Back Pain Patient Information Fact Sheet

How common is back pain?
If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States—only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

What causes back pain?
Your spine is made up of a column of bones (vertebrae) stacked one on top of another, with a cushioning disc between each. Your bones and discs are held in place by ligaments and muscles. All of these can become stretched, damaged, or move out of place, causing pain. Back pain can be caused by standing or sitting in the wrong position, straining the muscles suddenly, lifting in the wrong way, or being overweight. Back pain is also common during pregnancy. A “slipped disc” occurs when one of the discs in your spine gets compressed and bulges. Your disc does not slip out altogether, but it can put pressure on nerves causing sciatica, a numbness or pain traveling down the back of your leg. A slipped disc can also cause weakness in your ankle or foot, or problems with your bowels or bladder, such as constipation or being unable to pass urine. Less commonly, back pain may be caused by disease in the spine itself or in the joints of your spine.

What tests will I need?
Your doctor will examine your back, and if the pain is persistent may arrange an X-ray, although these are not recommended routinely. Although X-rays are not usually helpful in sorting out the cause of the pain, they can sometimes help to make the diagnosis. Occasionally, your doctor may want to do blood tests or refer you to a hospital for a scan.

How is back pain treated?
Bed rest is not recommended as a treatment for simple low back pain. Patients are advised to stay as active as possible and to continue normal daily activities. You should, therefore, move around again and do some walking to gradually loosen your back muscles. As the pain subsides, it is important to strengthen up the muscles with exercises to help prevent further problems. Your doctor or physical therapist will be able to tell you about these. If the pain starts, you can apply ice for 5 to 10 minutes at a time, or alternate ice with heat to help settle the pain. Your doctor or pharmacist will advise you on which painkillers or anti-inflammatory medications to take. These will help make you comfortable enough to move around gently and do the exercises. In most cases you will be advised to try a simple painkiller such as acetaminophen (Tylenol) to begin with. If this doesn’t help, you will usually be advised to try a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil) or naproxen (Anaprox, Naprosyn; also available over the counter as Aleve). If necessary, your doctor may prescribe a stronger painkiller which combines hydrocodone + acetaminophen (Vicodin) or a stronger NSAID such as diclofenac. Your doctor may also prescribe a short course of a muscle relaxant such as diazepam if painkillers or NSAIDs alone fail to control the pain. In a small percentage of cases, back surgery may be recommended. Pain is a warning to you that you have a problem. Do not ignore it. Even when the pain begins to settle, take things easy and avoid straining your back.