can be mitigated through conservative measures, such as hot or cold compresses, rest, massage therapy, or over-the-counter pain relievers. For chronic cases, we can recommend a number of treatment options to address your pain.
Is My Back Pain Serious?
The vast majority of back pain cases are not serious and quickly improve with home treatment/self care over the course of a few weeks. If yours does not improve then see your doctor.
With that being said, in rare cases back pain can signal a serious medical problem. Seek immediate care if your back pain coincides with:
New bowel or bladder problems
Or follows a fall, blow to your back or other trauma/injury
Contact a doctor if your back pain:
Is severe and doesn’t improve with rest
Radiates down one or both legs (especially if the pain goes past the knee)
Causes weakness, numbness or tingling in one or both legs
Is accompanied by unexplained weight loss
What Are The Causes?
Back pain often occurs without a definitive cause that your doctor can identify with a test or imaging. Most back pain can be attributed to mechanical causes, but a small number of cases are due to more serious illness. The most common causes of back pain include:
Degenerating, bulging or ruptured discs: Discs function like cushions between the bones (vertebrae) in your spine by helping absorb pressure. The soft material inside a disc can degenerate, bulge or rupture and press on a nerve. However, you can have a degenerating, bulging or ruptured disc without back pain. Disc disease is often non-painful and found accidentally when you have spine X-rays for some other reason.
Muscle or ligament strain: Repeated heavy lifting or a sudden awkward movement can strain back muscles and/or spinal ligaments. Maintaining good physical condition and form can help limit this, as someone in poor physical condition placing constant strain on their back can cause muscle spasms.
Arthritis: Osteoarthritis can affect the entire back. Sometimes the arthritis can be so severe it causes narrowing of the space around the spinal cord (i.e. spinal stenosis) or the space where the exiting nerve roots leave the back (i.e. neuroforaminal stenosis). Other conditions can also lead to arthritis of the back, such as Rheumatoid Arthritis and Ankylosing Spondylitis.
Osteoporosis: Porous and brittle bone in patients with osteoporosis can lead to spinal vertebral compression fractures. This can be very painful, sometimes requiring bracing, kyphoplasty, vertebroplasty or surgery. Sometimes despite these initial treatments, patients can continue to have pain that is only improved with either spinal cord stimulation or intrathecal drug delivery systems (pain pumps).
Other rare, more serious causes of back pain can include:
Damage to nervous tissues
Although generally affecting men and women between the ages of 20 and 40 equally, there are risk factors that increase your chances of back injury or pain, as well as complications and delayed healing. These risks include:
Excessive consumption of alcohol and drugs
Lack of regular physical activity
Repetitive, stressful motions and movements
Overweight and obesity
Diseases (arthritis and cancer)
One of the most important tools is the history and physical examine of your back pain. Your doctor will assess your ability to sit, stand, walk and lift your legs, as well as ask you to rate your pain on a scale of zero to 10. They will talk to you about how well you’re functioning with your pain and what limitations it may have placed on your life.
Depending on your back pain symptoms, your doctor might order one or more tests:
X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won’t show problems with soft tissues, such as your spinal cord, muscles, nerves or discs.
MRI or CT scans. These scans can reveal herniated discs or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
Bone scan. In rare cases, your doctor might use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. Nerve conduction studies (NCS) evaluates the function and electrical conduction or the motor and sensory nerves. These tests can confirm nerve compression caused by herniated discs, narrowing of your spinal canal (spinal stenosis) or narrowing of one of your neural foramina (neuroforaminal stenosis).
What Are The Treatments?
Most acute back pain gets better with a few weeks of home treatment. However, everyone is different, and back pain is a complex condition, and your pain may be caused from multiple problems going on in your back.
For acute back pain, over-the-counter pain relievers and the use of heat might be all you need. Bed rest for more than an hour or two at a time isn’t recommended.
Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living (housework). 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.
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, etc) or naproxen (Aleve), might help acute back pain. Take these medications only as directed because overuse can cause serious side effects. If OTC pain relievers don’t relieve your pain, your doctor might suggest prescription NSAIDs.
Muscle relaxants. Your doctor might also prescribe a muscle relaxant if your back pain doesn’t improve with OTC pain relievers. 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. These medications can contain local anesthetics (numbing medication) or NSAIDs.
Opioids. For acute back pain these medications may be used for a short time (usually less than a week) with close supervision by your doctor. Opioids typically don’t work well for chronic pain.
Antidepressants. Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline, and serotonin norepineprhine reuptake inhibitors, such as duloxetine (Cymbalta) — have been shown to relieve some types of chronic back pain independent of their effect on depression. Doses of these medications for pain are typically much lower than doses used to treat depression.
Physical Therapy and Exercise
Your doctor may refer you to a physical therapist who 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 core (back and abdominal) muscles, and improve your posture. Regular use of these techniques can help keep pain from returning.
There are several types of yoga with different postures or poses, breathing exercises, and relaxation techniques. Yoga has shown to help improve and prevent back pain. It can stretch and strengthen muscles and improve posture, although you might need to modify some poses if they aggravate your symptoms.
If other measures don’t relieve your pain, depending on the cause of your back pain different types of injections can be performed. These injections may include medial branch blocks, epidural steroid injections, and sacroiliac joint injections. Typically either local anesthetic (numbing medication) and/or corticosteroids are used in these injections. These injections can be done to help determine the cause of your pain, or to help treat your pain. A cortisone injection helps decrease inflammation around the nerve roots, and can help stabilize the nerve membrane reducing abnormal discharges.
Patients looking to treat the root cause of their pain whether it be a degenerating disc or arthritis of the facet joints may benefit from regenerative medicine injections to help promote natural repair to damaged structures. These injections can include platelet rich plasma (PRP), stem cells and/or exosomes. Schedule an appointment with one of our doctors today to learn more.
Minimally Evasive Surgery
Sometimes initial treatments stop working as well, and patients prefer to avoid having a large permanent surgery that alters their spinal biomechanics and the surrounding structures. If you continue to have back pain and/or pain radiating down your leg(s) your doctor may recommend spinal cord stimulation (neuromodulation) or intrathecal drug delivery systems (pain pump) to manage your pain.
A small number of patients may need to have surgery for their back pain. It is typically recommended for most patients to try conservative treatments first. Surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disc, that hasn’t responded to other therapy. In some circumstances the first line of treatment would be surgery, so please speak with your doctor to determine if surgery is a good option for you.
Chiropractic care. A chiropractor hand-manipulates your spine to ease your pain. They can also perform various techniques and treatments such as ultrasound and massage.
Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Acupuncture has been shown to help relieve symptoms in some people with low back pain.