Back Pain
Back pain is the most common cause of disability in the U.S. The vast majority of cases resolve quickly and are not serious and typically affects 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, which include: Tobacco use, excessive consumption of alcohol and drugs, poor diet, lack of regular physical activity, repetitive, stressful motions and movements, overweight and obesity. Back pain usually occurs in the lower back but it can occur in the upper back as well. Pain can be sharp and come with movement or it may be a dull ache that is ever-present (or a combination of the two). Patients may also have limited range of motion or tenderness upon touch and symptoms may occur with excessive movement after long periods of inactivity. Each person’s back pain is as unique as they are.
Most back pain can be attributed to mechanical causes, but a small number of cases are due to more serious illness. Beyond simple wear-and-tear, the most common causes of back pain include: disc degeneration (e.g. osteoarthritis), muscle strain, mechanical problems (for example, a herniated disc), and vertebral fractures associated with osteoporosis. In some cases, “sciatic pain” can also occur. This pain results from the compression of the sciatic nerve and comes with radiating pain across the buttocks and down your hip and leg.
Other rare, more serious causes of back pain can include: cancer, infection, vascular problems, or damage to nervous tissues. Certain red flags indicate a more serious condition that may require emergency evaluation or surgery. If you experience back pain accompanied by weakness, numbness, tingling, fever, weight loss, or problems with bowel or bladder control, head to your nearest emergency room.
Diagnosing back pain - The path to diagnosing the cause of your back pain starts with a comprehensive medical history and physical examination by your doctor. Some causes of back pain are genetic, and a family history can help identify those potential factors. For patients whose back pain persists beyond several weeks despite conservative treatments, your doctor may recommend supplemental imaging. Depending on your particular back pain symptoms, your doctor may order an X-ray if they suspect a bone infection or tumor or magnetic resonance imaging (MRI) or computed tomography (CT) scan to diagnose disc herniation. Imaging may also be necessary if your doctor suspects a serious condition based on family or medical history. Additionally, your doctor may order a full neurological work-up to identify compressed nerves from a herniated disc. While this is not always necessary, it can provide your doctor with valuable information for treatment.
Back Pain Treatments - There are a variety of treatment options that range from conservative approaches to surgery if pain persists, but for most patients, conservative treatments will help them relieve their pain and get back to their lives. Below are several recommended and effective treatments:
Rest - Rest is suggested only in the most acute phase of back pain, usually three days or fewer. Too much rest can make pain worse.
2. Lifestyle changes - All people will likely benefit from making adjustments to diet and activity to help facilitate weight loss or to help maintain a healthy body-mass index (BMI).
3. Exercise - Most back pain will resolve itself within a few weeks although exercise can help make this happen, especially core exercises and low-impact whole body workouts like swimming and yoga which help strengthen the body.
4. Physical therapy - PT uses individualized exercises to improve range of motion, increase flexibility, and speed recovery of both acute and chronic back pain which is a is a great first-line treatment for many more moderate to severe cases of back pain.
5. Acupuncture or chiropractic care - Acupuncture is gaining traction as a research-based treatment of back pain while chiropractic care offers spinal adjustments that can offer significant relief and improved function.
6. Non-steroidal anti-inflammatory drugs (NSAIDs) - Pain-relieving medications are typically the initial treatment of choice for acute back pain. These can include over-the-counter pain medicines such as acetaminophen and ibuprofen. For many, taking NSAIDs in conjunction with one of the above therapies can help you get the treatment you need with less pain.
7. Prescription medications - Muscle relaxants can help ease back spasm and tension for some patients. In general, opioids are ineffective for long-term management of back pain, but may be recommended during the acute phase.
8. Injections - Some types of injections can be helpful to manage back and address its causes, including epidural steroid injections. Seek guidance from your interventional pain management physician on the most effective types of injections for your particular condition.
9. Surgery - Back pain due to disc herniation may require surgical intervention via spinal fusion or discectomy (the removal of herniated tissue). Surgery is only recommended when other more conservative treatments have failed.
The most important part of back pain treatment is looking at the whole patient and designing an individualized treatment plan that addresses diet, exercise, the root cause of your back pain, and any other factors that might affect outcomes. Speak with your interventional pain management physician on the most effective types of treatment for back pain.