What Is Back Pain?
Back pain is one of the most frequent complaints that people have. In the United States, acute low back pain (also called lumbago) is the second most common reason for doctor visits. About eight out of ten adults experience back pain at some point in their life. In fact, five out of ten working adults have back pain every year, and after the common cold, back pain is the next leading reason for missed workdays for people under 45 years of age.
The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, all of which are capable of producing pain (see Spine Anatomy). Large nerves that originate in the spine can make the pain go down the arms and legs as well. To better understand back pain, we can divide it by anatomic region (neck pain, upper back pain, lower back pain or tailbone pain), duration (acute, subacute or chronic), and cause (musculoskeletal, infectious, cancer, etc.).
Fortunately, approximately 98% of back pain patients are diagnosed with nonspecific acute back pain with no serious underlying disease. However, back pain caused by a more serious condition accounts for about 2% of cases and needs further investigation. Herniated disc is the most common neurologic impairment which is associated with back pain, and 95% of disc herniations occur at the lowest two lumbar intervertebral levels. Rare causes such as cancer and infection account for 1% of back pain.
Signs and Symptoms
Below are some common symptoms:
- Back pain – either acute (short-term) or chronic (long-term)
- Pain that radiates down the leg – sciatica
- Numbness and weakness in the arms or legs
- Stiffness and tightness
Patients are advised to seek medical help right away when they experience certain symptoms like:
- Bowel and/or bladder incontinence or progressive weakness in the legs
- Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (for example, fever and unexplained weight loss)
- Back pain that occurs after a trauma, such as a car accident or fall
- Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma
- Back pain in individuals with a history of cancer
Causes of Back Pain
Back pain usually does not require immediate medical intervention, as the vast majority of back pain is self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months.
One potential source of pain is the back muscles when they are strained (pulled), are in spasm, or are in imbalance. Another potential source of low back pain is the facet joints of the spine (see Spine Anatomy). Other common causes of back pain include disc herniation, degenerative disc disease, spondylosis (arthritis of the spine), spondylolisthesis, lumbar stenosis, and fractures.
Most back pain can be successfully treated without surgery. The management goals of treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual’s ability to function in daily activities; to help the patient cope with residual pain; and to assess for side-effects of therapy.
Some of the non-operative treatments include exercise, physical therapy, various modalities (heat/cold treatments, massage therapy, and manipulation among others), education and attitude adjustment to focus on psychological or emotional causes of pain, as well as the judicious use of medications, such as muscle relaxants, non-steroidal anti-inflammatory drugs, Tylenol, or a short course of steroids.
Surgery is absolutely the last resort in the treatment of back pain. Dr. Cho recommends surgery only when there is an identifiable source of pain that is debilitating in nature and/or causing nerve irritation or damage. Some of these conditions include:
- Disc herniation
- Degenerative disc disease
- Lumbar stenosis
- Spondylosis (arthritis of the spine)
- Compression fracture