Back pain

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Back pain is a pervasive health concern that afflicts eight out of ten individuals at various points throughout their lifetime. The spectrum of back pain varies significantly, ranging from a persistent, dull ache to a sudden, sharp pain. Acute back pain, characterized by its sudden onset, typically persists from a few days to several weeks. When back pain extends beyond three months, it is categorized as chronic.

Dolor espalda

While most back pain cases tend to improve over time, the healing process might be prolonged. Temporary relief can often be found in over-the-counter pain medications and sufficient rest. However, excessive bed rest exceeding one or two days can exacerbate the problem.

If you experience severe back pain that doesn't show signs of improvement after three days, or if you experience back pain following a significant injury, it is strongly advised to consult a healthcare provider. Back pain can manifest suddenly, as a result of an accident, a fall, or lifting something heavy, or gradually, due to age-related spinal changes. The treatment for back pain varies according to its nature and cause, and may involve hot or cold packs, exercise, medicines, injections, complementary therapies, and sometimes, surgery.

Who is Susceptible to Back Pain?

While back pain can affect anyone, several factors can heighten an individual's risk:

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Depiction of a person suffering from back pain

• Age: The likelihood of experiencing back pain tends to increase with age, usually becoming prevalent between the ages of 30 and 40.
• Fitness level: Individuals who lack physical fitness, especially those with weak back and abdominal muscles that fail to adequately support the spine, are more prone to back pain. A sudden increase in exercise after a prolonged period of inactivity can also provoke back pain.
• Diet: Consuming a high-calorie, high-fat diet, coupled with a sedentary lifestyle, can lead to obesity, which in turn places added stress on the back.
• Heredity: Genetic predispositions can play a role in certain disorders that induce back pain.
• Race: African American women, for instance, have a higher likelihood than white women to develop spondylolisthesis, a condition where the lower spinal bones dislocate.
• Other diseases: Certain diseases, such as specific types of arthritis and cancers that metastasize to the spine, may cause or exacerbate back pain.
• Occupational hazards: Jobs that necessitate heavy lifting, pushing, pulling, or twisting can potentially injure the back. Conversely, desk jobs, particularly those involving poor posture or extended sitting in an uncomfortable chair, can also contribute to back pain.
• Cigarette smoking: While smoking may not directly induce back pain, it increases the risk of developing lower back pain and sciatica—pain that radiates to the hip and/or leg. Additionally, smoking can delay recovery from back injuries or surgeries.

Classifying Back Pain

• Acute pain is a sudden, often severe pain that follows an accident, a fall, or heavy lifting. It represents the most common type of back pain and usually subsides within six weeks.
• Chronic pain may develop abruptly or gradually, persisting for a significant duration, typically longer than three months. This type of back pain is less common.

Potential Causes of Back Pain

Back pain can stem from a multitude of factors, including:

• Mechanical issues: Problems with the way your spine moves or how it feels when you move in specific ways can lead to back pain. Mechanical causes include degeneration of the spinal disks, disk rupture, muscle spasms, and muscle tension.
• Injuries: Injuries like sprains and fractures can instigate short-term or chronic pain. Sprains result from tearing of the ligaments that uphold the spine, often due to improper twisting or lifting. Fractured vertebrae commonly arise from conditions like osteoporosis. Severe injuries leading to back pain may occur from significant accidents or falls.
• Medical conditions: Various health conditions can cause or contribute to back pain:
• Scoliosis, a curvature of the spine, typically does not cause pain until middle age.
• Spondylolisthesis, a condition in which a spinal bone dislocates.
• Different types of arthritis.
• Spinal stenosis, a narrowing of the spinal column that pressures the spinal cord and nerves.
• Osteoporosis, which can induce painful fractures of the vertebrae.
• Pregnancy.
• Kidney stones or infections.
• Endometriosis, a condition characterized by uterine tissue growing outside the uterus.
• Fibromyalgia, a disorder of widespread muscle pain and fatigue.
• Infections involving the spinal bones or intervertebral disks can cause pain.
• Tumors, although rare, can instigate back pain. Tumors can originate in the back or be secondary, spreading from other body regions.
• Stress can exacerbate pain by causing muscle tension and pain in the back.

Approaches to Back Pain Treatment

Spinal column curvature

The treatment approach for back pain largely depends on the duration and intensity of the pain:

Lower back pain

Acute (short-term) back pain often improves independently. Exercise and surgery are generally not recommended for acute back pain. However, while waiting for the pain to subside, some relief options include: Over-the-counter pain relievers like acetaminophen, aspirin, or ibuprofen can mitigate the pain. Engaging in mild physical activity can ease stiffness, relieve pain, and expedite return to regular activities. Chronic (long-term) back pain typically involves non-surgical treatment options before considering surgery: Nonsurgical treatments:

• Hot or cold packs can provide relief to persistently sore, stiff backs.
• Regular exercise can alleviate chronic pain and potentially lower the risk of its recurrence. Always consult your doctor before initiating a new exercise regimen.
• Over-the-counter or prescription medications can be used to treat chronic back pain.
• Topical or oral pain relievers such as acetaminophen and aspirin.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, ketoprofen, and naproxen sodium help relieve pain and inflammation.
• Muscle relaxants and some antidepressants might be prescribed for certain types of chronic back pain.
• Your healthcare provider might recommend steroid or numbing shots to alleviate pain.
• Traction, which involves using pulleys and weights to stretch the back, might enable a bulging disk to reposition itself. Pain relief during traction might not persist after the session.
• Behavioral modification techniques can teach proper body movement during daily activities, especially those involving heavy lifting, pushing, or pulling, along with fostering healthy habits such as regular exercise, relaxation, sufficient sleep, a balanced diet, and cessation of smoking.

Complementary and alternative treatments may be beneficial when other therapies fail to provide relief. Examples include:

• Manipulation: Professionals adjust or massage the spine or nearby tissues with their hands.
• Transcutaneous electrical nerve stimulation (TENS): A small box over the skin transmits minor electrical signals to the body.
• Acupuncture: This treatment involves inserting thin needles into specific body points.
• Surgical treatments: Surgery is generally a last resort, when other therapies have failed, and severe, persistent pain is accompanied by nerve compression resulting in weakness or numbness. The main types of surgery for back pain are:
• Diskectomy: Removal of a portion of a herniated disk to relieve irritation of nearby nerves.
• Laminectomy: The surgeon removes the bone overlaying the spinal canal, enlarging it to relieve nerve pressure caused by spinal stenosis.
• Fusion: Fusing spinal bones together restricts movement and prevents stretching of nerves.
• Artificial disks: An alternative to fusion, which involves inserting an artificial disk into the spine to mimic a real one.

Preventive Measures

Adopting certain lifestyle habits can reduce the risk of developing back pain:

• Regular exercise to keep the back muscles strong and flexible.
• Maintaining a healthy weight to avoid excessive pressure on the spine.
• Smoking cessation, as smoking impairs blood flow, depriving the spine tissues of necessary nutrients.
• Wearing low-heeled shoes.
• Avoiding heavy lifting, but if you must lift, bend your legs, not your back, and keep the load close to your body.
• Practicing good posture. Don't slump or slouch when you sit or stand.

Back pain is a symptom of a medical condition, not a diagnosis itself. In rare cases, back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome. In these cases, surgery is needed right away to ease the pain and prevent more problems.

You probably don’t need to see your doctor for back pain, unless you have:

• Numbness and tingling.
• Severe back pain that does not improve with medication.
• Back pain after a fall or injury.
• Back pain along with:
  • Trouble urinating.
  • Weakness, pain, or numbness in your legs.
  • Fever.
  • Weight loss that you didn’t intend.

Living With Back Pain

There are a few things you can do to help you live with back pain:

• Hot or cold packs can be soothing to constantly sore, stiff backs. Heat dilates the blood vessels to increase blood supply to the back and reduce muscle spasms. Cold may reduce inflammation and numb deep pain.
• Exercise can help ease chronic pain and may reduce the risk of it returning. Check with your doctor before starting a new exercise routine, which may include the following:
  • Flexion exercises have you bending forward to reduce pressure on the nerves, stretch the back and hip muscles, and strengthen the stomach and buttock muscles.
  • Extension involve bending backward, such as lying on your stomach while you lift your leg or raise your trunk. These exercises may reduce pain that spreads from one place and develop muscles that support the spine.
  • Stretching improves the extension of muscles and other soft tissues of the back. These exercises can reduce back stiffness and improve range of motion.
  • Aerobic exercise gets your heart pumping faster and include brisk walking, jogging, and swimming. Avoid exercise that requires twisting, bending forward quickly, such as aerobic dancing and rowing. Avoid high-impact activities if you have disk disease.

External links

• Low back pain fact sheet

Back pain Resources
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