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Treating Back Pain

Millions of Americans suffer from episodes of back pain each year. Back pain is the second most common reason that adults see a doctor, according to the American Association of Neurological Surgeons (AANS).

Most back pain occurs in the lower back because that's the part of the spine that bears the most weight. But pain can occur elsewhere in the back, as well.

The spine is made up of small bones called vertebrae. The spine is divided into three sections: the cervical (neck), thoracic (upper back) and lumbar (lower back). Disks of cartilage (also known as "discs") separate and cushion the vertebrae.

Although the causes of more than 80 percent of back-pain cases are unknown, there are five major severe low-back-pain conditions:

  • Herniated (slipped) disk. A damaged or bulging disk may pinch or irritate a nerve root, causing pain.

  • Disk degeneration. Disks can deteriorate with age. This deterioration can lead to inflammation and irritation in the spine, causing pain.

  • Sciatica. The sciatic nerve, which is really a bundle of lumbar nerves, can become irritated by a herniated disk, a condition called spinal stenosis. The nerve also can be irritated by an abnormality in a vertebra that puts pressure on it. Sciatic pain can be felt in the lower back, the buttocks, the calf and the foot. The pain can range from a mild tingling or ache to severe, and it is usually worse at night. Sciatica is aggravated by long stretches of standing or sitting.

  • Lumbar spinal stenosis. Spinal degeneration narrows the canal through which the spinal nerves travel. The degeneration occurs with age, because the disks dry out and shrink. If a disk then becomes inflamed from a minor injury, this can put pressure on a spinal nerve, causing pain. Spinal stenosis usually is associated with osteoarthritis of the spine.

  • Osteoarthritis. Osteoarthritis can affect the cartilage in the disks, the vertebrae or both, anywhere along the spine. This condition causes pain and muscle spasms. Spinal nerves also can become pinched, which is another cause of back pain.

Treatment options

Treatment of back pain depends on several factors. If the pain occurs because of an accident or injury, or fever is present, you should see your health care provider immediately, says the AANS.

Pain not accompanied by fever or not associated with an accident or injury may not need immediate treatment.

You should wait a few days to see if the pain subsides, the AANS says. Bed rest is no longer recommended, although you should stop normal activities for several days until symptoms ease. A good night's sleep is also important in recovering from back pain. If you have trouble getting to sleep because of the pain, take a warm bath and try relaxation techniques; avoid caffeine late in the day. You may need medication to help you sleep. Take an anti-inflammatory medication such as ibuprofen and try hot showers to relax the muscles. You can also alternate mild hot and cold packs for 20 minutes, up to 4 times a day, to the affected muscles. If this doesn't help, call your provider.

If you have chronic back pain, your treatment may also include anti-inflammatory medication and muscle relaxants, physical therapy, steroid injections, traction, ultrasound, electrical stimulation, alternating ice packs with heating pads, massage and whirlpool therapy. Acupuncture and exercise programs, such as Yoga, have also been tried as an alternative therapy.

Your health care provider may also advise you to make lifestyle changes such as losing excess weight; exercising for at least 30 minutes each day; adding abdominal core strengthening exercises and improving your posture when sitting and standing.

Surgery may be recommended if these remedies don't work after trying them for two or three months. The most common reasons for spinal surgery are spinal stenosis and sciatica.

These are possible signs that surgery may be needed:

  • Leg or back pain that limits normal activity, resulting in an unacceptable quality of life

  • Weakness or numbness in the legs

  • Difficulty walking or standing

  • Pain continues despite medication and physical therapy

Surgery may involve removing some of the gel-like material in the affected disk, removing a small piece of bone near the disk to allow more space without pinching a nerve, or fusing disks if several are affected or in cases of spinal degeneration.