Main Campus: Chesterfield, MO 63017 | 
Low back pain - chronic
Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low
Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.
Low back pain that is long-term is called chronic low back pain.
Causes
Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.
A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.
Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:
- Heavy use from work or sports
- Injuries or fractures
- Surgery
You may have had a herniated disk , in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.
Herniated disk
A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves...
If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis . These problems are called degenerative joint or spine disease.
Spinal stenosis
Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) wher...
Other possible causes of chronic low back pain include:
-
Curvature of the spine, such as
scoliosis
or
kyphosis
Scoliosis
Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a b...
ImageRead Article Now Book Mark ArticleKyphosis
Kyphosis is a curving of the spine that causes a bowing or rounding of the back. This leads to a hunchback or slouching posture.
ImageRead Article Now Book Mark Article -
Medical problems, such as
fibromyalgia
or
rheumatoid arthritis
Fibromyalgia
Fibromyalgia is a common syndrome in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue,...
ImageRead Article Now Book Mark ArticleRheumatoid arthritis
Rheumatoid arthritis (RA) is a long-term disease. It leads to inflammation of the joints and surrounding tissues. It can also affect other organs....
ImageRead Article Now Book Mark Article - Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle
You are at greater risk for low back pain if you:
- Are over age 30
- Are overweight
- Are pregnant
- Do not exercise
- Feel stressed or depressed
- Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
- Smoke
Symptoms
Symptoms may include any of the following:
- Dull aching pain
- Sharp pain
- Tingling or burning sensation
- Weakness in your legs or feet
Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you cannot move.
Depending on the cause of your back pain, you may also have pain in your leg, hip, or on the bottom of your foot.
Exams and Tests
During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.
Other tests you have depend on your medical history and symptoms.
Tests may include:
-
Blood tests, such as a
complete blood count
and
erythrocyte sedimentation rate
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
ImageRead Article Now Book Mark ArticleErythrocyte sedimentation rate
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures how much inflammation is in...
Read Article Now Book Mark Article -
CT scan of the lower spine
CT scan of the lower spine
A computed tomography (CT) scan of the lumbar spine makes cross-sectional pictures of the lower back (lumbar spine). It uses x-rays to create the im...
Read Article Now Book Mark Article -
MRI scan of the lower spine
MRI scan of the lower spine
A lumbar magnetic resonance imaging (MRI) scan uses energy from strong magnets to create pictures of the lower part of the spine (lumbar spine). An M...
Read Article Now Book Mark Article - Myelogram (x-ray or CT scan of the spine after dye has been injected into the spinal column)
-
X-ray
X-ray
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray particles through the body. The im...
ImageRead Article Now Book Mark Article
Treatment
Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.
Take care of your back at home
Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficult...
Your doctor may recommend measures to reduce your pain, including:
- A back brace to support your back
- Cold packs and heat therapy
- Traction
- Physical therapy, involving stretching and strengthening exercises
- Counseling to learn ways to understand and manage your pain
These other health care providers may also help:
- Massage therapist
- Someone who performs acupuncture
- Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)
If needed, your doctor may prescribe medicines to help with your back pain:
- Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
- Low doses of prescription medicines
- Narcotics or opioids when the pain is severe
If your pain does not improve with medicine, physical therapy, and other treatments, your doctor may recommend an epidural injection .
Epidural injection
An epidural steroid injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around...
Spinal surgery is considered only if you have nerve damage or the cause of the back pain does not heal after a long time.
In some patients, a spinal cord stimulator can help reduce back pain.
Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:
- Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
- Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals
Some people with low back pain may also need:
- Job changes
- Job counseling
- Job retraining
- Occupational therapy
Outlook (Prognosis)
Most back problems get better on their own. Follow your provider's advice on treatment and self-care measures.
When to Contact a Medical Professional
Call your provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.
References
El Abd O, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 48.
Malik K, Benzon HT. Low back pain. In: Benzon HT, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW, eds. Practical Management of Pain . 5th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 21.
Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician . 2013;16(2 Suppl):S49-283. PMID: 23615883 www.ncbi.nlm.nih.gov/pubmed/23615883 .
-
Factors that can cause and worsen chronic pain
Animation
-
Animation
-
AcutevsChronic9_0_117
Animation
-
Causes10_0_050
Animation
-
Spinal stenosis - illustration
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.
Spinal stenosis
illustration
-
Backaches - illustration
Although stress can cause backaches it is wise to watch out for other signs that may indicate a more serious condition. Pain which radiates to the buttocks, arms or legs, and weakness or numbness in the arms and legs should not be ignored.
Backaches
illustration
-
Factors that can cause and worsen chronic pain
Animation
-
Animation
-
AcutevsChronic9_0_117
Animation
-
Causes10_0_050
Animation
-
Spinal stenosis - illustration
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.
Spinal stenosis
illustration
-
Backaches - illustration
Although stress can cause backaches it is wise to watch out for other signs that may indicate a more serious condition. Pain which radiates to the buttocks, arms or legs, and weakness or numbness in the arms and legs should not be ignored.
Backaches
illustration
-
Low back pain
(Alt. Medicine)
-
Back pain and sciatica
(In-Depth)
-
Fibromyalgia
(In-Depth)
-
Prostatitis
(Alt. Medicine)
-
Viral hepatitis
(Alt. Medicine)
-
Exercise
(In-Depth)
-
Osteoarthritis
(Alt. Medicine)
-
Foot pain
(In-Depth)
-
Chronic fatigue syndrome
(Alt. Medicine)
-
Chiropractic
(Alt. Medicine)
Review Date: 6/1/2015
Reviewed By: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN), Gainesville, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
