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Low back pain - chronic

Definition

Back pain is one of the most common health complaints. Almost everyone will have back pain at some time in their life. Most of the time, the exact cause of the pain cannot be found.

This article discusses long-term (chronic) low back pain. For information on other types of low back pain that occur suddenly, see: Low back pain.

Alternative Names

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low

Causes

One single event may not cause your pain. You may have been doing many things improperly -- such as standing or lifting -- for a long time. Then suddenly, one simple movement (such as reaching for something or bending from your waist) leads to the feeling of pain.

The specific part of your back that is responsible for your pain is sometimes difficult to identify. There are several possible causes of low back pain:

• Certain medical conditions such as fibromyalgia
• Herniated disc (part of a spinal disc pushes onto nearby nerves)
• Strain or tears to the muscles or ligaments supporting the back
• Degenerative disc disease
• Pelvic injury or fracture
• Piriformis syndrome (a pain disorder involving a narrow muscle in the buttocks)
• Spinal stenosis (narrowing of the spinal canal)
• Small fractures to the spine from osteoporosis
• Spine curvatures (such as scoliosis or kyphosis), which may be inherited and seen in children and teens

You are at particular risk for low back pain if you:

• Are over age 30
• Are pregnant
• Feel stressed or depressed
• Have arthritis or osteoporosis
• Smoke
• Do not exercise
• Are overweight
• Have a job that requires heavy lifting, a lot of bending and twisting, or whole body vibration (such as truck driving or using a sandblaster)

Symptoms

You may feel a variety of symptoms if you have hurt your back, including:

• Tingling or burning sensation
• Dull aching
• Sharp pain
• Weakness in your legs or feet

Low back pain can vary widely. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or bottom of your foot. See: Sciatica

Exams and Tests

During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. You may be asked to try walking on your toes and then on your heels.
• Bend forward, backward, and sideways.
• Lift your legs straight up while lying down.

The health care provider will also move your legs into different positions to check your strength and ability to move. This usually includes bending and straightening your knees.

The health care provider will check the reflexes in your legs, which reveals how well certain nerves are working. This may include:

Gently tapping a rubber hammer on certain parts of your legs and feet to see how they respond

Touching different areas of the leg with a pin, cotton swab or feather to see how well you can feel each object

You should tell your doctor if there are areas where the sensation from the pin, cotton, or feather feels dull.

Further testing is determined by your medical history and symptoms (including how the symptoms developed). Tests that might be ordered include:

• X-ray
• Myelogram (an x-ray or CT scan of the spine after dye has been injected into the spinal column)
• CT of the lower spine
• MRI of the lower spine

Treatment

If you have any concerning symptoms, call your doctor right away.

Your back pain may not go away completely, or it may get more painful at times. Learning to take care of your back at home and how to prevent repeat episodes of back pain can help you avoid surgery.

Your doctor and other health professionals can help you manage your pain and keep you as active as possible.

• Your doctor may refer you for physical therapy. The physical therapist will help you try to reduce your pain using stretches and traction. The therapist will show you how to do exercises that make your back muscles stronger, so you can prevent furture back pain again.
• You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist). Sometimes a few visits will help back pain.
• Back braces may be needed to help support your back at work.
• Cold packs and heat therapy may help your back pain.
• Cognitive behavioral therapy may be helpful. This technique helps you better understand your pain and teaches you how to manage while you have back pain.

A number of different medications can help with your back pain:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen sodium (Aleve), and ibuprofen (Advil) can help with the pain. Always talk with your doctor if you need to take these drugs every day. Side effects may include stomach ulcers or bleeding, and liver or kidney damage.
• Low doses of prescription medicines used to treat seizures (called anticonvulsants) or depression (antidepressants) may help some patients whose long-term back pain has made it hard to work or interferes with daily activities.
• Your doctor may give you pain medicines called narcotics or opioids to use when the pain is very severe. These medicines are rarely, if ever, used to treat back pain on a daily basis.

Injections can be used to reduce inflammation around the nerve.

Spinal surgery should only be considered if you have nerve damage or the condition causing the back pain does not heal after a long period of time.

See also:

• Diskectomy
• Foraminotomy
• Laminectomy
• Spinal fusion

Some people with low back pain may also need:

• Job retraining
• Job counseling
• Job changes
• Occupational therapy

Outlook (Prognosis)

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures will allow you to get better.

Possible Complications

Future spine problems are possible for patients who have spine surgery. You may have a greater chance of future problems if you have more than one type of back surgery.

When to Contact a Medical Professional

Call your health care provider if you have persistent, severe back pain, especially if you have also have numbness, loss of movement, weakness, or bowel or bladder changes.

Prevention

Tips for preventing back pain include:

• Maintain a healthy weight.
• Keep your back and abdominal muscles strong and flexible.
• Sleep on a firm mattress, with a board under the mattress, or even on the floor.
• Use good posture and learn the proper way to lift or carry heavy objects.
• Avoid prolonged sitting or lying with pressure on the buttocks.

References

Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007;(2):CD003010.

Smeets RJ, Vlaeyen JW, Hidding A, et al. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain. 2008;134:263-276.

Urguhart DM, Hoving JL, Assendelft WW, et al. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2008:(1):CD001703.

Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505-514.

Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492-504.

Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

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