Back Pain

Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it hard to move. It can start quickly if you fall or lift something too heavy, or it can get worse slowly.

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. A diet high in calories and fat can make you gain weight. Too much weight can stress the back and cause pain.
Heredity. Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, can have a genetic component.
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 disks 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.

Another factor is race. For example, black women are two to three times more likely than white women to have part of the lower spine slip out of place.

What Are the Causes of Back Pain?

There are many causes of back pain. Mechanical problems with the back itself can cause pain. Examples are:

Disk breakdown
Spasms
Tense muscles
Ruptured disks

Injuries from sprains, fractures, accidents, and falls can result in back pain.

Back pain can also occur with some conditions and diseases, such as:

Scoliosis
Spondylolisthesis
Arthritis
Spinal stenosis
Pregnancy
Kidney stones
Infections
Endometriosis
Fibromyalgia.

Other possible causes of back pain are infections, tumors, or stress.

Can Back Pain Be Prevented?

The best things you can do to prevent back pain are:

Exercise often and keep your back muscles strong.
Maintain a healthy weight or lose weight if you weigh too much. To have strong bones, you need to get enough calcium and vitamin D every day.
Try to stand up straight and avoid heavy lifting when you can. If you do lift something heavy, bend your legs and keep your back straight.

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
Trouble urinating
Weakness
Numbness in your legs
Fever
Weight loss when not on a diet.
Pain plus any of these problems:

How Is Back Pain Diagnosed?

To diagnose back pain, your doctor will take your medical history and do a physical exam. Your doctor may order other tests, such as:

X rays
Magnetic resonance imaging (MRI)
Computed tomography (CT) scan
Blood tests.

Medical tests may not show the cause of your back pain. Many times, the cause of back pain is never known. Back pain can get better even if you do not know the cause.

What Is the Difference Between Acute and Chronic Pain?

Acute pain starts quickly and lasts less than 6 weeks. It is the most common type of back pain. Acute pain may be caused by things like falling, being tackled in football, or lifting something heavy. Chronic pain lasts for more than 3 months and is much less common than acute pain.

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.

Following are some types of treatments for chronic 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 may be prescribed for some types of chronic back pain, but these do not work for every type of back pain.

Behavior 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. Acupuncture 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 disk. When one or more of the disks that cushion the bones of the spine are damaged, the jelly-like center of the disk 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 disk disease. As people age, some have disks that break down and cause severe pain.

Rarely, when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, surgery is needed right away to ease the pain and prevent more problems.

What Kind of Research Is Being Done?

Highlights of recent research include:

Cost and effectiveness comparisons of surgical versus nonsurgical treatments for various types of back pain
Factors that go into patients' decisions about whether or not to have surgery for herniated disks
National statistics on back pain costs
Socioeconomic factors that relate to back pain costs and treatment.

Goals of current research are to:

Understand the many factors that can cause back pain
Identify ways to prevent back pain
Improve surgical and nonsurgical treatments for back pain
Prevent disability in people who suffer from back pain.

-NIH