Lower Back Pain

Low Back Pain If you are experiencing low back pain, you are not alone. An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime. Although low back pain can be quite debilitating and painful, in about 90 percent of all cases, pain improves without surgery. However, 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.

The Lumbar Spine

The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine between the ribs and the pelvis. The bones (vertebrae) that form the spine in your back are cushioned by small discs. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick ligaments attached to the vertebrae hold the pulpy disc material in place. Of the 31 pairs of spinal nerves and roots, five lumbar (L1-L5) and 5 sacral (S1-S5) nerve pairs connect beginning in the area of your lower back.

Common Causes of Low Back Pain

Herniated Disc

Lumbar Spinal Stenosis

 Osteoarthritis

Diagnosing Your Low Back Pain

Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination, and results of diagnostic studies, if necessary. Some patients may be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective. These tests may include:

  • Computed Tomography Scan (CT or CAT scan)
  • Discography
  • Electromyography (EMG)
  • Nerve Conduction Studies (NCS)
  • Magnetic Resonance Imaging (MRI)
  • Myleogram
  • Selective Nerve Root Block
  • X-rays

Conservative (Nonsurgical) Treatment Options

Treatment options include physical therapy, back exercises, weight reduction, steroid injections (epidural steroids), nonsteroidal anti-inflammatory medications, rehabilitation and limited activity. All of these treatment options are aimed at relieving the inflammation in the back and irritation of nerve roots. Physicians usually recommend four to six weeks of conservative therapy before considering surgery.

If low back pain occurs after a recent injury, such as a car accident, a fall or sports injury, you should call your primary care physician immediately. If there are any neurological symptoms, you should seek medical care immediately. If there are no neurological problems (i.e. numbness, weakness, bowel and bladder dysfunction), you may benefit by beginning conservative treatment at home for two to three days. You may take anti-inflammatory medications such as aspirin or ibuprofen and restrict strenuous activities for a few days.

If low back pain gets worse or does not improve after two to three days of home treatment, contact a primary care physician. The physician can evaluate you and perform a neurological exam in the office to determine which nerve root is being irritated, as well as rule out other serious medical conditions. If there are clear signs that the nerve root is being compressed, your physician can prescribe medications to relieve the pain, swelling and irritation, and may also recommend limitation of activities. If these treatment options do not provide relief within two weeks, it may be time to consider other diagnostic studies and possibly surgery.

When Surgery is Necessary

When conservative treatment for low back pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:

  • Back and leg pain limits normal activity or impairs your quality of life
  • You develop progressive neurological deficits, such as leg weakness and/or numbness

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Back Pain Information Page

Back Pain Relief

Back Pain Relief

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What is Back Pain?
Is there any treatment?
What is the prognosis?
What research is being done?

Organizations
Related NINDS Publications and Information
Publicaciones en Español
Additional resources from MEDLINEplus

What is Back Pain?

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Is there any treatment?

Most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation.  The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury.  Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies.  Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.  Bed rest is recommended for only 1–2 days at most.  Individuals should resume activities as soon as possible.  Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles.   In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

What is the prognosis?

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.  Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct pain research in laboratories at the NIH and also support pain research through grants to major medical institutions across the country.  Currently, researchers are examining the use of different drugs to effectively treat back pain, in particular, chronic pain that has lasted at least 6 months. Other studies are comparing different health care approaches to the management of acute low back pain (standard care versus chiropractic, acupuncture, or massage therapy). These studies are measuring symptom relief, restoration of function, and patient satisfaction. Other research is comparing standard surgical treatments to the most commonly used standard nonsurgical treatments to measure changes in health-related quality of life among patients suffering from spinal stenosis.

Select this link to view a list of studies currently seeking patients.

Organizations

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA   95677-0850
[email protected]
http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
Fax: 916-632-3208

American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, MD   21201-4111
[email protected]
http://www.painfoundation.org
Tel: 888-615-PAIN (7246)
Fax: 410-385-1832
National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD   20892-3675
[email protected]
http://www.niams.nih.gov
Tel: 877-22-NIAMS (226-4267) 301-565-2966 (TTY)
Fax: 301-718-6366

American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL   60008-3852
[email protected]
http://www.aans.org
Tel: 847-378-0500/888-566-AANS (2267)
Fax: 847-378-0600
American Academy of Orthopaedic Surgeons/ American Association of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL   60018
[email protected]
http://www.aaos.org
Tel: 847-823-7186
Fax: 847-823-8125

American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Suite 440
Leawood, KS   66211-2672
[email protected]
http://www.aafp.org
Tel: 913-906-6000/800-274-2237
Fax: 913-906-6095
Alzheimer’s Association
225 North Michigan Avenue
17th Floor
Chicago, IL   60601-7633
[email protected]
http://www.alz.org
Tel: 312-335-8700 TDD: 312-335-5886
Fax: 866.699.1246

American Academy of Neurological and Orthopaedic Surgeons
10 Cascade Creek Lane
Las Vegas, NV   89113
[email protected]
http://www.aanos.org
Tel: 702-388-7390
Fax: 702-871-4728
American Academy of Physical Medicine & Rehabilitation
330 North Wabash Ave.
Suite 2500
Chicago, IL   60611-7617
[email protected]
http://www.aapmr.org
Tel: 312-464-9700
Fax: 312-464-0227

 

Related NINDS Publications and Information

Low Back Pain Fact Sheet
Back Pain information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS).
Chronic Pain: Hope Through Research

Chronic pain information page compiled by the National Institute of Neurological Disorders and Stroke (NINDS).
Publicaciones en Español

Dolor Lumbar

 

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

 

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. A