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Low back pain - chronic

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

Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.

 

Low back pain that is long-term is called chronic low back pain.

Test Your Back Pain IQ

  • Which is the most common area for back pain?

     

    A. Upper back

     

    B. Middle back

     

    C. Lower back

    Correct Answer
  • Which type of back pain is often caused by a sudden injury?

     

    A. Chronic

     

    B. Acute

    Correct Answer
  • Most people with acute back pain feel better in four to six weeks.

     

    A. True

     

    B. False

    Correct Answer
  • Which is better to treat acute back pain?

     

    A. Ice

     

    B. Heat

     

    C. Both

    Correct Answer
  • If you hurt your back, you should rest in bed.

     

    A. True

     

    B. False

    Correct Answer
  • Which activity should you avoid until your back is healed?

     

    A. Jogging

     

    B. Contact sports

     

    C. Dancing

     

    D. Golf

     

    E. A and B

     

    F. All of the above

    Correct Answer
  • People who smoke are more likely to have low back pain.

     

    A. True

     

    B. False

    Correct Answer
  • Which of the following can help relieve chronic back pain?

     

    A. Physical therapy

     

    B. Massage

     

    C. Talk therapy

     

    D. Acupuncture

     

    E. A and B

     

    F. All of the above

    Correct Answer
  • You'll need prescription medicines for acute back pain.

     

    A. True

     

    B. False

    Correct Answer
  • Your may need an injection in your spine if your back pain doesn't improve.

     

    A. True

     

    B. False

    Correct Answer
  • You'll need surgery if your pain doesn't get better in 12 weeks.

     

    A. True

     

    B. False

    Correct Answer
  • You should call your doctor when you have this back pain symptom.

     

    A. Severe back pain

     

    B. Numbness or weakness in an arm or a leg

     

    C. Bowel or bladder changes or loss of control

     

    D. Pain traveling down your legs below the knee

     

    E. Any of the above

    Correct Answer

Causes

Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.

A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, 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. Or they may have extra wear and tear of the spine, which may be due to:

  • Heavy use from work or sports
  • Injuries or fractures
  • Surgery

You may have had a herniated disk, in which 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 include:

  • Curvature of the spine, such as scoliosis or kyphosis
  • Medical problems, such as fibromyalgia or rheumatoid arthritis
  • Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle

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

Symptoms

Symptoms may include any of the following:

  • Dull aching pain
  • 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 cannot 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.

Exams 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.

Other tests you have depend on your medical history and symptoms.

Tests may include:

Treatment

Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.

 

Your provider may recommend measures to reduce your pain, including:

  • A back brace to support your back
  • Cold packs and heat therapy
  • Traction
  • Physical therapy, involving stretching and strengthening exercises
  • Counseling to learn ways to understand and manage your pain

These other health care providers may also help:

  • Massage therapist
  • Someone who performs acupuncture
  • Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

If needed, your provider may prescribe medicines to help with your back pain:

  • Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
  • Low doses of prescription medicines
  • Narcotics or opioids when the pain is severe
 

If your pain does not improve with medicine, physical therapy, and other treatments, your provider may recommend an epidural injection.

Spinal surgery is considered only if you have nerve damage or the cause of the back pain does not heal after a long time.

In some patients, a spinal cord stimulator can help reduce back pain.

Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:

  • Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
  • Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals

Some people with low back pain may also need:

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

Outlook (Prognosis)

Most back problems get better on their own. Follow your provider’s advice on treatment and self-care measures.

When to Contact a Medical Professional

Call your provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.

References

Abd OE, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 48.

Malik K, Benzon HT. Low back pain. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain. 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 21.

Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(2 Suppl):S49-S283. PMID: 23615883 www.ncbi.nlm.nih.gov/pubmed/23615883.

BACK TO TOP

    • Factors that can cause and worsen chronic pain

      Factors that can cause and worsen chronic pain

      Animation

    • Taking the first steps to manage pain

      Taking the first steps to manage pain

      Animation

    • The differences between acute and chronic low back pain

      The differences between acute and chronic low back pain

      Animation

    • Common causes of low back pain

      Common causes of low back pain

      Animation

    • Spinal stenosis

      Spinal stenosis

      illustration

    • Backaches

      Backaches

      illustration

    • Factors that can cause and worsen chronic pain

      Animation

    • Taking the first steps to manage pain

      Animation

    • The differences between acute and chronic low back pain

      Animation

    • Common causes of low back pain

      Animation

    • Spinal stenosis

      Spinal stenosis

      illustration

    • Backaches

      Backaches

      illustration

    A Closer Look

     

    Self Care

     

    Tests for Low back pain - chronic

     
     

    Review Date: 5/14/2017

    Reviewed By: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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