Adam Sewell MD


The only condition more common, in the United States, than common headache is back pain (National Institutes of Health, 2011). It is estimated that nearly a quarter of the population is suffers from it. Billions of dollars are spent each year on back pain treatments (Jones et al, 2010; National Institutes of Health, 2011). Both men and women suffer equally from this common annoyance that interferes with functioning, daily activities, work performance and leisure (National Institutes of Health, 2011). It is the leading cause of missed days at work and job-related disability (National Institutes of Health, 2011). Often, back pain will go away on its own, but sometimes it returns and a qualified pain physician needs to be consulted.

Common Causes of Back Pain

Pain that lasts several weeks is acute, or severe, and this is different than chronic back pain which lasts for more than three months progressively (National Institutes of Health, 2011). Back pain can be the result of trauma, disease, spinal stress, muscle strain, car accidents, sports or work related injuries, and herniated or ruptured discs (National Institutes of Health, 2011). Non-traumatic medical issues can include, malignancy, osteoporosis, degeneration, nerve tissue damage, arthritis, viral infections, bone diseases, disc disease, congenital abnormalities, vascular dysfunction, bone infection, or joint or disc irritation (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Symptoms of Back Pain

Any part of the back may experience acute to chronic levels of pain, though the most common form of back pain is found in the lower portion of the spine. Symptoms may present as restricted range of motion, the inability to stand straight, limited flexibility, sharp shooting pains, sudden stabbing pains, stiffness, soreness, tenderness, numbness, tingling and muscle aches (National Institutes of Health, 2011). The pain often radiates to other areas and/or extremities or becomes aggravated with strenuous activity or movement (Jones et al, 2010). Any of symptoms of back pain can cause serious damage if left untreated by a physician (National Institutes of Health, 2011).

Immediate Attention Required

Some back pain symptoms are indicate an emergency and require immediate attention from a medical professional. These are – fever, pain when coughing, weight loss, numbness or tingling, loss of bladder control, bowel dysfunction, pain that radiates into the legs or progressive weakness in the legs, and increasing pain that lasts more than three months (National Institutes of Health, 2011).

Back Pain Diagnosis

A physician will perform a comprehensive evaluation before back pain treatment can begin. The initial exam should include a thorough patient history, a full neurological workup, and a physical examination. Blood work, scans and imaging, may be ordered, based upon levels of pain and symptoms. Additional tests may reveal broken bones, fractures, injury, disc herniation, bone infections, tumors, ruptured disc, malignancy, spinal stenosis, vertebral damage or degeneration (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Back Pain Treatment

Back pain treatments are meant to alleviate pain and improve daily functioning (Lin, 2009). Within a few weeks of conservative back pain treatments, pain is usually reduced (Jones et al, 2010; National Institutes of Health, 2011). Physicians may prescribe several conservative back pain treatment methods (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011). These may include muscle relaxants, anticonvulsants (to treat nerve pain), antidepressants (relieves pain and aids in sleep) or pain medications (National Institutes of Health, 2011). Physical therapy may be recommended to stretch and relax muscles, strengthen the back and speed recovery (National Institutes of Health, 2011). Reducing risk factors, losing weight, and eliminating strenuous activities that aggravate pain, are all important in aiding back pain relief. Massage, acupuncture, biofeedback, or yoga may be suggested as alternative therapies as well (National Institutes of Health, 2011).

Invasive Back Pain Treatment for Serious Pain Sufferers

Physicians might suggest more aggressive pain management treatments if conservative treatments are not producing adequate results. Pain can be reduced or, even completely eliminated, with interventional therapy using injections that pain signals from getting to already irritated nerves (National Institutes of Health, 2011). These include narcotic, steroid or local anesthetic injections (National Institutes of Health, 2011). For more severe pain, nerve blocks, spinal cord stimulation or drugs administered by catheter into the spinal cord (National Institutes of Health, 2011). Pain management procedures such as spinal fusion, discectomy, foraminotomy, rhizotomy, cordotomy or spinal laminectomy are surgical options used in cases of extreme chronic back pain (National Institutes of Health, 2011).


  1. Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from
  2. Lin, M. (2009). Upper Back Pain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from
  3. National Institutes of Health 2011. Low Back Pain Fact Sheet. NINDS. Available at NIH Publication No. 03-5161
  4. Nidus Information Services 2010: Low Back Pain – Chronic. Patient Handouts page. MD Consult Web site, Core Collection. Available at Accessed January 14, 2011

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