Back Pain

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is back pain?

Back pain is any type of pain or discomfort throughout the posterior (back) portion of your trunk, from the pelvis up through the neck. Back pain is a very common problem in the United States, second only to headache, according to the National Institute of Neurological Disorders and Stroke.

Your back pain may last briefly or it may be chronic, which is pain lasting more than three months. Back pain may feel like a dull, annoying ache or a sharp, acute pain. Acute back pain often resolves with basic self-care measures within a few weeks, but it can persist and lead to more serious problems over time.

The back consists of the spine (spinal column), spinal cord, nerves, discs, muscles, ligaments, and tendons. Any of the structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions. Causes of back pain include sports injuries, poor posture, arthritis, muscle strain, and trauma from a car accident. The origin and cause of chronic back pain is harder to diagnose and treat.

Back pain may be localized to a specific area, such as lower back pain, or it may cover a more generalized section of the back. In addition, localized pain anywhere in the back can radiate, or spread, to other areas of your body. The converse is also true; pain somewhere else in your body can radiate to your back.

Back pain accompanied by other symptoms, such as loss of bladder or bowel control and numbness in your extremities (arms or legs), is a serious condition and should be evaluated as soon as possible or in an emergency medical setting. In addition, if your pain is extreme, persistent, or causes you concern, contact a medical professional.

What other symptoms might occur with back pain?

Back pain may occur with other symptoms depending on the underlying disease, disorder or condition. For instance, if your back pain is due to arthritis, you may experience pain in other parts of your body. Back pain due to a pinched nerve can even lead to loss of bladder control. Back pain is often a major symptom of fibromyalgia, which is also characterized by fatigue and sleep problems. The range of symptoms that may accompany back pain include:

  • Anxiety

  • Blood in the urine (hematuria)

  • Depression

  • Fatigue

  • Fever

  • Headache

  • Morning back stiffness

  • Pain through the buttocks and down one leg to below the knee

  • Paresthesias (stinging, burning, tingling, crawling sensations)

  • Redness, warmth or swelling of the back

  • Shoulder, neck or hip pain

  • Sleep disturbance

Serious symptoms that might indicate a life-threatening condition

In some cases, back pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as a heart attack or cauda equina syndrome (when the nerves in the spinal cord are compressed or paralyzed, cutting off sensation and movement).

Back pain that occurs with any of the following symptoms should be immediately evaluated in an emergency setting:

What causes back pain?

Understanding the parts that make up your back and how it works can help you understand why you have back pain. Your back is made up of bony structures called vertebrae that surround and protect the spinal cord. Within the spinal cord run nerve roots from the brain that send and receive messages to and from the rest of the body. Between the vertebrae are spongy sacs of cartilage, called discs, that act as a cushion and provide range of motion to the back. Muscles, ligaments and tendons provide additional support.

Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions. A common cause of mild to severe back pain is a sudden or awkward movement during activities, such as gardening and sports, particularly in people who normally lead a relatively sedentary lifestyle. A problem in another part of the body, such as the heart or the reproductive organs, can also radiate to the back. This is “referred” back pain.

Structural causes of back pain

Back pain can be due to injury, inflammation or infection of the bones and tissues including:

  • Herniated disc

  • Muscle spasm

  • Osteoarthritis

  • Osteomyelitis (infection or inflammation of the spinal bones)

  • Osteoporosis (metabolic bone disease)

  • Paget’s disease of the bone

  • Sciatic nerve damage and sciatica due to spinal stenosis or degenerative disc disease

  • Spinal degeneration (degenerative disc disease, also called spondylosis)

  • Spinal stenosis (a narrowing of the spinal canal that presses on the spinal cord or nerves)

  • Spine fracture

  • Spondylitis (infection or inflammation of the spinal joints)

  • Sprains and strains due to overuse or injury

Other possible causes of back pain

Back pain can also be due to systemic (body-wide) problems or problems affecting other body systems including:

Life-threatening causes of back pain

In some cases, back pain may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Possible life-threatening conditions that involve back pain include:

What are the risk factors for back pain?

Although anyone can experience back pain, there are certain risk factors that make you more likely to face back pain at some point in your life. Back pain most often begins between 30 and 50 years of age. The activities associated with this age group, along with the increasing age of the spine and associated tissues, are the most influential factors in back pain.

Back pain risk factors include:

  • Congenital (present at birth) or acquired back deformities, such as scoliosis)

  • Family history of back pain or disease, such as degenerative disc disease)

  • Increasing age

  • Obesity

  • Poor posture

  • Sedentary lifestyle

  • Smoking

  • Stress and anxiety

  • Weak abdominal (core) muscles

When should you see a doctor for back pain?

Although most causes of back pain resolve with home treatment, there are times when seeing a doctor is the safest option. Contact your doctor when back pain:

  • Interferes with your usual activities or interrupts your sleep

  • Is intense or constant, does not get better with rest, or gets worse when lying down

  • Lasts for more than two weeks

  • Occurs with unexplained weight loss, redness and swelling on the back, or weakness, numbness or tingling in the legs

  • Spreads down your leg, especially below the knee

Call 911 or go to your nearest emergency room when back pain:

  • Accompanies new bowel or bladder problems

  • Occurs with fever or chest or abdominal pain

  • Follows an injury, such as a fall, car accident, blow to the back, or a sports injury

How do doctors diagnose the cause of back pain?

To diagnose the cause of your back pain, your doctor may ask you several questions including:

  • When did your back pain start?

  • Can you describe your pain? Is it sharp, dull, achy or burning?

  • On a scale of 1 to 10 with 10 being the worst pain ever, how would you rate your pain?

  • Where is your back most painful?

  • Is your back pain constant or does it come and go?

  • What, if anything, makes your back pain better or worse?

  • Are you experiencing any other symptoms, such as tingling or numbness?

  • Does your back pain wake you at night or limit your activities during the day?

  • Have you ever injured your back?

  • What do you do for work?

  • Do you exercise?

Your doctor will also perform a physical exam. During the exam, you may need to bend or lift your legs and walk or sit. This will help your doctor understand how movement affects your pain. Your doctor may also test your reflexes and muscle strength. Using the exam results and your answers to questions, your doctor may order testing including:

  • Blood tests to check your blood cell counts and electrolytes

  • Bone scan if osteoporosis or a bone tumor is a possibility

  • Imaging exams, including X-rays, CT (computed tomography) scans, and MRIs (magnetic resonance imaging)

  • Nerve studies to evaluate how well your nerves send signals and how your muscles respond to them

  • Urinalysis to rule out UTI (urinary tract infection)

It is not always possible to diagnose an underlying cause or condition. Even without a firm diagnosis, your doctor may recommend rest, activity modification, and physical therapy as part of your treatment. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

How do you treat back pain?

If possible, the goal of back pain treatment is to correct any underlying physical problem. Treatment also aims to improve back pain symptoms and prevent future back problems. The specific treatment that will accomplish these goals varies depending on the cause and where the back pain is. Doctors usually start with conservative and noninvasive treatments including:

  • Corset braces, which support and stabilize the lower back
     
  • NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), to help relieve pain and swelling
  • Other medications, including muscle relaxants, narcotic pain relievers, and antidepressants, which can help with certain types of nerve pain
  • Physical therapy to strengthen back muscles, restore flexibility and function, and teach you how to protect your back with proper posture and body mechanics. Physical therapists can also teach you how to promote back pain relief with specific back pain exercises and stretches.
  • Rest, ice or heat therapy to relieve pain and reduce swelling from minor back injuries
  • Topical pain relievers in the form of creams, ointments and patches
  • Traction

If these treatments fail, doctors may recommend other options. This includes corticosteroid injections, which can relieve pain and inflammation for up to two months. Otherwise, when back pain persists, surgery may be necessary. Surgery may also be an option early in treatment if doctors can find a specific cause that will respond to it. The back and spine treatment you need will depend on the cause. That’s why it’s important for you and your doctor to take the necessary time to determine an accurate diagnosis.

Alternative treatments for back pain

For back pain, many people turn to acupuncture or massage therapy. Acupuncture often provides short-term relief of back pain. Research suggests it works best as an add-on therapy to traditional medicine. Massage therapy can also help as an add-on treatment. These alternative treatments can help some people reach their treatment goals sooner than traditional medicine alone.

What home back pain remedies may be effective?

In many cases, back pain responds well to home remedies including:

  • Devices: Use simple devices to help relieve pain or support your back. This includes lumbar support cushions, back braces, and home TENS (transcutaneous electrical nerve stimulation) units.

  • Ice and heat: Apply an ice pack to your back for short periods of time several times throughout the day. Some people like heat as an alternative to cold therapy for relieving back pain.

  • Over-the-counter pain relievers: Take NSAIDs to relieve pain and swelling from minor injuries. If you can’t take them, acetaminophen (Tylenol) is an alternative for pain relief. However, it will not help with inflammation.

  • Pillows and mattresses: Evaluate your bed and how you sleep. In general, firmer mattresses are better for your back. Sleeping with a pillow between your knees can also help align your spine while you sleep on your side.

  • Rest: Stop any activity that triggers back pain and let your back heal before resuming it.

  • Shoes: Wear supportive shoes to help keep your spine in proper alignment and prevent abnormal gait changes that can contribute to back pain.

What are the potential complications of back pain?

The complications associated with back pain depend on the underlying disease, disorder or condition. For example, back pain resulting from a degenerative condition such as spondylosis can lead to inactivity and its associated complications. Fortunately, most cases of back pain can be alleviated or minimized by physical therapy, basic self-care measures, and the treatment plan outlined by your doctor.

However, in some cases the degree and duration of your back pain may become overwhelming and affect your everyday living. Research into the diagnosis and treatment of back pain is ongoing, so ask your doctor about the latest information.

Over time, back pain can lead to complications, including:

  • Absenteeism from work or school

  • Chronic pain or discomfort

  • Permanent nerve damage (due to a pinched nerve), including paralysis

  • Permanent physical disability

  • Physiological and psychological response to chronic pain

  • Poor quality of life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 12
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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