Lower Back Pain

Lower back pain symptoms depend on the underlying disease, disorder or condition. Back pain due to infection or inflammation may be accompanied by a fever; whereas, back pain due to fibromyalgia may include symptoms such as insomnia and fatigue. The range of symptoms that may occur with lower back pain include:

• Anxiety

• Blood in the urine (hematuria)

• Depression

• Fatigue

• Fever

• Headache

• Hip pain

• Morning back stiffness

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

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

• Redness, warmth, or swelling of the back

• Sleep disturbances

In some cases, pain in the lower back may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting (call 911 for immediate attention). Symptoms that may indicate a serious or life-threatening condition include:

• Chest pain

• Abdominal pain

• Difficulty breathing

• Loss of bladder or bowel control

• Blood in the urine

• Progressive weakness and numbness in the legs

Lower back pain causes can be hard to pinpoint. In most cases, back pain may be caused by strenuous activity, improper heavy lifting, repetitive strain, poor muscle tone or muscle strain. It can also be a symptom of degeneration of vertebrae, herniated disk, osteoarthritis, or spondylitis.

A common cause of mild to severe lower back pain is a sudden movement during activities, such as sports or home improvement projects. People who normally lead a relatively sedentary lifestyle are at increased risk for these types of strains and sprains. Lower back pain causes can also be more serious conditions, such as spinal trauma, disc herniation, and spinal cancer. A problem in another part of the body, such as the reproductive organs, can also radiate to the lower back. This is “referred” lower back pain.

The lower back consists of the lumbar spine (bony structures called vertebrae surrounding the nerves of the spinal cord). Between the vertebrae are spongy sacs of cartilage called discs that act as a cushion and provide a range of motion to the back. The vertebral column protects the spinal cord. Nerve roots extend from the spinal cord between each vertebra out to the rest of the body. Muscles, tendons and ligaments 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.

Lower 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 a nerve root)

• Spine fracture

• Spondylitis (infection or inflammation of the spinal joints)

• Sprains and strains due to overuse or injury

Body systems other than the neuromuscular system can lead to lower back pain, such as:

• Fibromyalgia

• Pelvic inflammatory disease

• Pregnancy

• Premenstrual syndrome

• Uterine prolapse

In some cases, lower back pain may be due to a serious or life-threatening condition that should be evaluated as soon as possible or examined in an emergency setting. Possible life-threatening conditions that involve lower back pain include:

• Ectopic pregnancy

• Kidney stones and disease (including infections and tumors)

• Multiple myeloma

• Prostate cancer

• Spinal tumor or cancer (the tumor can be noncancerous, also known as benign)

Although anyone can experience low back pain, there are certain risk factors that make you more likely to encounter back pain at some point in your life. Being older than 30 years of age and leading a sedentary lifestyle are the most common. The risk factors include:

• Congenital (present at birth) or acquired back deformities (for example, scoliosis)

• Family history of back pain or spine disease

• Increasing age

• Obesity, which causes increased weight on the spine and pressure on the discs

• Poor posture

• Sedentary lifestyle

• Smoking

• Stress and anxiety

• Weak abdominal (core) muscles

In most cases, back pain will resolve with self-care at home. Make an appointment to see your doctor if it continues for more than a week or two despite home treatment. See a doctor promptly when:

• Back pain interferes with sleep, work, or your usual activities.

• Back pain is constant or severe.

• Back pain is worse when you lie down.

• Back pain radiates down one or both legs.

• Back pain occurs along with numbness, tingling or weakness in one or both legs.

• Back pain occurs with unintended weight loss or swelling and redness.

Call 911 or go to your nearest emergency room when lower back pain is the result of an injury or trauma or it occurs with any of the following symptoms:

• Chest or abdominal pain

• Fever

• Paralysis

• Problems with bladder or bowel control

• Shortness of breath or problems breathing

• Worsening numbness, tingling or weakness

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

• When did your lower back pain start?

• Can you describe your pain?

• 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 lower back pain constant or does it come and go?

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

• Are you experiencing any other symptoms, such as tingling or loss of sensation?

• Does your lower 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 and may order testing including:

• Blood tests to check your blood cell counts and electrolytes

• Bone density tests if osteoporosis is a possibility

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

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

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

In general, the goals of treating lower back pain are to correct any physical problem, improve symptoms, and prevent future problems. The exact way doctors accomplish these goals will depend on the underlying cause of lower back pain. Doctors often start with conservative treatments first including:

• Corset braces that wrap around the back and stomach to support and stabilize the lower back

• NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), which can 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 core and back muscles, restore function, and teach you how to protect your back. Physical therapists can also teach you how to ease lower back pain with specific lower back pain stretches.

• Rest, ice or heat therapy can relieve pain and reduce swelling due to minor injuries

• Topical pain relievers

• Traction

When conservative treatments fail, doctors may recommend corticosteroids, either orally or as an injection. If lower back pain persists for six months to a year (despite conservative treatment), it may be time to consider surgery for lower back pain. Surgery is also an option when doctors can identify a specific cause of lower back pain that will respond to it. Examples include disc replacement and spinal fusion.

Self-care treatment at home is often effective for lower back pain. This includes:

• Rest: Take a break from any activity that triggers lower back pain. Give your back time to heal before resuming it. It can take several weeks to months for a full recovery.

• Ice: Applying an ice pack to your back for short periods of time every day can help relieve pain and inflammation.

• Heat: Some people find heat to be more comforting and effective at relieving lower back pain.

• Over-the-counter pain relievers: NSAIDs treat pain and swelling from minor injuries. Acetaminophen (Tylenol) may work for pain, but not inflammation, if you can’t take NSAIDs.

• Yoga: Yoga benefits include stretching, flexibility, strengthening and balance to help with lower back pain relief, while managing stress and promoting relaxation.

• Exercises and stretching: Stretching can help alleviate many types of back pain, and exercises can strengthen core and postural muscles to relieve and prevent back pain.

Acupuncture and massage therapy are two popular choices for alternative treatments to manage lower back pain. Acupuncture can provide short-term pain relief and seems to work well as an add-on therapy.

Massage therapy is another good option to add on to traditional treatment. It helps some people achieve their treatment goals more quickly than using traditional treatment alone.

In general, you should start with your primary care doctor for lower back pain. Your doctor can prescribe drugs and recommend lifestyle changes to protect your back and help improve your pain. Your primary care doctor can also provide referrals to specialists and other providers if necessary. This includes:

• Orthopedic surgeons, who specialize in treating conditions related to the joints, muscles and bones. An orthopedic surgeon uses both medical treatments and surgery to manage these types of problems.

• Physical therapists, who work with people to restore function, build strength, and improve flexibility with the goal of relieving symptoms and preventing or improving disability

• Chiropractors, who use spinal manipulation to treat uncomplicated lower back pain

• Neuromusculoskeletal doctors, who also use manipulation techniques to manage lower back pain

• Neurologists and neurosurgeons, who can address nerve-related causes of lower back pain

• Physical medicine and rehabilitation doctors, who specialize in preventing and minimizing disability from conditions such as lower back pain

Lower back pain can lead to various complications depending on the underlying disease, disorder or condition. The good news is that most cases can be alleviated or minimized by physical therapy, basic self-care measures, and the treatment plan outlined by your doctor. However, your back pain may become chronic and overwhelming, affecting your quality of life. Research into the diagnosis and treatment of back pain is ongoing, so contact your healthcare professional for the most effective treatments.

Over time, lower 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