Back pain (patient information)

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Overview
Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain.

What are the symptoms of Back pain?
It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Back pain may occur by itself, or along with other symptoms. Back pain is categorized into acute pain and chronic pain.

Pain that hits you suddenly—after falling from a ladder, being tackled on the football field, or lifting a load that is too heavy, for example—is acute pain. Acute pain comes on quickly and often leaves just as quickly. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.

Chronic pain, on the other hand, may come on either quickly or slowly, and it lingers a long time. In general, pain that lasts longer than 3 months is considered chronic. Chronic pain is much less common than acute pain.

What causes Back pain?
Medical problems that can cause back pain include the following:


 * Mechanical problems: A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disk degeneration (such as degenerative disk disease, which simply means that the disks located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms, muscle tension, and ruptured disks, which are also called herniated disks.


 * Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis. Less commonly, back pain may be caused by more severe injuries that result from accidents or falls.


 * Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include:
 * scoliosis, a curvature of the spine that does not usually cause pain until middle age
 * spondylolisthesis
 * various forms of arthritis, including:
 * osteoarthritis
 * rheumatoid arthritis
 * ankylosing spondylitis
 * spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves.
 * kidney stones or kidney infections
 * endometriosis, which is the buildup of uterine tissue in places outside the uterus
 * fibromyalgia, a condition of widespread muscle pain and fatigue.


 * Additionally, although osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Pregnancy is also a common cause of back pain.


 * Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the disks that cushion the vertebrae, which is called diskitis. Tumors also are relatively rare causes of back pain.


 * Emotional:Although the causes of back pain are usually physical, emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.

Who is at highest risk?
Although anyone can have back pain, a number of factors increase your risk. They include:


 * Age: The first attack of low back pain typically occurs between the ages of 30 and 40. Back pain becomes more common with age.


 * Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise is good for the disks that cushion the vertebrae, the individual bones that make up the spine.


 * Diet: A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity, which can put stress on the back.


 * Heredity: Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, have a genetic component.


 * Race: Race can be a factor in back problems. African American women, for example, are two to three times more likely than white women to develop spondylolisthesis, a condition in which a vertebra of the lower spine— also called the lumbar spine— slips out of place.


 * The presence of other diseases: Many diseases can cause or contribute to back pain. These include various forms of arthritis, such as osteoarthritis and rheumatoid arthritis, and cancers elsewhere in the body that may spread to the spine.


 * Occupational risk factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when this involves twisting or vibrating the spine, can lead to injury and back pain. An inactive job or a desk job may also lead to or contribute to pain, especially if you have poor posture or sit all day in an uncomfortable chair.


 * Cigarette smoking: Although smoking may not directly cause back pain, it increases your risk of developing low back pain and low back pain with sciatica. For example, smoking may lead to pain by blocking your body’s ability to deliver nutrients to the disks of the lower back. Repeated coughing due to heavy smoking may also cause back pain. It is also possible that smokers are just less physically fit or less healthy than nonsmokers, which increases the likelihood that they will develop back pain. Smoking also increases the risk of osteoporosis, a condition that causes weak, porous bones, which can lead to painful fractures of the vertebrae. Furthermore, smoking can slow healing, prolonging pain for people who have had back injuries, back surgery, or broken bones.

When to seek urgent medical care?
In most cases, it is not necessary to see a doctor for back pain because pain usually goes away with or without treatment. However, a trip to the doctor is probably a good idea if you have numbness or tingling, if your pain is severe and doesn’t improve with medication and rest, or if you have pain after a fall or an injury.

In most cases, it is best to see your primary care physician first. In many cases, he or she can treat the problem. In other cases, your doctor may refer you to an appropriate specialist.

It is also important to see your doctor if you have pain along with any of the following problems: trouble urinating; weakness, pain, or numbness in your legs; fever; or unintentional weight loss. Such symptoms could signal a serious problem that requires treatment soon.

Diagnosis
Diagnosing the cause of back pain requires a medical history and a physical exam. During the physical exam, your doctor may:
 * watch you stand and walk
 * check your reflexes to look for slowed or heightened reflexes, either of which might suggest nerve problems
 * check for fibromyalgia by examining your back for tender points, which are points on the body that are painful when pressure is applied to them
 * check for muscle strength and sensation
 * check for signs of nerve root irritation.

Often a doctor can find the cause of your pain with a physical exam and medical history alone. However, depending on what the history and exam show, your doctor may order medical tests to help find the cause. These tests may include:
 * X-rays
 * Magnetic resonance imaging (MRI)
 * Computed tomography (CT) scan
 * Blood tests

Treatment options
Treatment for back pain generally depends on what kind of pain you experience: acute or chronic. Acute Back Pain

Acute back pain usually gets better on its own and without treatment, although you may want to try acetaminophen, aspirin, or ibuprofen to help ease the pain. Perhaps the best advice is to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness, relieve pain, and have you back doing your regular activities sooner. Exercises or surgery are not usually advisable for acute back pain.

Chronic Back Pain: Treatment for chronic back pain falls into two basic categories: the kind that requires an operation and the kind that does not. In the vast majority of cases, back pain does not require surgery. Doctors will nearly always try nonsurgical treatments before recommending surgery. In a very small percentage of cases— when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, for example— prompt surgery is necessary to ease the pain and prevent further problems.

Following are some of the more commonly used non-surgical treatments for chronic back pain:
 * Hot or cold packs, or sometimes a combination of the two, can be soothing to chronically sore, stiff backs.
 * Exercise and stretching: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce the risk of it returning.
 * Medications: A wide range of medications are used to treat chronic back pain. Some are available over the counter. Others require a doctor’s prescription. Types of medications used include:
 * Analgesics
 * NSAIDs
 * Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.
 * Traction: Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disk to slip back into place. Some people experience pain relief while in traction, but that relief is usually temporary.
 * Corsets and braces
 * Behavioral modification
 * Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief.
 * Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. Although such therapies won’t cure diseases or repair the injuries that cause pain, some people find them useful for managing or relieving pain. Such treatments include:
 * Manipulation
 * Transcutaneous electrical nerve stimulation (TENS)
 * Acupuncture and/or acupressure
 * Massages such as Rolfing

Surgical treatments: In general, two groups of people may require surgery to treat their spinal problems. People in the first group have chronic low back pain and sciatica. People in the second group are those with only predominant low back pain (without leg pain). Usually, the outcome of spine surgery is much more predictable in people with sciatica than in those with predominant low back pain.

Some of the diagnoses that may need surgery include:
 * Herniated disks
 * Spinal stenosis
 * Spondylolisthesis
 * Vertebral fractures
 * Diskogenic low back pain (degenerative disk disease)

Each diagnosis has its own specific surgeries to help. Your doctor can refer you to a specialist who treats these problems.

Where to find medical care for Back pain?
Directions to Hospitals Treating Back pain

What to expect (Outlook/Prognosis)?
The outlook for acute back pain is very good. Many times it will leave as quickly as it came.

Chronic pain, on the other hand, may come on either quickly or slowly, and it lingers a long time. Outlook varies greatly for chronic pain, and depends on what conditions accompany it and what treatments are required.

For those patients who require surgery, the outcome is generally much more predictable in people with sciatica than in those with predominant low back pain.

Possible complications
Since back pain is a symptom of a medical condition, not a diagnosis itself, complications are mostly dependent on the medical condition or injury that caused the pain.

Additionally, each surgery comes with its own risks of complication. If your doctor recommends surgery, be sure to review all the risks and benefits prior to the surgery.