Back Pain: An Obvious Problem, but What Is It, Really?

Woman rubbing aching back
Woman rubbing aching back. Tom Merton / Getty Images

What is Back Pain?

Back pain is an easily recognizable problem that can bring on a number of sensations and movement limitations. It can present itself in any location along the spine, a stack of 26 bones connected by ligaments, muscles and shock-absorbing discs.  All structures that make of the spine may contribute to your back pain.

Back pain is one of the most common complaints brought to doctors in the United States.

Over six million cases are seen annually, with the majority being in the lower back. It's expensive, too, ranking 3rd after heart disease and cancer. Around 80 percent of people get back pain sometime in their lives.

Although back pain can be categorized in a number of ways, the most obvious is by location. Common conditions include (but are not limited to) the following:

Lower Back Pain

Low back pain occurs in the area of the back that goes from just below the bottom of the ribs down to the​ tailbone. It may be caused any number of things from bone spurs, thickened ligaments, degenerated or herniated discs, spinal cysts, or plain 'ole muscle spasms

According to the New England Journal of Medicine, about two-thirds of adults will experience low back pain at some point.

A 2005 study from Toronto Western Hospital Research showed that while most lower back pain is mild in severity, less than 1/3 of the cases resolve within a year. The study also notes that seniors have more persistent and recurring back pain than young adults, and that 20 percent of all lower back pain cases recur within 6 months.

Sometimes low back pain is accompanied by pain going down the leg, a condition many people refer to as sciatica. Sciatica is created when pressure is put directly on the sciatic nerve  in some way. An example of this is when a butt muscle known as the piriformis is too tight (piriformis syndrome.) More often, however, sciatica is due to herniated or spinal stenosis.  When a herniated disc pressures the spinal nerve roots from which the sciatic nerve originates, the sciatica symptoms, most notably pain and other symptoms that go down one leg, is technically known as radiculopathy.

And a 2016 review published by the Agency for Healthcare Quality and Research found that many treatments for low back pain exist that confer but small to moderate benefits.  Generally, they say, these treatments give better pain relief than function improvement. One strategy many physical therapists use when treating their back pain patients is to combine several treatments in order to realize enough improvement.

Types of Low Back Pain

Back Pain Causes

It can be difficult to find the cause of chronic pain. Even with the use of the latest imaging and other types of tests, doctors often are not able to pinpoint the cause of back pain. On the flip side, many times imaging tests such as MRIs show problems in the spine of a patient who feels no back pain.

Back pain is rarely life-threatening. But if you have lost control of or have no feeling in your bowels or bladder, if your legs are growing progressively weaker and/or if you can't feel anything in your seat (if you were in a saddle), seek medical attention immediately.

Chronic and Acute and Back Pain

Back pain can be acute or chronic. Distinguishing between these two types of pain may help you determine what to do about yours.

Acute symptoms tend to come on suddenly, usually in response to an event such as an injury. They generally last for a few days to a few weeks; they often resolve on their own, or with modified activity and simple treatments (including over-the-counter pain medications such as non-steroidal anti-inflammatories and/or simple exercises.)  

But an acute spine injury can become chronic, especially if you don't scale your activities back so that you're not in pain, or if you need treatment that you don't get it in a timely way.

Chronic back pain will likely nag you for a long time, and in some cases may force you to alter your lifestyle significantly. Experts vary on the length of time pain has to be present before they will call it chronic pain, but it generally ranges from 3 to 6 months. If your back pain has been bothering you for at least 3 months, consult your physician.

Sources:

Chou R., Deyo R., et. al. Noninvasive Treatments for Low Back Pain. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb. http://www.ncbi.nlm.nih.gov/pubmed/26985522

Deyo, R., & Weinstein, J. (2001). "Low Back Pain". New England Journal of Medicine, 344, Retrieved February 19, 2007.

"Adult Low Back Pain". Institute for Clinical Systems Improvement (ICSI), (June 1994 rev. Sept. 2006). Retrieved February 28, 2007, from National Guideline Clearinghouse Web site.

"Low Back Pain Fact Sheet". National Institute of Neurological Disorders and Stroke (NINDS). Retrieved: June 15, 2006.

"Lost-worktime Injuries and Illnesses: Characteristics and Resulting Time Away From Work". 2005. Bureau of Labor Statistics. Retrieved: June 15, 2006.

Cassidy, J., Cote, P., Carroll, L., & Kristman, V. (2005) "Incidence and Course of Low Back Pain in Episodes in the General Population". Spine, 30(24), Retrieved: March 5 2007.

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