What is back pain?

Back pain can range from a dull, constant ache to a sudden, sharp pain that makes it hard to move. It can start quickly if you fall or lift something too heavy, or it can get worse slowly.

Who Gets Back Pain?

Anyone can have back pain, but some things that increase your risk are:

Getting older. Back pain is more common the older you get. You may first have back pain when you are 30 to 40 years old.
Poor physical fitness. Back pain is more common in people who are not fit.
Being overweight. A diet high in calories and fat can make you gain weight. Too much weight can stress the back and cause pain.
Some causes of back pain, such as ankylosing spondylitis, a form of arthritis that affects the spine, can have a genetic component.
Other diseases. Some types of arthritis and cancer can cause back pain.
Occupation. If you have to lift, push, or pull while twisting your spine, you may get back pain. If you work at a desk all day and do not sit up straight, you may also get back pain.
Smoking. Your body may not be able to get enough nutrients to the disks in your back if you smoke. Smoker’s cough may also cause back pain. People who smoke are slow to heal, so back pain may last longer.

What Are the Causes of Back Pain?

There are many causes of back pain. Mechanical problems with the back itself can cause pain. Examples are:

Disc breakdown
Spasms
Tense muscles
Ruptured disks

Injuries from sprains, fractures, accidents, and falls can result in back pain.

Back pain can also occur with some conditions and diseases, such as:

Scoliosis
Spondylolisthesis
Arthritis
Spinal stenosis
Pregnancy
Kidney stones
Infections
Endometriosis

Other possible causes of back pain are infections, tumors, or stress.

Can Back Pain Be Prevented?

The best things you can do to prevent back pain are:

Exercise often and keep your back muscles strong.
Maintain a healthy weight or lose weight if you weigh too much. To have strong bones, you need to get enough calcium and vitamin D every day.
Try to stand up straight and avoid heavy lifting when you can. If you do lift something heavy, bend your legs and keep your back straight.

When Should I See a Health Professional for Pain?

You should seek advice from a qualified health professional if you have:

Numbness or tingling in your arms or legs
Severe pain that does not improve with rest
Pain after a fall or an injury
Pain plus any fever or unintended weight loss
Symptoms requiring emergency medical attention include:
- Difficulty with passing water (or a feeling of fullness in your bladder)
- Incontinence (not being able to retain urine or faeces)
- Progressive weakness one or both legs
- Numbness or loss of sensation in your buttocks, genital area (often known as the saddle area) or legs
- Sexual dysfunction

How Is Back Pain Diagnosed?

To diagnose back pain, your health profession will take your medical history and do a physical exam. Although imaging is now used far less commonly and only for specific circumstances, you doctor may order tests, such as:

X rays
Magnetic resonance imaging (MRI)
Computed tomography (CT) scan
Blood tests.

It is important to understand that these tests may not show the cause of your back pain. Many times, the cause of back pain is never known. Back pain can get better even if you do not know the cause.

What Is the Difference Between Acute and Chronic Pain?

Acute pain starts quickly and lasts less than 6 weeks. It is the most common type of back pain. Acute pain may be caused by things like falling, an awkward movement during sport, or lifting something heavy. Chronic pain lasts for more than 3 months and is much less common than acute pain.

How Is Back Pain Treated?

Treatment for back pain depends on what kind of pain you have. Acute back pain usually gets better without any treatment, but you may want to take short term over the counter medication to help ease the pain. Exercise and surgery are not usually used to treat acute back pain.

Following are some types of treatments for chronic back pain.

Hot or Cold Packs (or Both)

Hot or cold packs can soothe sore, stiff backs. Heat reduces muscle spasms and pain. Cold helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this treatment does not fix the cause of chronic back pain.

Exercise

Proper exercise can help ease chronic pain but should not be used for acute back pain. Your doctor or physical therapist can tell you the best types of exercise to do.

Medications

The following are the main types of medications used for back pain:

Analgesic medications are over-the-counter drugs such as acetaminophen and aspirin or prescription pain medications.
Topical analgesics are creams, ointments, and salves rubbed onto the skin over the site of pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that reduce both pain and swelling. NSAIDs include over-the-counter drugs such as ibuprofen, ketoprofen, and naproxen sodium. Your doctor may prescribe stronger NSAIDs.
Muscle relaxants and some antidepressants may be prescribed for some types of chronic back pain, but these do not work for every type of back pain.

Behavior Changes

You can learn to lift, push, and pull with less stress on your back. Changing how you exercise, relax, and sleep can help lessen back pain. Eating a healthy diet and not smoking also help.

Manual therapy

Manual therapy, such as that provided by a chiropractor, osteopath or physiotherapist, is often used to treat many types of back and neck pain:

Manual therapists use their hands to mobilize or manipulate joints of the spine and associated soft tissues, such as muscles.
Acupuncture and myofascial dry needling are techniques that use thin needles to relieve pain and restore health. These approaches may be effective when used as a part of a comprehensive treatment plan for low back pain.
Manual therapists use a package of care that utilizes hands-on techniques, patient education, exercise prescription and therapeutic advice.

Surgery

The vast majority of people with chronic back pain do not need surgery. It is usually used for spinal pain and disability if other treatments do not work or there is an emergency. You may need surgery if you have:

Herniated intervertebral disc (also known as a prolapsed or ‘slipped’ disc). The discs are the shock absorbers that are positioned between the bony vertebrae in your spine. When one or more of the discs that cushion the bones of the spine are damaged (either by injury or degeneration, the jelly-like center of the disc can leak and cause pressure or irritation of nerves, causing pain. This is often referred to as sciatica. When it does not resolve itself or starts to cause damage to nerves affecting power in the legs or problems with bowel and bladder function, surgery may be recommended.
Spinal stenosis. This condition, which is usually caused by degeneration, causes the spinal canal to become narrow, resulting in nerves becoming compressed.
Spondylolisthesis. This occurs when one or more bones of the spine slip out of place. Many types of spondylolisthesis are stable and do not require surgery, but unstable conditions may require surgical stabilization.
Vertebral fractures. A fracture can be caused by a serious injury, such as a blow to the spine. They can also occur with relatively minor trauma if the bones are particularly fragile (osteoporosis).
Scoliosis. Certain types of scoliosis (curvature of the spine) may require surgery if they are severe and are affecting general health.

When back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, emergency treatment may be needed right away to ease the pain and prevent more problems.

What Kind of Research Is Being Done?

Highlights of recent research include:

Cost and effectiveness comparisons of surgical versus nonsurgical treatments for various types of back pain
Factors that go into patients’ decisions about whether or not to have surgery for herniated disks
National statistics on back pain costs
Socioeconomic factors that relate to back pain costs and treatment.

Goals of current research are to:

Understand the many factors that can cause back pain
Identify ways to prevent back pain
Improve surgical and nonsurgical treatments for back pain
Prevent disability in people who suffer from back pain.

Seeking advice

If you are unsure about the cause of your back pain and need advice or treatment, always seek the advice of your general medical practitioner or a qualified health professional.