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Nonspecific back pain
Back pain is one of the most common complaints treated by physicians. Nearly 4 out of 5 people will experience back pain at some time in their life. The vast majority of these cases do not have a definable cause for their pain. This is an important, common problem and the annual cost of treating this pain runs in the tens of billions of dollars. Back pain can develop in association with a number of causes, including muscle strain, injury to the back, overuse, muscle disorders, pressure on a nerve root, poor posture, and many others. Pregnant women, smokers, construction workers, and people who perform repetitive lifting all have increased risk of back pain. Symptoms
Signs and testsA physical examination focused on the back, the abdomen, and the extremities may confirm back pain or muscle spasm, but the examination does not reveal a specific cause (such as a herniated disk) or any neurological problem (such as weakness or change in sensation). X-rays of the spine are usually normal. Further work-up may include a CT scan or MRI of the spine.
TreatmentThe majority of nonspecific back pain is probably caused by muscle strain. This usually responds to 2-5 days of rest and pain medications (such as nonsteroidal anti-inflammatory agents -- ibuprofen, naproxen, aspirin, etc.), followed by gradual return to activities. Medications may be needed to reduce muscle spasms. Physical therapy is often prescribed to instruct the patient on proper body mechanics (such as good posture and lifting correctly) and to improve strength and flexibility in the spine, abdomen, and legs. Surgery is not useful for the treatment of nonspecific back pain.
Expectations (prognosis)Most cases of nonspecific back pain resolve on their own or respond to treatment. It is helpful to sleep on a firm mattress, with a board under the mattress, or even on the floor. Heat or ice applied to the affected area may provide some relief.
ComplicationsChronic pain can develop which can be debilitating and keep people out of work. Calling your health care provider Call for an appointment with your health care provider if there is significant pain that persists beyond a week. Call your health care provider if you have been diagnosed with nonspecific back pain and the pain changes in intensity or quality. This is particularly important if the pain travels down the legs below the knee (suggesting pressure on the nerves as they leave the spinal cord), or if there is weakness or numbness in a leg. If you develop progressive weakness, urinary incontinence or bowel incontinence, or if you have numbess in your groin or anal region, you should get to an emergency room or call the local emergency number.
PreventionPrevention is very important, given the tremendous number of people who suffer from this problem. Maintain your weight in a healthy range and keep the back muscles strong and flexible to help prevent back problems. Good posture and correct technique when lifting heavy objects (lifting with legs, keeping back straight) or carrying heavy objects (keep object close to body) are also beneficial.
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