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Coordinated Health

Definition

Back pain is one of the most common health complaints. Almost everyone will have back pain at some time in their life. Most of the time, the exact cause of the pain cannot be found.

This article discusses long-term (chronic) low back pain. Other types of low back pain may occur more suddenly (acute low back pain).

Which is the most common area for back pain?The correct answer is the lower back. The lower back is most likely to hurt because it supports your body’s weight. You can help prevent low back pain by learning how to protect your back. Ask your health care provider about back-friendly ways to exercise, bend, and lift heavy objects.Which type of back pain is often caused by a sudden injury?The correct answer is acute. A sudden injury to the muscles and ligaments that support the back causes acute pain. Chronic pain is present when your back pain lasts for longer than two months or continues to recur. Your doctor can help figure out what type of back pain you have and how to treat it. Most people with acute back pain feel better in four to six weeks.The correct answer is true. You should start to feel better after one week, and your pain should be completely gone in four to six weeks. To get better quickly, ask your doctor what you can do at home to help your back recover.Which is better to treat acute back pain?The correct answer is both. Heat, ice, or both help treat back pain. Try using ice for the first 48 to 72 hours, and then apply heat. If you hurt your back, you should rest in bed.The correct answer is false. Staying in bed can make back pain worse. You may want to take it easy for a day or two, and then slowly get back to your regular activities. You can start exercising again after about two to three weeks, but avoid heavy lifting or twisting for six weeks. If you recover more quickly, you be more active sooner. Which activity should you avoid until your back is healed?The correct answer is all of the above. Don’t do any of these activities until your doctor or physical therapist tells you it’s okay. You should also avoid weight lifting, racquet sports, sit-ups, and leg lifts when lying on your stomach. All these exercises can strain your back.People who smoke are more likely to have low back pain.The correct answer is true. You also may have a greater risk for low back pain if you are overweight, pregnant, don’t exercise, feel stressed or depressed, are over age 30, or do a lot of heavy lifting or bending. Ask your doctor how to reduce your risk for back pain. Which of the following can help relieve chronic back pain?The correct answer is all of the above. Depending on what’s causing your back pain, your doctor may recommend any of these treatments. A physical therapist can help you heal and recover from back pain. Massage may help ease tight muscles and acupuncture may reduce pain. Talk therapy can help you understand and deal with chronic back pain. You’ll need prescription medicines for acute back pain.The correct answer is false. You can treat most acute back pain with over-the-counter pain relievers such as ibuprofen (Motrin) or acetaminophen (Tylenol). If these medicines don’t provide enough relief for your back pain, ask your doctor if there’s another medicine you can take. Your may need an injection in your spine if your back pain doesn’t improve.The correct answer is true. If your back pain doesn’t get better with other treatments, your doctor may recommend an injection in your spine. This delivers powerful medicine that reduces swelling in the spine. If other methods haven’t worked, ask your doctor if this treatment is an option for you. You’ll need surgery if your pain doesn’t get better in 12 weeks.The correct answer is false. Back surgery may be recommended only when you have nerve damage or have had back pain that doesn’t improve after a long time with other treatments. Work with your doctor to try other treatments first. You should call your doctor when you have this back pain symptom.The correct answer is any of the above. Also call if you have been losing weight without trying, back pain has lasted longer than 4 weeks, or you have had back pain before, but this time feels worse or different.

Alternative Names

Nonspecific back pain; Backache – chronic; Lumbar pain – chronic; Pain – back – chronic; Chronic back pain – low

Causes, incidence, and risk factors

One single event may not cause your pain. You may have been doing many things improperly — such as standing or lifting — for a long time. Then suddenly, one simple movement (such as reaching for something or bending from your waist) leads to pain.

Many people with chronic back pain have arthritis and extra wear and tear on the spine. This may be due to:

  • Heavy use from work or sports
  • Past injuries and fractures
  • Past surgery

You may have had a herniated disk, where part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.

If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.

Other possible causes of chronic low back pain:

  • Curvatures of the spine (such as scoliosis or kyphosis), which may be passed down in families
  • Medical problems, such as fibromyalgia, rheumatoid arthritis, and psoriatic arthritis
  • Piriformis syndrome (a pain disorder involving a narrow muscle in the buttocks)

You are at greater risk for low back pain if you:

  • Are over age 30
  • Are overweight
  • Are pregnant
  • Do not exercise
  • Feel stressed or depressed
  • Have a job in which you have to do a lot of heavy lifting, bending and twisting, or that involves whole body vibration (such as truck driving or using a sandblaster)
  • Smoke

Symptoms

You may feel a variety of symptoms if you have back pain, including:

  • Dull aching
  • Sharp pain
  • Tingling or burning sensation
  • Weakness in your legs or feet

Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or on the bottom of your foot.

Signs and tests

During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.

What other tests you have depend on your medical history and symptoms (including how the symptoms developed). Tests might include:

  • Blood tests, especially a complete blood count and erythrocyte sedimentation rate
  • CT scan of the lower spine
  • MRI scan of the lower spine
  • Myelogram (an x-ray or CT scan of the spine after dye has been injected into the spinal column)
  • X-ray

Treatment

If you have any concerning symptoms, call your doctor right away.

Your back pain may not go away completely, or it may get more painful at times. Learning to take care of your back at home and how to prevent repeat episodes of back pain can help you continue with your normal activities.

Your doctor and other health professionals can help you manage your pain and keep you as active as possible.

  • Your doctor may refer you for physical therapy. The physical therapist may try to reduce your pain, using stretches and traction. The therapist will show you how to do exercises that make your back muscles stronger, so you can prevent future back pain.
  • You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist). Sometimes a few visits with these specialists will help back pain.
  • You may need a back brace to support your back at work.
  • Cold packs and heat therapy may help your back pain.
  • Cognitive behavioral therapy may be helpful. This technique helps you better understand your pain and teaches you how to manage your back pain.

A number of different medications can help with your back pain:

  • Drugs (NSAIDs) such as aspirin, naproxen sodium (Aleve), and ibuprofen (Advil)
  • Low doses of prescription medicines used to treat seizures or depression (antidepressants)
  • Pain medicines called narcotics or opioids when the pain is very severe

When a severe episode of pain does not improve with medicine, physical therapy, and other treatments, you may need an epidural injection.

Spinal surgery should be considered only if you have nerve damage, or the condition causing the back pain does not heal after a long period of time.

Some people with low back pain may also need:

Expectations (prognosis)

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures will allow you to get better.

Complications

Future spine problems are possible for patients who have spine surgery. You may have a greater chance of future problems if you have more than one type of back surgery.

Calling your health care provider

Call your health care provider if you have persistent, severe back pain, especially if you also have numbness, loss of movement, weakness, or bowel or bladder changes.

Prevention

See also: Taking care of your back at home

Related:Spine surgery – discharge, Diskectomy, Foraminotomy, Laminectomy, Spinal fusion, Sciatica

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