Back Pain

Fast Facts

• Approximately 80% of the world's population develops back pain at some point during their life.
• Back pain is one of the most common reasons that people see their doctor.
• The cause of low back pain can be determined by a medical history and physical examination, and rarely requires expensive or uncomfortable tests. Sometimes it can be difficult to pinpoint the exact cause though.
• The vast majority of patients will recover within a few weeks, usually by remaining active and exercising while occasionally taking pain-relieving drugs.
• In some patients back pain can become chronic.
• Lifestyle changes can be beneficial in successful management of back pain.

What Causes Back Pain?

Most episodes of back pain are caused by mechanical disorders associated with accidents and lifting incidents, or the gradual changes associated with aging.

• Muscle strains are usually related to sustained physical activity such as shoveling snow, gardening or prolonged driving. Acute strain may also occur when completing a common task from a twisted or rotational posture.
• Degenerative back disease often involves both the bony parts (the vertebral bodies) and the intervertebral discs, which provide cushioning between the vertebral bodies. In osteoarthritis, both the vertebral bodies and the intervertebral discs are affected. The vertebral bodies develop bone spurs, and the intervertebral discs lose integrity. This often leads to back pain, stiffness, and sometimes, muscle spasms.
• The intervertebral discs can also herniate, meaning they slip out of place. This can cause back pain associated with muscle spasms. Sometimes, as the disc slips out of place, it can press on a nerve and cause pain related to this. This type of pain is usually not limited to the back, but rather can cause symptoms radiating down the leg, as a result of the nerve being compressed. Disc herniation may cause a loss of function of the nerve that may include a loss of reflex, sensation, or muscle strength.
• Spinal stenosis is a narrowing of the canal that the spinal cord occupies. This narrowing has many causes including bone spurs growing around the spinal joints, thickening of spinal ligaments, or bulging of a disc. The narrowed canal squeezes the nerve roots causing leg pain, numbness, or weakness. The pain is increased by standing, bending, and sitting, and may be relieved by changing posture and positions.
• Diffuse Idiopathic Skeletal Hyperostosis (DISH), resulting from excessive bone growth, can affect the vertebrae from the neck to the lower back causing pain and stiffness.

Less common causes of back pain include ankylosing spondylitis, tumors, spinal infections, and osteoporosis resulting in compression fractures.

How Is Back Pain Diagnosed and Treated?

In a majority of patients, the cause of the back pain can be determined based on your history and physical exam. Plain x-rays may be helpful to document the presence of degeneration, or to demonstrate that there is truly narrowing of spaces where the nerves come out, to confirm what your doctor is already suspecting. Only when your symptoms don’t get better within the expected time will more sophisticated testing, like an MRI, be necessary. Most episodes of back pain respond to what we call “conservative” measures, meaning invasive procedures are not needed. Physical therapy is the key to this. Stretching and strengthening the muscles will help you recover and help keep the issue from happening again or happening too often. When treating back pain, bed rest should be kept to a minimum. Instead, patients should continue their activities as much as possible.

While excessive exercise should be discontinued until the pain is relieved, there are exercises that can help reduce pain. Pain management exercises may include flexion exercises (bending forward), extension exercises (bending backwards), stretching, and strengthening.

Five- to ten-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain. Beyond the first 48 hours, heat may help to relax the muscles. 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. In some cases, muscle relaxants may help.

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, may require surgery.

Sometimes back pain does not improve and becomes chronic. In such situations, it can be helpful to explore whether biopsychosocial factors are also playing a role. In this instance, mental health therapeutic modalities such as cognitive behavioral therapy have proven efficacy. Some medications that are targeted at overactive pain sensors can also be helpful in reducing the degree of chronic pain. Other, more aggressive treatments include spinal injections administered by pain management physicians.

Living with Back Pain

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 lifestyle. If you smoke, stop. Smoking is a predisposing factor for back pain. Obesity does not cause back pain, but is a factor that makes it more difficult to heal. If you are overweight, try to increase your activity level and eat healthier to get into shape. No diet is known to prevent episodes of low back pain.

Updated April 2023 by Karmela Kim Chan, 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.