If you’ve ever groaned, “Oh, my aching back!”, you are not alone. 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. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take awhile. Taking over-the-counter pain relievers and resting can help. However, staying in bed for more than 1 or 2 days can make it worse.

If your back pain is severe or doesn’t improve after three days, you should call your health care provider. You should also get medical attention if you have back pain following an injury.

Treatment for back pain depends on what kind of pain you have, and what is causing it. It may include hot or cold packs, exercise, medicines, injections, complementary treatments, and sometimes surgery.

What is Back Pain ?

Back pain is one of the most common medical problems in the United States. It might feel like a dull, constant ache or a sudden, sharp pain. Back pain can result from:

• An accident.
• A fall.
• Lifting something heavy.
• Changes that happen in the spine as you age.
• A disorder or medical condition.

Treatment depends on the cause and symptoms of your pain. You can do things to improve your health and lower your chance of developing chronic (long-lasting) back pain.

What are the Symptoms of Back Pain?

Your back may hurt in one specific part or it may spread all over your back. It also can cause pain in other areas, such as the:

• Buttocks.
• Legs.
• Abdomen.

Depending on the type, cause, and location, your back pain may get worse when:

• Lifting and bending.
• Resting.
• Sitting.
• Standing.

It may come and go. You also may feel stiffness in the morning when you wake up, and the pain may get better as you move around.

You should see a doctor if your pain does not get better after a few weeks or if any of the following symptoms happen with your back pain:

• Numbness and tingling.
• Very bad back pain that does not get better with medication (see Treatment section).
• Back pain after a fall or injury.
• Back pain along with:
  • Trouble urinating.
  • Weakness, pain, or numbness in your legs.
  • Fever.
  • Weight loss that you did not intend.

How to Classify Back Pain?

Back pain can be categorized into different types based on the underlying causes and the specific areas of the back affected. Here are some common types of back pain:

1. Mechanical or Non-specific Back Pain: This is the most common type of back pain and is often related to muscle strains, ligament sprains, or overuse. It is typically not associated with any underlying medical condition and is referred to as non-specific because the exact cause may not be clear.
2. Herniated Disc (Bulging Disc or Slipped Disc): This type of back pain occurs when one of the rubbery discs between the vertebrae in the spine ruptures or bulges, putting pressure on nearby nerves. It can lead to shooting pain, numbness, and tingling in the legs, often referred to as sciatica.
3. Degenerative Disc Disease: Over time, the intervertebral discs can naturally degenerate, causing back pain due to the reduced cushioning between the vertebrae.
4. Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can lead to pressure on the spinal cord or nerves, resulting in pain, numbness, and weakness, particularly in the legs.
5. Spondylolisthesis: This occurs when a vertebra slips out of place, typically forward over the vertebra below it. It can cause lower back pain and may lead to nerve compression.
6. Sciatica: Sciatica is a type of back pain characterized by pain that radiates down one leg. It is often caused by compression of the sciatic nerve, typically due to a herniated disc or spinal stenosis.
7. Muscle Spasms: Muscle spasms in the back can result from muscle overuse, strain, or injury. These spasms can cause acute, intense pain.
8. Ankylosing Spondylitis: This is a chronic inflammatory condition that primarily affects the spine, leading to stiffness and pain. It can cause the vertebrae to fuse together over time.
9. Scoliosis: Scoliosis is an abnormal curvature of the spine, which can lead to back pain in some cases. It typically occurs during growth spurts in childhood or adolescence.
10. Osteoarthritis: Osteoarthritis can affect the spine, leading to pain and stiffness in the back. It involves the degeneration of the cartilage that cushions the joints.
11. Fibromyalgia: While fibromyalgia is a systemic condition, it can result in widespread muscle pain, including back pain, and is often accompanied by other symptoms like fatigue and sleep disturbances.
12. Infections and Tumors: Infections of the spine, such as vertebral osteomyelitis, and tumors in the spine can cause back pain. These are less common but may require urgent medical attention.

Each type of back pain may require different diagnostic and treatment approaches.

You may feel back pain that happens suddenly and lasts a few days to a few weeks, or you may have back pain that lasts longer, such as 4 to 12 weeks or more.

Back pain can be acute (short term) or chronic (long term). It can feel like a sudden, sharp pain or a dull, constant ache.

Acute back pain lasts from a few days to a few weeks. It’s often caused by an accident, fall, or lifting something that’s too heavy. Acute back pain usually gets better on its own, without any treatment.

Chronic back pain lasts for more than 3 months. It’s much less common than acute back pain. Most chronic back pain can be treated without surgery.

Who Gets Back Pain?

Back pain is a common condition that can affect people of all ages and backgrounds. While back pain is more prevalent in certain populations and age groups, it can impact anyone. Here are some factors that contribute to the likelihood of experiencing back pain:

1. Age: Back pain becomes more common as people age, particularly once they reach their 30s and 40s. This is often due to natural wear and tear on the spine, including degenerative changes in the discs and joints.
2. Occupation: Jobs that involve heavy lifting, repetitive movements, or prolonged periods of sitting or standing can increase the risk of back pain. Occupations with physically demanding tasks, such as construction workers or nurses, are at a higher risk.
3. Sedentary Lifestyle: A lack of regular physical activity and poor posture can lead to weakened back muscles and increased susceptibility to pain. Office workers who spend long hours at a desk are more prone to developing back pain.
4. Excess Weight: Being overweight or obese can place extra stress on the spine, increasing the likelihood of back pain.
5. Poor Physical Conditioning: Weak core muscles, inflexibility, and a lack of strength can contribute to back pain. People who do not engage in regular exercise may be more susceptible.
6. Genetics: There may be a genetic component to back pain susceptibility. Individuals with a family history of back problems may be at a higher risk.
7. Psychosocial Factors: Stress, anxiety, and depression can contribute to the perception and intensity of back pain. Emotional factors may exacerbate or prolong the experience of pain.
8. Gender: Back pain affects both men and women, but some studies suggest that women may be more likely to experience certain types of back pain, such as lumbar radicular pain.
9. Underlying Medical Conditions: Conditions such as osteoporosis, arthritis, scoliosis, and spinal abnormalities can increase the risk of back pain.
10. Injuries: Traumatic injuries from accidents or sports-related activities can cause acute or chronic back pain.
11. Pregnancy: Pregnancy-related hormonal changes, weight gain, and postural shifts can lead to back pain in pregnant women.
12. Fitness level: Back pain is more common among people who are out of shape. You may also get back pain if you exercise too hard after not being active for a while.
13. Family history: Your genes play a role in some disorders that cause back pain.

What Causes Back Pain?

How is Back Pain Diagnosed?

Doctors use many tools to help figure out the possible cause for your back pain, which helps them know how best to treat it.

How is Back Pain Treated?

Doctors treat back pain with medications, other treatments, and surgery. Medications may help relieve pain or help tense muscles relax.

The treatment of back pain varies depending on the underlying cause and the severity of the pain. Here are common approaches to treating back pain:

1. Rest: In cases of acute back pain, especially when caused by muscle strains or minor injuries, short-term rest can help. However, prolonged bed rest is generally discouraged as it can lead to muscle weakness and stiffness.
2. Pain Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can provide pain relief. For more severe pain, prescription medications may be considered, including muscle relaxants or stronger pain relievers. Your doctor will determine the appropriate medication based on your specific condition.
3. Physical Therapy: Physical therapy is often recommended for back pain. A physical therapist can provide exercises and stretches to improve strength, flexibility, and posture, as well as techniques to alleviate pain and prevent recurrence.
4. Heat and Cold Therapy: Applying heat or cold to the affected area can help reduce pain and muscle spasms. Cold packs are typically used in the first 48 hours after an injury, while heat therapy is used to relax tense muscles after that initial period.
5. Exercise: Regular exercise can strengthen the muscles that support the back, improve flexibility, and alleviate pain. Your healthcare provider or physical therapist can recommend appropriate exercises tailored to your condition.
6. Epidural Steroid Injections: For severe back pain, especially when associated with inflammation, epidural steroid injections may be used to deliver anti-inflammatory medication directly to the affected area, reducing pain and inflammation.
7. Chiropractic Care: Chiropractors use manual techniques to adjust the spine and musculoskeletal system, which can relieve pain and improve mobility for some individuals.
8. Acupuncture: This alternative therapy involves the insertion of thin needles into specific points on the body to alleviate pain and promote healing.
9. Transcutaneous Electrical Nerve Stimulation (TENS): TENS units deliver low-level electrical currents to the skin over the painful area, which can provide relief by disrupting pain signals.
10. Surgery: In cases where conservative treatments are ineffective or when there is a structural issue requiring intervention, surgery may be recommended. Surgical options include discectomy (removal of a herniated disc), spinal fusion, and laminectomy (removal of part of a vertebra). Surgery is typically considered a last resort.
11. Lifestyle Changes: Maintaining a healthy weight, practicing good posture, using ergonomic equipment, and avoiding activities that exacerbate your pain can all contribute to long-term back pain management.

The most effective treatment for your back pain will depend on its cause and severity. It’s crucial to consult with a healthcare professional for an accurate diagnosis and to discuss the most appropriate treatment plan tailored to your specific condition.

Who Treats Back Pain?

Different types of health care providers treat back pain, depending on the cause:

• Pain specialists, who have training in diagnosing and treating different types of pain.
• Family or primary care doctors.
• Orthopaedists, who treat and perform surgery for bone and joint diseases.
• Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
• Neurosurgeons, who perform surgery for disorders and diseases of spine, brain, and nerves.
• Rheumatologists, who specialize in treating musculoskeletal diseases and autoimmune disorders.
• Physical therapists, who specialize in movement and strengthening muscles.

Living With Back Pain

Living with back pain can be hard; however, most people feel better within 6 weeks. Remember to follow your doctor’s directions. These tips may make it easier for you to manage your pain and recover:

• Add exercises slowly and talk to your doctor about the types of exercises that are best for you or those that you should not do.
• When sitting for a long time, get up, move around, and switch positions frequently.
• Wear shoes that feel good and that have a low heel.
• When driving a long way, try using support behind your back, and stop frequently to stand up and walk around.
• Sleep on your side, and place a small pillow between your knees. If you tend to sleep on your back, place a pillow under your knees. If possible, try to avoid sleeping on your stomach.
• Limit the amount you carry. Instead, make a few extra trips to avoid carrying too much weight.

Living with back pain can be challenging, but there are several strategies and lifestyle adjustments that can help you manage your pain and improve your quality of life:

1. Consult a Healthcare Professional: First and foremost, consult a healthcare provider to determine the cause of your back pain and receive an accurate diagnosis. They can recommend appropriate treatments and therapies.
2. Medication Management: If your doctor prescribes pain medications, take them as directed and be aware of potential side effects. Over-the-counter pain relievers may also be helpful for mild pain.
3. Physical Therapy: A physical therapist can teach you exercises and techniques to strengthen your back and improve flexibility. Regular physical therapy sessions can be essential for long-term back pain management.
4. Posture and Ergonomics: Maintain good posture, whether sitting, standing, or lifting. Use ergonomic chairs and equipment if you have a desk job. Proper body mechanics can reduce strain on your back.
5. Regular Exercise: Engage in regular, low-impact exercises that strengthen your core and back muscles. Activities like swimming, walking, and yoga can be beneficial. Always consult your doctor or physical therapist before starting a new exercise regimen.
6. Weight Management: Maintaining a healthy weight can reduce the stress on your back and improve overall health. A balanced diet and regular physical activity are essential.
7. Appropriate Footwear: Choose supportive shoes with good arch support to reduce stress on your back. Avoid high heels or shoes with inadequate cushioning.
8. Pain Relief Techniques: Use hot or cold packs as needed to alleviate pain and muscle stiffness. Experiment to find what works best for you.
9. Sleep Comfort: Invest in a comfortable mattress and pillows that provide proper support. Maintain a consistent sleep schedule and avoid sleeping in awkward positions.
10. Stress Management: Chronic pain can increase stress, which in turn can exacerbate pain. Practice relaxation techniques like deep breathing, meditation, and mindfulness to manage stress and pain.
11. Avoid Prolonged Sitting: If you have a desk job, take regular breaks to stand and stretch. Consider using a standing desk or ergonomic chair.
12. Stay Active: Continue with your daily activities as much as possible. Inactivity can lead to muscle weakness and further pain. Adapt your activities as needed, but strive to maintain a level of mobility.
13. Supportive Furniture: Consider using ergonomic chairs, lumbar cushions, or back supports to promote good posture while sitting.
14. Assistive Devices: If mobility is limited, consider using assistive devices like canes, walkers, or braces as recommended by your healthcare provider.
15. Psychological Support: Chronic pain can have emotional and psychological effects. Counseling or support groups can help you manage the emotional impact of living with back pain.
16. Balance Rest and Activity: Avoid overexertion, but also avoid excessive rest, which can weaken muscles. Find the right balance that works for you.

Can I prevent back pain?

One of the best ways to prevent back pain is to keep your back muscles strong. Follow these steps to help protect your back and prevent back pain:

• Do back-strengthening and stretching exercises at least 2 days a week.
• Stand and sit up straight.
• Avoid heavy lifting. If you do lift something heavy, bend your knees and keep your back straight. This way, your leg muscles will do most of the work.
• Get active and eat a balanced diet. Being overweight can strain your back. Getting active and heating healthy can help you stay at a healthy weight.

You may be able to prevent back pain that happens because of overuse or moving the wrong way. The following tips may help:

• Get regular exercise that keeps your back muscles strong. Exercises that increase balance and strength can lower your risk of falling and injuring your back or breaking bones. Your doctor may recommend that you try tai chi or yoga.
• Eat a healthy diet with enough calcium and vitamin D, which help keep your spine strong.
• Maintain a healthy weight to avoid stress and strain on your back.
• Sit up straight. Try to support your back when sitting or standing.
• If you have to lift something heavy, use your leg and stomach muscles, not your back.
• Focus on good posture.
  • Try not to slouch when standing and sitting.
  • Sit up straight with your back against the back of your chair and your feet flat on the floor. If possible, keep your knees slightly higher than your hips.
  • Stand tall with your head up and shoulders back.
  • If you can, switch between standing and sitting so you aren’t in the same position for too long.
• Healthy Habits

Healthy Habits for Preventing Back Pain

Watch your weight.

Staying at a healthy weight lowers your risk of back pain. If you are overweight, losing weight in a healthy way can reduce the strain on your back.

Get enough calcium and vitamin D.

Getting enough calcium and vitamin D can help keep your bones strong and prevent osteoporosis. Osteoporosis makes your bones weaker and more likely to fracture (break).

Spine fractures from osteoporosis are a leading cause of back pain.

What You Can Do About Your Back Pain

Avoid bed rest. Studies show that lying down too much can slow recovery and raise the pain.

“Over the last 25 years or so, probably the one thing we’ve learned definitively about back pain and bed rest is that is not OK,” says William Lauretti, DC, an associate professor at New York Chiropractic College and a spokesperson for the American Chiropractic Association. Instead, “you want to be as active as you can be with your back pain.”

Move. You may not want to move when you’re in pain, but it’s important to do as much as you can handle.

Robertson says most back pain isn’t serious, even if it may be very painful. “So not being afraid of motion and continuing to move despite the pain is something that’s really important,” he says. Walking is a good choice you can do on your own. You also can work with a physical therapist to learn how to spot dangerous levels of pain and which moves are best for you.

Keep good posture. Pay attention to the way you hold your back when you sit, stand, walk, sleep, or do day-to-day activities. Good posture is when all the bones in your spine are correctly aligned. Poor posture can leave your back stiff and tense. This often to leads to back pain.

Lauretti offers these tips on posture:

• Don’t sit up in your bed hunched over your laptop. That’s a surefire recipe for back pain over time.
• If you must sit for a long time, use cushioned chairs. Hard seats won’t support your back and may prevent you from sitting up straight.
• Use a comfortable desk and chair if you need them while working.

Here are some general tips to maintain good posture:

• Keep your feet shoulder-width apart.
• Tuck your stomach in when you’re standing.
• If you’re standing for too long, regularly shift your weight from one foot to the other and from your toes to heels.
• Roll your shoulders back.
• Let your arms hang naturally on the sides of your body.

Sleep smart. The ideal bed, Lauretti says, is one that’s “comfortable for you.” As for the best sleep posture, he says on your side or back is easier on your back than sleeping on your belly. If you’re face down, your head will be turned all night so you can breathe, which can lead to neck pain.

Bhamgara says tucking a pillow between her legs to help align her hips lessens her back pain.

Relax. Back pain can be linked to stress, tension, and other non-physical problems, Robertson says. Massages and acupuncture may help loosen muscles. Yoga, meditation, and other mindfulness practices may help lift your mood, stretch your muscles, and make you relax so you can better manage your back pain.

Bhamgara says mediation made her feel alive, especially when her back pain made it painful to move freely.

“I would think about healing every inch of my body,” she says. “There were times I would imagine myself walking in a park with my headphones on and just dancing! That brought me life.”

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• Back Pain

What is Back Pain Prescriptions ?

Prescription medications for back pain are typically prescribed by a healthcare provider to manage pain, reduce inflammation, and improve your ability to function while addressing the underlying cause of the pain. The specific prescription medication prescribed will depend on the type and severity of the pain, as well as the individual’s medical history. Here are some common prescription medications used for back pain:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Prescription-strength NSAIDs, such as diclofenac, meloxicam, or indomethacin, are used to reduce pain and inflammation. They can be helpful for conditions like osteoarthritis or acute episodes of back pain.
2. Muscle Relaxants: These medications, like cyclobenzaprine or tizanidine, are prescribed to relieve muscle spasms and reduce muscle tension. They can help with acute back pain caused by muscle strains.
3. Opioid Pain Medications: In some cases, when the pain is severe and not well-controlled with other treatments, healthcare providers may prescribe opioid pain relievers, such as oxycodone or hydrocodone. These medications should be used cautiously due to their potential for dependence and side effects. They are typically prescribed for short periods and under close supervision.
4. Anticonvulsants: Certain anticonvulsant medications, such as gabapentin or pregabalin, may be prescribed to manage neuropathic pain, including pain associated with conditions like herniated discs or sciatica.
5. Tricyclic Antidepressants: Tricyclic antidepressants like amitriptyline or nortriptyline can be used to manage chronic back pain, especially when it is associated with nerve pain. These medications can help to alleviate pain by affecting the way pain signals are processed in the brain.
6. Steroids: In some cases, corticosteroids may be prescribed to reduce inflammation and pain associated with certain back conditions. These may be administered orally or through epidural injections.
7. Biologics: Biologic medications, such as tumor necrosis factor (TNF) inhibitors, may be prescribed for individuals with inflammatory back pain conditions like ankylosing spondylitis.
8. Topical Medications: Topical analgesic medications, like prescription-strength lidocaine patches or diclofenac gels, can be used to target localized pain and provide relief.

How About Muscle Relaxants ?

If over-the-counter pain relievers or prescription NSAIDs are not relieving your back pain, your doctor may suggest adding a muscle relaxant. These medications include:

• Cyclobenzaprine (Flexeril)
• Tizanidine (Zanaflex)
• Baclofen (Lioresal)
• Carisoprodol (Soma)

There are many brand names in the same category, says Jung. They help relieve the muscle spasms that are causing your back pain.

Muscle relaxants may be particularly useful for acute injuries (such as straining your back playing basketball), says Jung. For example, carisoprodol (Soma) significantly reduced back pain and improved function after three days of treatment, according to the results of clinical trials presented at the American Academy of Pain Medicine’s 2010 annual meeting.

Most of these drugs have similar side effects, with drowsiness being the most common. “They can be quite sedating,” Jung says. “If you’ve never tried them before, don’t operate heavy machinery or drive until you know how they affect you. I usually start patients on these at night to see how they react.”

Opioids Medications for Back Pain

For some patients, NSAIDs and muscle relaxants are not enough. People with long-lasting, chronic back pain, particularly after multiple surgeries, are sometimes prescribed opioid or narcotic medications. In fact, one study showed that as many as 70% of back pain patients receive opioids, which some experts suggest is probably too many.

These drugs act on pain receptors in the brain and nerve cells to alleviate pain. Jung says there are milder, shorter-acting versions, such as Vicodin (acetaminophen and hydrocodone) and Tylenol with codeine — which is what most people begin with — as well as stronger drugs like morphine.

Opioid medications are sometimes prescribed for the management of severe and chronic back pain when other treatment options have proven ineffective. It’s important to note that opioids are powerful medications with a high risk of dependence and potential side effects, so they are generally considered a last resort and are prescribed with caution. Here is a list of some common opioids that may be prescribed for back pain:

1. Oxycodone: Oxycodone is a potent opioid medication often prescribed for severe pain, including chronic back pain. It is available in various forms, including immediate-release and extended-release versions.
2. Hydrocodone: Hydrocodone is another strong opioid medication used to manage severe pain. It is often combined with acetaminophen (as in Vicodin) or other analgesics.
3. Morphine: Morphine is one of the most powerful opioids and is reserved for severe, uncontrolled pain, such as that resulting from advanced cancer or major surgical procedures.
4. Fentanyl: Fentanyl is a synthetic opioid that is much more potent than other opioids. It is typically prescribed as a transdermal patch (Duragesic) for chronic pain management.
5. Codeine: Codeine is a less potent opioid and is often combined with other pain relievers, such as acetaminophen or aspirin. It is prescribed for moderate to moderately severe pain.
6. Tramadol: Tramadol is an atypical opioid medication with both opioid and non-opioid properties. It may be prescribed for moderate to moderately severe pain, including some types of chronic back pain.

There’s also a step between NSAIDs and muscle relaxants and a more classic opioid or narcotic drugs. Tramadol (brand names Rybix, Ryzolt or Ultram) also acts on the opioid receptors in the brain, but it is weaker compared to morphine or hydrocodone, so it’s not regulated like a controlled substance, says Jung. “So it’s a milder approach and patients who don’t want to move on to narcotics often think that’s a good option, he says.

Corticosteroids

Like anti-inflammatory drugs, corticosteroids can also relieve inflammation and alleviate back pain. They can be taken either orally or via injection into your back.

Back Pain Background

Back pain is a particularly prominent issue in adults and can be caused by a number of different factors. As you may know if you are suffering from back pains, it can be an extremely debilitating health issue.

The majority of back pain is the result of sprains or strains that occur due to movements putting stress on the muscles and tendons of the back. In such cases, the most effective treatment often involves rest and time. Additionally, applying ice to the affected area and using anti-inflammatory medication can help alleviate pain and bring it to a more manageable level.