Low Back Pain

Short-term pain that generally lasts for a few days or weeks before subsiding. Most acute back pain results from an injury or trauma to the lower back, or a flare-up of a disorder such as arthritis. Symptoms of acute back pain include muscle spasms and aches, shooting or stabbing pains, limited flexibility and range of motion or an inability to stand straight. In some cases, pain felt in one part of the body may radiate from a disorder or injury located elsewhere in the body. Left untreated, some forms of acute back pain can become more serious and chronic.

Often defined as pain that lasts for more than three months, or longer than is expected for the condition causing the pain. It is frequently progressive, with pain increasing over a period of time. In many cases, the cause of chronic back pain can be difficult to determine as pain can persist even though the underlying condition has healed.

If the spine becomes strained or compressed, an intervertebral disc may bulge or rupture, depriving the vertebrae of the “shock absorbers” they need. Cartilage from the disc may protrude into the space containing the spinal cord and nerve root, resulting in pain. In more serious cases, disc material may compress the bundle of lumbar and sacral nerve roots at the end of the spinal cord, known as the cauda equina. This condition is called cauda equina syndrome, and it may cause permanent neurological damage if left untreated.

In some cases, a herniated disc may press on one or both of the sciatic nerves, large nerves that exit the spinal column in the pelvis. The sciatic nerves carry nerve fibers to the leg. When the nerve is compressed, it causes shock-like or burning low back pain, as well as pain through the buttocks and down one leg to below the knee. In some cases, it may reach the foot. Sciatica can involve a pinched nerve between a disc and an adjacent bone. Symptoms in such cases are not only painful but may also include numbness and loss of motor control over the leg.

Deterioration of intervertebral discs. This condition is common as people age and can press on nerves.

Narrowing of spinal passages, producing pressure on the spinal cord or nerve roots.

Pain within a joint. Each vertebra is joined to the vertebra above and below by a joint called facet or zygapophyseal joint. Forms of arthritis that can cause back pain include:

• Osteoarthritis. Characterized by chronic degeneration of the cartilage of the joints. Osteoarthritis of the spine may be referred to as spondylosis. This may involve bone spurs (osteophytes).
• Rheumatoid arthritis. Chronic disease marked by stiffness and inflammation of the joints, weakness, loss of mobility and deformity.
• Ankylosing spondylitis. Chronic inflammation of the spinal joints and ligaments.

These produce strain on the vertebrae and supporting muscles, tendons, ligaments and tissues. They include:

• Scoliosis. Abnormal sideways curve of the spine.
• Kyphosis. Severely rounded forward curve in the upper back.
• Lordosis. Abnormally accentuated inward arch in the lower back.

Abnormal loss of bony tissue resulting in porous and brittle bones. Osteoporosis most often affects women after menopause but is also common in elderly men. Osteoporosis may lead to vertebral compression fracture, which can cause severe back pain and kyphosis (“dowager’s hump”).

A stress fracture in a posterior vertebral area called the pars interarticularis. This usually affects the fifth (lowest) lumbar vertebra and is a common source of low back pain in school-age athletes but can affect anyone. Sometimes the damaged vertebra becomes so weak it slips out of place, which is known as spondylolisthesis.

Inflammation of entheses, which are sites where tendons or ligaments attach to bone. Enthesitis is often related to other musculoskeletal conditions such as arthritis or tendinitis.

Bulging of part of the wall of the aorta, the large artery that directs blood from the heart to the rest of the body. Thoracic and abdominal aneurysms seldom produce symptoms but in some cases can cause back pain. A ruptured aneurysm is often marked by sudden and severe abdominal or back pain.

Several conditions related to diabetes can cause back pain, including focal neuropathy and diffuse idiopathic skeletal hyperostosis (DISH, in which spinal or other ligaments become bony).

This can be due to cancer originating in or near the spine, cancer that has spread (metastasized) from another area (e.g., prostate cancer, breast cancer) or referred pain from some cancers, such as testicular cancer. Benign tumors can also cause back pain.

A group of inherited disorders in which enzyme abnormalities impair the production of an important substance called heme. Heme’s functions including carrying oxygen in the blood. Acute porphyrias affect the nervous system and can cause pain in the back, chest and elsewhere.

Lab tests used in detecting or ruling out a wide range of conditions, from arthritis to sickle cell anemia.

A painless test in which an image is created of part of the body by using low doses of electromagnetic radiation that are reflected on film or fluorescent screens. Images may show the alignment of bones and whether or not the patient has degenerative joint disease or broken bones. However, these images cannot reveal problems with the spinal cord, muscles, fibrous tissues, nerves or intervertebral discs.

A noninvasive or minimally invasive test that uses sound waves and a magnetic field to produce clear cross-sectional or three-dimensional images of the body’s tissues. Images can be used to examine the lumbar region for bone degeneration. MRI can also help diagnose injury or disease in tissues, nerves, muscles, ligaments and blood vessels.

A noninvasive or minimally invasive test that uses multiple x-ray images, taken from different angles, to create three-dimensional images of body structures. Images may reveal disorders such as herniated discs, spinal stenosis or damage to vertebrae.

Uses high-frequency sound waves to create images of internal organs or tissues. It works by sending low-energy sound waves against tissue. It works by sending low-energy sound waves against tissue. Some waves pass through and some bounce back. As sound waves bounce back, they are recorded and displayed on a computer screen or television-type monitor. Ultrasound can be helpful to rule out the abdominal causes of back pain (e.g., kidney stones).

A type of radionuclide imaging test. Images may reveal bone tumors or compression fractures caused by osteoporosis. To perform the procedure, a physician injects a small amount of radioactive substance into the patient’s veins. After the substance has collected in the bones, a special camera is used to detect bone problems highlighted by the substance.

Measures electrical impulses generated by nerves and the muscles’ response to those impulses. This information can be used to confirm nerve compression resulting from herniated discs or spinal stenosis.

A special dye is injected into a spinal disc that is thought to be causing back pain. The dye highlights damaged areas that are revealed when x-rays are taken. This procedure is often used on patients who are considering spine surgery or whose pain has not responded to conventional treatments. A variation called functional anesthetic discography (FAD) involves injection of anesthetic into the disc.

Insertion of a needle into the spinal canal to extract cerebrospinal fluid for analysis. Spinal tap may be used in diagnosing conditions that can affect the central nervous system, such as Lyme disease or tumors.

When other tests are inconclusive, injections (e.g., facet joint injections) are sometimes done to diagnose the condition.

Medications including acetaminophen can ease pain, and nonsteroidal anti-inflammatorydrugs (NSAIDs) such as aspirin or ibuprofen can reduce inflammation, swelling and stiffness. Even over-the-counter acetaminophen or NSAIDs are not without side effects, especially in higher doses, so talking to a physician before taking these medications is recommended.

Start with cold compresses before moving on to hot compresses (or using hot baths instead of hot compresses). This technique can soothe sore and inflamed muscles. Cold treatment should be used first. Upon injuring the back, ice should be applied several times a day for up to 20 minutes at a time. Ice should not be applied to the back directly – there should always be at least a thin barrier between the ice and the skin. Cold treatments should be used as long as spasms persist.

Once acute pain has subsided – or after two or three days – heat from a heating pad or heat lamp should be used to loosen tight muscles. Again, applications should last no longer than 20 minutes. Although not scientifically proven to actually resolve back pain, these treatments do appear to reduce pain and inflammation and increase mobility for some patients.

Light activity speeds up healing and recovery. Immediately stop any activity that aggravates the muscles. A physician, physical therapist or exercise physiologist can suggest appropriate exercises, which may include stretching, swimming or walking. Prolonged bed rest – more than one or two days – should be avoided.

These drugs, primarily used to treat seizures, may also be effective in treating certain types of nerve pain. Anticonvulsants are often prescribed with analgesics.

Some antidepressants, particularly tricyclic antidepressants, can relieve pain and assist with sleep. The U.S. Food and Drug Administration (FDA) has cautioned that antidepressants may increase the risk of suicide. People taking antidepressants should be monitored for unusual behavior.

Prescribed to manage severe pain, they should be used only for short periods of time under close supervision of a physician, as they can have numerous side effects, including drowsiness, decreased reaction time, impaired judgment, depression and potential for addiction.

Needles the width of a human hair are inserted into trigger points around the body. Advocates of acupuncture say that it releases natural painkilling molecules. Some clinical studies have found acupuncture helpful in relieving back pain. A variation is a needle-free treatment called acupressure.

A special electronic machine is used to help train patients to become aware of and gain control over muscle tension, heart rate and skin temperature. The purpose is to help patients change their response to pain through relaxation techniques.

A range of approaches are used, including injections of local anesthetics or corticosteroids into soft tissues, joints or nerve roots. In some cases more complex nerve blocks and spinal cord stimulation are used. Spinal cord stimulation may be another option.

Involves the use of weights to apply a force intended to “pull” the skeletal structure into better alignment.

Helps increase the strength and endurance of the lower back. It is best to engage in regular aerobic exercise that does not strain or jolt the back, such as walking, swimming or biking.

Proper weight training can help strengthen abdominal and back muscles, allowing them to serve as a natural corset for the back. Stretching, yoga, tai chi and other exercises can increase flexibility in the hips and upper legs, which allows for proper pelvic bone alignment.

Excess weight strains the back muscles and increases back pain.

Smoking reduces the level of oxygen that reaches spinal tissue, thereby hindering the healing process when back muscles are strained or injured.

Measures such as using seatbelts and not diving into shallow water can reduce the risk of back pain.

Adequate intake of nutrients including vitamin D, calcium and magnesium may reduce the risk of osteoporotic fractures. Several recent studies suggest that carotenoids (found in orange and yellow vegetables and fruits) and certain enzymes in cruciferous vegetables (the broccoli and cabbage family) could protect the joints and help stave off arthritis. Some research indicates the mineral selenium, found in foods including seafood and meat, may help in preventing osteoarthritis.

• You or a family member has mild, low back pain that persists for 3 or 4 days after self-treatment.
• Back pain is severe or recurrent.
• New or unexplained symptoms appear. Medications used in treatment may cause side effects.