Back pain

What is back pain?

Back pain is experienced by 15-20% of people in the U.S., affects males and females equally, and can occur at any age, with the majority of initial episodes taking place between ages 20-40. Generally, back pain can be attributed to mechanical causes, most of which are relatively benign, although a small number of cases are due to more serious illness.

What causes back pain?

  • Degeneration (i.e. – osteoarthritis)
  • Muscle strain
  • Mechanical problems (i.e. – herniated disc)
  • Vertebral fractures associated with osteoporosis
  • Tobacco, alcohol and drugs, poor diet
  • Lack of regular physical activity have been implicated as risk factors for back pain
  • Rare, more serious causes include cancer, infection, vascular problems, and damage to nervous tissues

Common types of back pain

Lower back pain

Lower back pain is one of the most frequent musculoskeletal complaints. Pain may arise from damage or irritation to structures of the lower back including the vertebrae (bony spine), facet joints, discs between the vertebrae, vertebral ligaments, muscles of the lower back, spinal cord, and peripheral nerves, as well as internal organs of the pelvis and abdomen (spleen, kidney, pancreas, and liver).

Upper back pain

Upper back pain is less common than low back pain or neck pain, and it’s caused when the discs between the vertebrae begin to deteriorate or are deformed.

Typical diagnosis

Diagnosis leading to productive back pain treatment is done by a doctor through a comprehensive history and physical examination. Additionally, a full neurological work-up is often performed to identify compressed nerves from a herniated disc. Supplemental imaging is usually reserved for symptoms that persist beyond several weeks despite conservative treatment or if a physician suspects a serious pathology.

Depending on your particular back pain, the doctor may order an X-ray if a bone infection or tumor is suspected or magnetic resonance imaging (MRI) or computed tomography (CT) scan if the disc herniation is suspected.


The pain may be aggravated with movement or may radiate into the upper or lower extremities. Patients may also have limited range of motion and/or tenderness upon touch. Certain red flags indicate a more serious condition that may require emergency evaluation or surgery, including weakness, numbness or tingling, fever, weight loss, or problems with bowel or bladder control.


  • Physical therapy and exercise help strengthen the back to avoid future injury and speed the recovery process.

Treatments (cont.)

  • Lifestyle adjustments to avoid aggravating movements and reducing body weight.
  • Alternative therapies such as massage, yoga, and acupuncture may provide benefit to some patients.

Injection Therapy

When conservative measures suggested by your doctor for back pain are ineffective, local anesthetics, steroids, or opiates can often be injected at the site of pain to block the conduction of pain signals to the brain.


Back pain treatments range from conservative management to surgery, depending on the cause and severity of the pain. The goal of treatment is to relieve symptoms and improve functioning.

Procedures / Surgeries

Back pain due to disc herniation may require surgical intervention via spinal fusion or discectomy, the removal of herniated tissue.


Pain-relieving medications are the initial treatment of choice for back pain. These can include over-the-counter pain medicines such as acetaminophen (Tylenol™), ibuprofen (Advil™), muscle relaxants, or prescription opioids.

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