The Misery of Back Pain

If misery loves company and your misery is low back pain, you have a lot of company. An estimated 80 percent of men and women in the United States will have low back pain at least once in their lives. It’s the most frequent cause of disability and lost work time and the second most common reason for seeing a doctor. Colds and the flu take first place.

Our back, especially the lower back or lumbar spine, is vulnerable because we’re upright creatures and it is our spine that must bear our weight. The spine is a complex structure made up of bones or vertebrae, cushioning discs between those bones, small joints called facets, muscles and ligaments that support the spine and nerves that run its length. Even for a trained medical professional, it can be difficult to pinpoint the exact origin of someone’s back pain.

Most back pain is caused by overuse or injury, a strain or sprain for instance, from lifting something improperly or shoveling snow. For some people, the cause is obvious, but for others, what seems like an innocent movement — bending over or turning to reach for something — can lead to sudden, excruciating pain. Damage to the spine can also be cumulative and happen over time, as with the normal wear and tear of aging or with arthritis.

When should you worry about back pain?

Occasionally, low back pain is due to a serious underlying medical problem, such as cancer or osteoporosis. Let your doctor know if you have low back pain and anything else on the following list:

  • History of cancer
  • Unexplained weight loss
  • Fever
  • Intravenous drug use
  • Steroid use for months or longer
  • Trauma
  • Back pain at night
  • Progressive weakness
  • Bowel or bladder problems
  • Age under 25 or over 55

The quality of back pain

If you have back pain and someone asked you to describe it, could you? The quality of pain is different depending on its cause. Does it get worse when you sit? Does it travel down your leg? Is it there even when you’re resting? Understanding the quality of the pain may help identify its origin.

Vertebral (from the bones): Boring, deep and still present when you’re resting.

Sciatica: Deep, gnawing, burning, radiating down your leg.

Disc: Poorly localized pain when you sit or lean forward, causing you to change your position frequently.

Facet joints: Deep, dull, gets worse when you straighten up, wake up or are active.

Spondylolisthesis: Pain gets worse by bending over or when you go from sitting to standing.

Stenosis: Aching in back, buttock and leg that gets worse when you stand and walk and better if you bend over or sit.

Treating back pain

Most back pain can be treated with conservative measures or, in other words, without surgery. The best thing you can do for yourself is to get out of bed and resume your normal activity. You don’t want to do anything strenuous or something that will aggravate your situation, but research shows that the people who recover most slowly are the ones who stay in bed.

Conservative measures

  • Normal activity
  • Medications or injections to control inflammation and pain
  • Physical therapy and exercise
  • Manual therapy
  • Bracing
  • Massage

Surgery

While the majority of low back pain can be controlled conservatively, sometimes surgery is the treatment of choice, particularly for:

  • Fractures
  • Pinched nerves because of a herniated disc or stenosis
  • Infection
  • Tumors
  • Arthritis or degenerative disc disease

Generally, lower back surgery is most successful when:

  • You have more leg pain than back pain
  • Imaging studies, e.g., X-rays, CT scan or MRI, match up with your symptoms
  • You don’t smoke
  • You are not a long time user of narcotic pain medication

If you have low back pain, chances are it’s nothing serious. Most of the time, the pain will be gone in a few weeks, but may come back every now and again. Contact a doctor if you have any concerns that something else might be going on or if you have chronic or persistent pain.

If you want to try to prevent low back pain, several studies have shown that exercise is key, but it’s not the only thing you should be thinking about.

Some tips on preventing low back pain

  • Regular low-impact aerobic exercise
  • Regular core-strengthening exercise
  • Weight loss if you are overweight
  • Proper posture, standing or sitting
  • Proper lifting — let your legs do the work
  • If you smoke, quit