Back pain (medically referred to as “lumbago”) is not a disease; it is a symptom.
Back pain usually refers to a problem with one or more of the structures of the lower back such as ligaments, muscles, nerves, or the vertebral bodies (the bony structures that make up the spine). It can also describe pain caused by a problem with nearby organs, such as the kidneys or lungs.
Eighty to 90 percent of Americans will experience back pain in their lifetime. Of these, 50 percent will have more than one episode. Eighty-five percent of the time, no cause for this problem is found. Back pain is a major cause of missed days at work and costs the American public $50 billion annually.
To understand the causes of back pain, it helps to understand the back. Your back is composed of many parts, including:
- the spine
- blood vessels
The spine is one of the keys to back pain. It is made up of lumbar and sacral vertebrae (the bones of the spine), disks of cartilage between the vertebrae, nerves and your spinal cord, and muscles and ligaments that hold it together.
The most common causes for back pain are strain and problems with back structures.
Strained muscles and ligaments often cause back pain. Strain commonly occurs with improper lifting of heavy objects and sudden awkward movements. However, strain can also result from over-activity. An example is the sore feeling and “stiffness” that might occur after a few hours of yard work or after playing a sport.
Vertebrae are interlocking bones that are stacked on top of one another at the back of the torso or trunk of your body. Disks made of cartilage cushion the area between each vertebra. Disk injuries are a fairly common cause of back pain.
Sometimes these disks can bulge (herniate) or rupture. When this happens, nerves can get compressed. Herniated disks can be very painful. If a bulging disk presses on the nerve that travels from your back down your leg, it can cause sciatica or irritation of the sciatic nerve. Sciatica can be experienced as a pain, tingling, numbness, or weakness in the leg.
Abnormalities of the skeleton such as scoliosis or narrowing of the spinal canal due to arthritis can also cause back pain.
Osteoporosis, loss of bone density and thinning of the bone, is a very common bone condition that can lead to fractures in the vertebral bodies of your spine. These fractures, which can cause serious pain, are referred to as compression fractures.
Other Causes of Back Pain
There are many other potential causes of back pain, but most of these are fairly rare. If you experience regular back pain that does not go away, be sure to see your doctor. After ruling out the more common causes of back pain, your doctor will perform tests to determine if you have one of these rarer causes of pain:
- spinal stenosis (narrowing of the spinal canal)
- degenerative spondylolisthesis (displacement of one vertebral body onto another)
- cauda equine syndrome (loss of nerve function at the lower spinal cord)
- infection of the spine (fungal or bacterial—typically Staphylococcus or E. Coli)
- cancer or non-malignant tumor in the spine
Back pain can have any of the following characteristics:
- dull, aching sensation in the lower back
- stabbing or shooting pain that can radiate down the leg to the foot
- inability to stand up straight
- decreased range of motion and diminished ability to flex the back
The symptoms of back pain, if due to strain or misuse, are usually short-lived but can last for days or weeks. Back pain is chronic when symptoms have been present for longer than three months.
The Mayo Clinic states that you should see your doctor if back pain does not improve within the first 72 hours of self-care. There are times when back pain can be a symptom of a serious medical problem. Symptoms that can indicate a more serious medical problem are:
- loss of bowel or bladder control
- numbness, tingling, or weakness in one or both legs
- onset following trauma such as a fall or a blow to the back
- intense, constant pain that gets worse at night
- presence of unexplained weight loss
- pain associated with a throbbing sensation in the abdomen
- presence of fever
You are at an increased risk for back pain if:
- You work in a sedentary environment. Going from a sedentary workplace to high-impact activity can lead to back strain.
- You are of older age.
- You are female
- You are obese
- You are a smoker
Studies show that your emotional health also has an effect on your risk for back pain. If you have a stressful job or suffer from depression and anxiety, you are at a high risk for back pain.
Most of the time, a physical exam is all that is needed to diagnose back pain. During the physical exam, your doctor will test the range of motion of your spine and your ability to sit, stand, and walk. The doctor may also test your reflexes, leg strength, and your ability to detect sensations in your legs.
If a more serious condition is suspected, your doctor might order other tests. These might include:
- blood and urine tests to check for underlying conditions
- X-rays of the spine to show alignment of your bones and check for breaks
- computed tomography (CT) scan, or magnetic resonance imaging (MRI) to assess your disks, muscles, tendons, ligaments, nerves, and blood vessels
- bone scan
- electromyography (EMG) to test nerve conduction
The majority of back pain episodes are relieved by treatment with nonsteroidal anti-inflammatory medications such as: aspirin, ibuprofen (Motrin), or naproxen (Aleve) or analgesics (pain relievers) such as acetaminophen (Tylenol). Except for acetaminophen, these medications should be taken with food because they can irritate the stomach and cause it to bleed.
If back pain is severe, your physician may prescribe medications that contain a narcotic such as codeine. Low dose amitriptyline, a tricyclic antidepressant, can also relieve back pain.
At times, your doctor might recommend cortisone steroid injections for severe back pain. Pain relief from steroid injections lasts no longer than a few months; the body builds up immunity to the effects of cortisone.
In the acute phase of back pain, ice packs may relieve discomfort and help lessen inflammation. When inflammation has subsided, warm compresses may relieve pain.
Exercises to improve posture and strengthen the muscles of the back and all abdominal muscles (core muscles) are a treatment option that should be strongly considered. Improving posture, using proper lifting techniques, and having stronger back and abdominal muscles help to prevent recurrences.
Surgery is a treatment of last resort and is rarely needed for back pain. It is usually reserved for structural abnormalities that have not responded to conservative treatment, severe, unremitting pain, and nerve compression that cause muscles to become weak.
Spinal fusion is a surgery in which painful vertebrae are fused into one single, more solid bone. It helps eliminate painful motion of the spine.
Surgery to partially remove and replace disks and vertebrae may be done to relieve pain caused by degenerative bone diseases.
According to the Mayo Clinic, devil’s claw, (Harpagophytum procumbens—a plant in the sesame family) and willow bark (Salix alba) taken orally and capsicum (Capsicum frutescens—chili pepper) plaster applied topically may relieve low back pain. These herbs are known to have anti-inflammatory properties.
Other alternative therapies include: acupuncture, massage, chiropractic adjustments, cognitive behavioral therapy, and progressive relaxation.
According to the National Institutes of Health, acupuncture is a proven remedy for chronic pain such as low back pain.
Be sure to talk to your doctor before undergoing any alternative or complementary treatment.
Written by: Verneda Lights and Marijane Leonard
Medically reviewed by Brenda B. Spriggs, MD, MPH, FACP