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 widespread musculoskeletal disorder that affects approximately 80% of individuals at some point in their lives. It can present as a dull, constant ache or a sudden, sharp sensation. Acute pain typically lasts a few days to several weeks, while chronic pain persists for more than three months.

Back pain can range from mild to debilitating

Although most cases of back pain resolve over time, recovery may be gradual. Over-the-counter analgesics and short periods of rest can provide temporary relief. However, extended bed rest beyond one or two days may worsen symptoms.

Medical attention is advised if severe back pain does not improve within three days or follows a spinal injury, fall, or lifting a heavy object. The causes and treatments for back pain vary widely and may involve medications, physical therapy, complementary and alternative medicine, and in some cases, spinal surgery.

Epidemiology

• Back pain affects nearly 8 in 10 people at some point in life.
• It is one of the most common reasons for missed work and doctor visits.
• Chronic back pain is more common in adults over the age of 30.

Risk Factors

Postural habits can contribute to back pain

Back pain can affect anyone, but certain factors increase susceptibility:

• Age: Risk increases with age, especially between 30 and 50 years.
• Physical fitness: Weak core and back muscles contribute to instability and pain.
• Obesity: Excess body weight places strain on the spine.
• Genetics: Some spinal conditions have a hereditary component.
• Race and ethnicity: African American women are more likely to develop spondylolisthesis.
• Occupational hazards: Jobs involving heavy lifting, twisting, or prolonged sitting can cause back problems.
• Smoking: Contributes to decreased blood supply and delayed healing.
• Stress: Increases muscle tension and perception of pain.
• Diseases: Arthritis, osteoporosis, and metastatic cancer can all contribute to spinal pain.

Classification

Back pain is broadly categorized into:

• Acute back pain: Sudden onset, usually resolving within six weeks.
• Chronic back pain: Lasting more than three months, may arise gradually or abruptly.

Causes

Back pain may result from a range of mechanical, traumatic, or pathological conditions:

Mechanical Causes

• Herniated disc or degenerative disc disease
• Spinal stenosis
• Scoliosis or abnormal spinal curvature
• Spondylolisthesis
• Facet joint dysfunction

Injuries

• Ligament sprains or muscle strains
• Vertebral fractures, often related to osteoporosis
• Whiplash or trauma from accidents

Medical Conditions

• Arthritis, including rheumatoid arthritis and osteoarthritis
• Kidney stones or urinary tract infections
• Endometriosis or fibromyalgia
• Spinal infections or tumors
• Pregnancy-related musculoskeletal stress

Diagnosis

Evaluation typically involves:

• Medical history and physical examination
• X-rays to assess bone abnormalities
• MRI or CT scan for soft tissue or nerve issues
• Blood tests to rule out infections or inflammatory conditions
• Nerve conduction studies if radiculopathy is suspected

Treatment

Curvatures of the spine can affect posture and pain

Acute Back Pain

• Short-term use of NSAIDs or acetaminophen
• Gentle movement and modified activity
• Avoidance of prolonged bed rest

Chronic Back Pain

Lower back pain is common and may persist

• Physical therapy and guided exercises
• Hot/cold packs
• Muscle relaxants or low-dose antidepressants
• Corticosteroid injections
• Behavioral therapy to address posture and coping
• Complementary approaches:
  • Chiropractic adjustment
  • Acupuncture
  • TENS (Transcutaneous electrical nerve stimulation)

Surgical Options

Only considered in specific cases:

• Discectomy: Removing part of a herniated disc
• Laminectomy: Removing bone to relieve nerve pressure
• Spinal fusion: Fusing vertebrae to prevent movement
• Artificial disc replacement: Inserting a synthetic disc

Prevention

• Regular exercise, especially core strengthening
• Maintaining a healthy weight
• Good posture
• Ergonomic furniture and workspaces
• Lifting with the legs, not the back
• Avoiding smoking and managing stress

When to Seek Medical Attention

Consult a healthcare provider if you experience:

• Persistent pain despite rest and medication
• Neurological symptoms like numbness or weakness
• Difficulty urinating or loss of bladder control
• Fever, unintended weight loss, or history of cancer

Living With Back Pain

• Use of hot or cold therapy as needed
• Structured exercise programs such as flexion, extension, and aerobic routines
• Avoid high-impact activities if you have existing disc disease
• Follow a multidisciplinary approach for chronic conditions

External Links

• NIH: Low Back Pain Fact Sheet

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