How common is back pain?
Eighty-five to 90% 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 doctor (just behind upper respiratory infections).
On any given day, almost 2% of the entire United States workforce is disabled by back pain. In people under age 40, 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 clear, 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).
How is acute back pain treated?
Most people recover from an episode of acute back pain (pain that comes on suddenly) within two weeks with minimal medical intervention. For most people, safe, appropriate use of over-the-counter pain relievers — such as acetaminophen, ibuprofen, or cold packs — and early return to normal activities as permitted by pain, 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:
- Worsening pain
- Progressive movement of the pain from the back into the leg
- Pain that is unrelieved at rest or disturbs sleep.
How is chronic persistent back pain treated?
Most back pain resolves within a few days with simple treatment. When back pain persists beyond 2-4 weeks, further careful medical evaluation is recommended. This evaluation focuses on a complete 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.
Most chronic, persistent back pain can be successfully treated without surgery. After 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 and deconditioning, and delays recovery.
What role do medications play in the treatment of back pain?
The role of medication in the management of back pain is primarily to relieve symptoms and facilitate an active, exercise-oriented rehabilitation program. A variety of new medications are now available to help achieve this goal.
New roles for some older medications, too, 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 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. Usually the exercise program can be done 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 life.
© Copyright 1995-2017 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: 3/30/2017...#8417