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Back pain is just that—pain in the back. It can be localized to the lumbar spine or may radiate into the legs below the knee (sciatica). Most episodes of back pain are caused by mechanical disorders. On occasion, “Oh my aching back,” can signal systemic illnesses that generate very real pain. In fact, back pain is associated with over 60 illnesses and can result in serious disability and escalating medical bills. The good news is about half of individuals with low back pain improve within a week or two, and 90 percent of these episodes are resolved in eight weeks.
As a rule, most episodes of back pain are caused by mechanical disorders associated with overuse of the back and spine, or the gradual changes associated with aging. In about 10 percent of the cases, back pain is caused by a systemic illness.
The disorders affecting the low back can be divided into mechanical and systemic disorders. Mechanical disorders that can result in back pain include:
Systemic disorders that can lead to back pain include ankylosing spondylitis, osteoporosis, tumors and spinal infections.
Typically, only a medical history and physical examination are required to diagnose low back pain. In some cases, individuals who do not respond to initial therapy may undergo specialized radiographic tests, such as magnetic resonance imaging (MRI) and computerized tomography to screen for additional involvement of soft tissues, ruptured discs, spinal stenosis, tumors or nerve injuries.
When treating back pain, it should not be equated with a need for bed rest. In fact, bed rest should be kept to a minimum. Instead, patients should continue their activities of daily living, as tolerated.
While excessive exercise should be discontinued until the pain is relieved, there are exercises that can help reduce pain. These include flexion exercises (bending forward) for pain with standing, and extension exercises (bending backwards) for pain made worse with sitting. Forward bending exercises are helpful for back pain with standing.
Five- to ten-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain as can heat, which relaxes the muscles. Heat should be used to treat back pains that last longer than 48 hours. Over-the-counter pain relievers such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) are frequently adequate to control episodes of back pain, and muscle relaxants may help those with limited motion secondary to muscle tightness.
Massage therapy has proven helpful for those with chronic muscular pain, and some patients with back pain localized to the lumbar spine have been known to benefit from manipulation of the spine.
A small minority of low back pain patients, particularly those with leg pain due to a herniated intervertebral disc, spinal stenosis, or tumors affecting structures in the spine will require surgery. Surgery for disc replacement is limited to a very small group of individuals with disc damage and no other abnormality.
In most instances, individuals with low back pain will improve over a two- to six-week period. The goal is to minimize recurrences and, while being in good physical condition does not prevent all back pain episodes, it will make the resolution of those episodes easier. Lifestyle changes may be necessary. Be sure to pay attention to your body, exercise, eat right and maintain a healthy life style. If you smoke, stop. Smoking is a predisposing factor for back pain. Obesity does not cause back pain, but it does make it harder to heal. If you are overweight, try to increase your activity level and eat healthier to get into shape. No particular diet is known to prevent episodes of low back pain.
Reviewed May 2015. Written by David Borenstein, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
© 2015 American College of Rheumatology
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