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Low back pain - chronic

Definition

Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.

Low back pain that is long-term is called chronic low back pain.

Test Your Back Pain Knowledge

Which is the most common area for back pain?

Answer:

The correct answer is the lower back. The lower back is most likely to hurt because it supports your body's weight. You can help prevent low back pain by learning how to protect your back. Ask your health care provider about back-friendly ways to exercise, bend, and lift heavy objects.
Which type of back pain is often caused by a sudden injury?

Answer:

The correct answer is acute. A sudden injury to the muscles and ligaments that support the back causes acute pain. Chronic pain is present when your back pain lasts for longer than two months or continues to recur. Your doctor can help figure out what type of back pain you have and how to treat it.
Most people with acute back pain feel better in four to six weeks.

Answer:

The correct answer is true. You should start to feel better after one week, and your pain should be completely gone in four to six weeks. To get better quickly, ask your doctor what you can do at home to help your back recover.
Which is better to treat acute back pain?

Answer:

The correct answer is both. Heat, ice, or both help treat back pain. Try using ice for the first 48 to 72 hours, and then apply heat.
If you hurt your back, you should rest in bed.

Answer:

The correct answer is false. Staying in bed can make back pain worse. You may want to take it easy for a day or two, and then slowly get back to your regular activities. You can start exercising again after about two to three weeks, but avoid heavy lifting or twisting for six weeks. If you recover more quickly, you be more active sooner.
Which activity should you avoid until your back is healed?

Answer:

The correct answer is all of the above. Don't do any of these activities until your doctor or physical therapist tells you it's okay. You should also avoid weight lifting, racquet sports, sit-ups, and leg lifts when lying on your stomach. All these exercises can strain your back.
People who smoke are more likely to have low back pain.

Answer:

The correct answer is true. You also may have a greater risk for low back pain if you are overweight, pregnant, don't exercise, feel stressed or depressed, are over age 30, or do a lot of heavy lifting or bending. Ask your doctor how to reduce your risk for back pain.
Which of the following can help relieve chronic back pain?

Answer:

The correct answer is all of the above. Depending on what's causing your back pain, your doctor may recommend any of these treatments. A physical therapist can help you heal and recover from back pain. Massage may help ease tight muscles and acupuncture may reduce pain. Talk therapy can help you understand and deal with chronic back pain.
You'll need prescription medicines for acute back pain.

Answer:

The correct answer is false. You can treat most acute back pain with over-the-counter pain relievers such as ibuprofen (Motrin) or acetaminophen (Tylenol). If these medicines don't provide enough relief for your back pain, ask your doctor if there's another medicine you can take.
Your may need an injection in your spine if your back pain doesn't improve.

Answer:

The correct answer is true. If your back pain doesn't get better with other treatments, your doctor may recommend an injection in your spine. This delivers powerful medicine that reduces swelling in the spine. If other methods haven't worked, ask your doctor if this treatment is an option for you.
You'll need surgery if your pain doesn't get better in 12 weeks.

Answer:

The correct answer is false. Back surgery may be recommended only when you have nerve damage or have had back pain that doesn't improve after a long time with other treatments. Work with your doctor to try other treatments first.
You should call your doctor when you have this back pain symptom.

Answer:

The correct answer is any of the above. Also call if you have been losing weight without trying, back pain has lasted longer than 4 weeks, or you have had back pain before, but this time feels worse or different.

Alternative Names

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

Causes

Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.

A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.

Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:

  • Heavy use from work or sports
  • Injuries or fractures
  • Surgery

You may have had a herniated disk, in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.

Patient Education Video: Herniated disk

If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.

Spinal stenosis
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.

Other possible causes of chronic low back pain include:

  • Curvature of the spine, such as scoliosis or kyphosis
  • Medical problems, such as fibromyalgia or rheumatoid arthritis
  • Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle

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

  • Are over age 30
  • Are overweight
  • Are pregnant
  • Do not exercise
  • Feel stressed or depressed
  • Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
  • Smoke

Symptoms

Symptoms may include any of the following:

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

Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you cannot move.

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

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.

Other tests you have depend on your medical history and symptoms.

Tests may include:

Treatment

Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.

Your provider may recommend measures to reduce your pain, including:

  • A back brace to support your back
  • Cold packs and heat therapy
  • Traction
  • Physical therapy, involving stretching and strengthening exercises
  • Counseling to learn ways to understand and manage your pain

These other health care providers may also help:

  • Massage therapist
  • Someone who performs acupuncture
  • Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

If needed, your provider may prescribe medicines to help with your back pain:

  • Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
  • Low doses of prescription medicines
  • Narcotics or opioids when the pain is severe

If your pain does not improve with medicine, physical therapy, and other treatments, your provider may recommend an epidural injection.

Spinal surgery is considered only if you have nerve damage or the cause of the back pain does not heal after a long time.

In some patients, a spinal cord stimulator can help reduce back pain.

Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:

  • Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
  • Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals

Some people with low back pain may also need:

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

Outlook (Prognosis)

Most back problems get better on their own. Follow your provider's advice on treatment and self-care measures.

When to Contact a Medical Professional

Call your provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.

Gallery

Spinal stenosis
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.
Spinal stenosis
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.

References

Abd OHE, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 48.

Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 50.

Malik K, Nelson A. Overview of low back pain disorders. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

Last reviewed May 3, 2021 by Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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