Back Pain

Oooooh, my aching back?

Back pain is a very common medical problem with as many as 80% of people having some problem with it in their lifetime.

Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Is there any treatment?

Most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. Bed rest is recommended for only 1–2 days at most. Individuals should resume activities as soon as possible. Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

What is the prognosis?

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

Who Gets Back Pain?

Anyone can have back pain, but some things that increase your risk are:

• Getting older. Back pain is more common the older you get. You may first have back pain when you are 30 to 40 years old.
• Poor physical fitness. Back pain is more common in people who are not fit.
• Being overweight. Too much weight can stress the back and cause pain.
• Inherited diseases or conditions. Some kinds of back pain, such as disc disease, can be inherited.
• Other diseases. Some types of arthritis and cancer can cause back pain.
• Your job. If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.
• Smoking. Your body may not be able to get enough nutrients to the discs in your back if you smoke. Smoker's cough may also cause back pain. People who smoke are slow to heal, so back pain may last longer.

When Should I See a Doctor for Pain?

You should see a doctor if you have:
• Numbness or tingling
• Severe pain that does not improve with rest
• Pain after a fall or an injury
• Pain plus any of these problems:
• Trouble urinating
• Weakness
• Numbness in your legs
• Fever
• Weight loss when not on a diet.

How is back pain treated?

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take acetaminophen, aspirin, or ibuprofen to help ease the pain. Exercise and surgery are not usually used to treat acute back pain.

Hot or Cold Packs (or Both)

Hot or cold packs can soothe sore, stiff backs. Heat reduces muscle spasms and pain. Cold helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this treatment does not fix the cause of chronic back pain.

Exercise

Proper exercise can help ease chronic pain but should not be used for acute back pain. Your doctor or physical therapist can tell you the best types of exercise to do.

Medications

The following are the main types of medications used for back pain:

• Analgesic medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications.
• Topical analgesics are creams, ointments, and salves rubbed onto the skin over the site of pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that reduce both pain and swelling. NSAIDs include over-the-counter drugs such as ibuprofen, ketoprofen, and naproxen sodium. Your doctor may prescribe stronger NSAIDs.
• Muscle relaxants and some antidepressants have also been prescribed for chronic back pain, but it is not yet known if they work for back pain.

Behavioral Changes

You can learn to lift, push, and pull with less stress on your back. Changing how you exercise, relax, and sleep can help lessen back pain. Eating a healthy diet and not smoking also help.

Injections

Your doctor may suggest steroid or numbing shots to lessen your pain.

Complementary and Alternative Medical Treatments

When back pain becomes chronic or when other treatments do not relieve it, some people try complementary and alternative treatments. The most common of these treatments are:

• Manipulation. Professionals use their hands to adjust or massage the spine or nearby tissues.
• Transcutaneous electrical nerve stimulation (TENS). A small box over the painful area sends mild electrical pulses to nerves. Studies have shown that TENS treatments are not always effective for reducing pain.
• Acupuncture. This Chinese practice uses thin needles to relieve pain and restore health. Acupunture may be effective when used as a part of a comprehensive treatment plan for low back pain.
• Acupressure. A therapist applies pressure to certain places in the body to relieve pain. Acupressure has not been well studied for back pain.

Surgery

Most people with chronic back pain do not need surgery. It is usually used for chronic back pain if other treatments do not work. You may need surgery if you have:

• Herniated disc. When one or more of the discs that cushion the bones of the spine are damaged, the jelly-like center of the disc leaks, causing pain.
• Spinal stenosis. This condition causes the spinal canal to become narrow.
• Spondylolisthesis. This occurs when one or more bones of the spine slip out of place.
• Vertebral fractures. A fracture can be caused by a blow to the spine or by crumbling of the bone due to osteoporosis.
• Degenerative disc disease. As people age, some have discs that break down and cause severe pain.