Ninety percent of American adults will experience an episode of back pain
during their lifetime. Back pain is the second most common reason people visit
their family physician (just behind upper respiratory infections). On any given
day, almost two percent of the entire United States workforce is disabled by
back pain. In people under 40 years of age, back pain is the most common reason
for inability to perform daily activities.
Pain that affects primarily the back should be distinguished from spinal
conditions that result in predominant leg pain, commonly called sciatica.
Typically, sciatica is the result of a "pinched nerve" in the spinal
column. In most cases, the cause of the sciatica is clearly defined - such as
disc or arthritic spur. The cause of an episode of back pain, on the other hand,
is often more difficult to pinpoint, and may be related to the spinal discs,
joints, vertebrae, or soft tissue supports (muscles, ligaments, tendons).
Acute back pain
Most people recover from an episode of acute back pain within two weeks with
minimal medical intervention. Appropriate use of over-the-counter pain
relievers, such as acetaminophen or ibuprofen, and early resumption of normal
activities as permitted by pain, for most are simple and effective treatments.
X-rays or scans (MRI, CT scan) are rarely required.
Warning signs or "red flags" that should prompt urgent medical
evaluation include the presence of fever, worsening pain, progressive movement
of the pain from the back into the leg, and pain that is unrelieved at rest or
Chronic persistent back pain
Most back pain resolves within a few days with simple treatment. When back
pain persists beyond 2-4 weeks, further careful medical evaluation is required.
This evaluation focuses on a careful medical history and physical examination to
identify, if possible, a precise cause of the pain. Rarely, malignancy or
infection is found. More commonly, the source of the pain is discovered to be
related to the spinal joints, discs, or supporting musculature.
In many people with back pain, an MRI is not helpful in defining the cause.
For example, the MRI provides little information as to the condition of the
ligaments, muscles, and tendons. It may demonstrate common degenerative, or
"wear and tear" changes in the discs or joints in the spine. However,
these changes are common in people who have no symptoms. It is often difficult
to know whether or not to "blame" back symptoms on a finding seen on
the MRI scan.
Treatment of back pain: An "aggressive, conservative" approach
Most chronic, persistent back pain can be successfully treated without
surgery. Following a careful medical evaluation for rare, serious causes, and,
in some cases, X-ray or MRI imaging, treatment focuses on symptom relief and
active, exercise-oriented rehabilitation of the back. Excessive bed rest or
restricted activity promotes muscular stiffness, deconditioning, and delays
The role of medication in the management of back pain is primarily to relieve
symptoms and facilitate an active, exercise-oriented rehabilitation program. An
array of new medications is now available to assist in achieving this goal.
New roles for some older medications have been found in the treatment of back
pain. For example, disruption of sleep by chronic back pain is common. Poor
sleep may, in fact, magnify pain. Improving the quality of sleep with low doses
of traditional anti-depressant medicine such as doxepin may reduce pain. Anti-convulsants
such as gabapentin are often helpful for nerve irritation symptoms such as
burning or numbness. In rare instances, careful use of long-acting opioid pain
relievers may improve function and quality of life.
Active, exercise-oriented physical therapy is the cornerstone of treatment
for people with chronic back pain. Treatments methods such as heat, ice,
massage, and ultrasound may provide temporary relief, but rarely provide
long-term benefit. Exercise programs should be individualized by a
spine-oriented physical therapist. Typically, the exercise program can be
performed at home without special equipment. Follow-up visits with the therapist
are necessary to "fine-tune" the program.
When back pain is chronic, persistent and disabling, a comprehensive
treatment approach addressing all aspects of the problem, including physical as
well as psychological issues, offers the best hope for rehabilitation and
recovery. A multi-disciplinary treatment team consisting of a doctor, physical
therapist, psychologist or psychiatrist, and pain management specialist offers
the best hope for return to an active, productive lifestyle.
© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/26/2008...#8417