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Generally back pain can be attributed to mechanical causes, most of which are relatively benign, although a small number of cases are due to more serious illness1. Common causes of back pain include degeneration (e.g. osteoarthritis), muscle strain, mechanical problems (e.g. a herniated disc), and vertebral fractures associated with osteoporosis. Rare, more serious causes include cancer, infection, vascular problems and damage to nervous tissues (1, 2).
Back pain usually occurs in the lower back, but can occur in the upper back as well. The pain may be aggravated with movement, or may radiate into the upper or lower extremities1. Patients may also have limited range of motion and/or tenderness upon touch. Certain red flags indicate a more serious condition that may require emergency evaluation or surgery, including weakness, numbness or tingling, fever, weight loss or problems with bowel and/or bladder control1, (4).
Diagnosing the cause of back pain is done by a doctor through a comprehensive history and physical examination. Additionally, a full neurological work up is often performed to identify compressed nerves from a herniated disc. Supplemental imaging is usually reserved for symptoms that persist beyond several weeks despite conservative treatment, or if a physician suspects serious pathology (1, 2). A physician may, however, order an X-ray if a bone infection or tumor is suspected, or magnetic resonance imaging (MRI) or computed tomography (CT) scan if disc herniation is suspected (2, 3).
The goals of treating back pain are to relieve symptoms and improve functioning; treatments range from conservative management to surgery depending on the cause and severity of the pain2. Back pain typically resolves on its own within weeks with conservative treatment1, (3.) More conservative treatments include (1, 2, 3):
- Pain-relieving medications are the initial treatment of choice for back pain. These can include over-the-counter pain medicines such as acetaminophen (Tylenol™), ibuprofen (Advil™), muscle relaxants, or prescription opioids
- Physical therapy and exercise helps strengthen the back to avoid future injury and speed the recovery process
- Lifestyle adjustments to avoid aggravating movements and reduce body weight
- Alternative therapies such as massage, yoga, and acupuncture may provide benefit to some patients
When conservative measures are ineffective, local anesthetics, steroids or opiates can often be injected at the site of pain to block the conduction of pain signals to the brain. Back pain due to disc herniation may require surgical intervention via spinal fusion or discectomy, the removal of herniated tissue.
Tobacco, alcohol and drugs, poor diet and lack of regular physical activity have been implicated as risk factors for back pain(1). Modifying these risk factors, avoiding certain repetitive motions such as bending and twisting or heavy lifting, and treating obesity and depression can help prevent back pain before it occurs(1, 4).
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- Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/pdxmd/body/268245516-3/0?type=med&eid=9-u1.0-_1_mt_1014913.
- Lin, M. (2009). Upper Back Pain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy1.library.arizona.edu/books/page.do?eid=4-u1.0-B978-0-323-05472-0..00051-7–s0220&isbn=978-0-323-05472-0&sid=1175026577&uniqId=262415626-3#4-u1.0-B978-0-323-05472-0..00051-7–s0220.
- National Institutes of Health 2003. Low Back Pain Fact Sheet. NINDS. Available at http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#167453102. NIH Publication No. 03-5161
- Nidus Information Services 2010: Low Back Pain – Chronic. Patient Handouts page. MD Consult Web site, Core Collection. Available at http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/patient/body/231440260-4/1104412125/10041/37946.html. Accessed January 14, 2011