Back Pain

Lower back pain is not a disease. It is a symptom that can result from many different causes. Lower back pain is defined by the location of the pain in one or both legs and neurological symptoms including weakness, loss of reflexes, loss of sensation, difficulty walking or standing for extended periods.

Low back pain can range in intensity from a dull and constant ache to sudden, sharp, and shooting pain. It can begin after an accident or lifting something heavy, or it can develop over time with age.

Lower back pain can be acute, short-term pain that lasts days or weeks but can take months to resolve with self-care without loss of function, or it can be chronic back. Chronic back pain is defined as lasting longer than 12 weeks, even after an injury or underlying cause has been treated. About 20% of people with acute back pain progress to chronic pain by one year. Sometimes chronic pain persists despite treatment.

Most people with a new episode of back pain recover quickly, but recurrence is common, and for some lower back pain persists and becomes disabling, interfering with function, social activities, and work.

People with physically demanding jobs, physical and mental conditions, smokers, and the obese are at increased risk of low back pain. Other risk factors include aging, physical fitness, and genetics.

Most acute back pain is mechanical, meaning there is a disruption in the interaction between the vertebrae, muscles, discs, and nerves. However, for many people it is not possible to identify a specific cause.

Causes include:

• Skeletal irregularities like scoliosis and other congenital anomalies.
• Injuries like strained ligaments and muscles. Muscle strain is a common cause.
• Trauma from sports, a fall or auto accident that cause a fracture, compress the nerves, or herniate a disc.
• Degenerative diseases including disc disease, arthritis and spondylosis which is a general deterioration of the spine due to normal wear and tear.
• Nerve and spinal cord problems like nerve compression, spinal stenosis, inflamed spinal joints, sciatica, infections, osteoporosis and more.
• Non spine causes: kidney stones, endometriosis, fibromyalgia, tumors, and pregnancy.

Your orthopedic specialist will review your medical history and conduct an orthopedic exam, and ask questions about your pain, the location and it affects your life. Imaging tests may be ordered to rule out herniated discs, fractures, tumors, and spinal stenosis. A bone scan may be ordered to rule out osteoporosis.

For acute pain the initial treatment is conservative with the use of over-the-counter anti-inflammatory medications, topical pain creams, analgesics for pain, heat and ice, stretching, exercise, yoga, chiropractic, acupuncture, TENS, and physical therapy.

For chronic back pain initial treatment will also be conservative measures, plus epidural steroid injections, and physical therapy. If pain is not relived, surgery may be indicated.