Back pain

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Most people will experience back pain at least once during their lifetime. The good news is that most of these episodes are benign and will resolve with no consequences after minimal, if any, treatment.

There are several anatomical structures in the back that may cause pain:

  • Sprained muscles around the spine
  • Sprained small joints (facets) connecting the bones
  • Pinched nerves
  • Deteriorated (degenerative) discs
  • Arthritis of the joints
  • Fractured spine bones (called vertebrae)
  • Sometimes back pain may be referred from internal organs (such as kidney stones)

Most people that experience back pain will notice improvement within six weeks. However, sometimes pain may linger. The duration of back pain is considered in three categories:

  • acute (up to six weeks)
  • sub-acute (six to twelve weeks)
  • chronic (longer than three months)

During the acute period (six weeks), unless there are red flags, there is no need for additional imaging. The usual cause is muscle sprain. Short-term rest, local heat or ice, Tylenol, over-the-counter anti-inflammatories like ibuprofen or naproxen, prescription muscle relaxants like methocarbamole, gentle physical therapy or chiropractic manipulation is all that is recommended. Patients are usually managed by their general practitioner during this period.

In the sub-acute phase (six weeks to three months), additional imaging (x-rays) is common. Advanced imaging, like CT or MRI, may be considered. Unless additional findings are identified, conservative treatment described for the acute phase is continued. Medications may be adjusted.

In the chronic phase (more than three months), advanced imaging is usually done and interventional treatments, such as injections, may be considered. Surgery is typically not effective in back pain unless there is identified instability in the spine. Fusion surgery may be effective in carefully selected patients.

Red flags are indicators that a more serious condition may exist. They should prompt you to seek qualified medical help sooner. They are:

  • history of high-energy trauma
  • weakness in the legs
  • inability to control bowel or bladder function
  • pain increasing over the course of several days
  • increasing pain at night
  • unexplained fever and chills
  • history of poor bone quality (osteoporosis)
  • history of cancer in other body parts
  • history of IV drug use

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