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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. Other types of low back pain may occur more suddenly (acute low back pain).

Alternative Names

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

Causes, incidence, and risk factors

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 pain.

Many people with chronic back pain have arthritis and extra wear and tear on the spine. This may be due to:

  • Heavy use from work or sports
  • Past injuries and fractures
  • Past surgery

You may have had a herniated disk, where 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.

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.

Other possible causes of chronic low back pain:

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 a lot of heavy lifting, bending and twisting, or that involves whole body vibration (such as truck driving or using a sandblaster)
  • Smoke

Symptoms

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

  • Dull aching
  • 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 are unable to 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.

Signs 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.

What other tests you have depend on your medical history and symptoms (including how the symptoms developed). Tests might include:

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 continue with your normal activities.

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 may 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 future back pain.
  • 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 with these specialists will help back pain.
  • You may need a back brace to 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 your back pain.

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

  • Drugs (NSAIDs) such as aspirin, naproxen sodium (Aleve), and ibuprofen (Advil)
  • Low doses of prescription medicines used to treat seizures or depression (antidepressants)
  • Pain medicines called narcotics or opioids when the pain is very severe

When a severe episode of pain does not improve with medicine, physical therapy, and other treatments, you may need an epidural injection.

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

Some people with low back pain may also need:

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

Expectations (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.

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.

Calling your health care provider

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

Prevention

See also: Taking care of your back at home

References

Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7).

Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2010;(5):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. 2010:(10):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.

Misulis KE. Lower back and lower limb pain. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 33.


Review Date: 5/1/2011
Reviewed By: Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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