Back pain

Diagnosis

Your healthcare professional examines your back and assesses your ability to sit, stand, walk and lift your legs. The health professional also might ask you to rate your pain on a scale of zero to 10 and to talk about how your pain affects your daily activities.

These assessments help determine where the pain comes from and how much you can move before pain or muscle spasms force you to stop. Exams also can help rule out more-serious causes of back pain.

One or more of these tests might help pinpoint the cause of the back pain:

• X-ray. These images show arthritis or broken bones. But the images alone won't find conditions affecting the spinal cord, muscles, nerves or disks.
• MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
• Blood tests. These can help determine whether an infection or other condition might be causing pain.
• Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and how the muscles respond to them. This test can confirm pressure on the nerves caused by herniated disks or narrowing of the spinal canal, called spinal stenosis.

Treatment

Most back pain gets better within a month using home treatment, especially for people younger than age 60. However, for many, the pain lasts several months.

Pain relievers and the use of heat might be all that's needed. Bed rest isn't recommended.

Continue your activities as much as you can with back pain. Try light activity, such as walking. Stop activity that increases pain, but don't avoid activity out of fear of pain. If home treatments aren't working after several weeks, your healthcare professional might recommend stronger medicines or other therapies.

Medicines

Medicines depend on the type of back pain. They might include:

• Pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might help. Take these medicines only as directed. Overuse can cause serious side effects. If pain relievers you can buy without a prescription don't help, your healthcare professional might suggest prescription NSAIDs.
• Muscle relaxants. If mild to moderate back pain doesn't improve with pain relievers, a muscle relaxant might help. Muscle relaxants can cause dizziness and sleepiness.
• Topical pain relievers. These products, including creams, salves, ointments and patches, deliver pain-relieving substances through the skin.
• Narcotics. Medicines containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close medical supervision.
• Antidepressants. Some types of antidepressants, particularly duloxetine (Cymbalta) and tricyclic antidepressants such as amitriptyline, have been shown to relieve chronic back pain.

Physical therapy

A physical therapist can teach exercises to increase flexibility, strengthen back and abdominal muscles, and improve posture. Regular use of these techniques can help keep pain from returning. Physical therapists also teach how to modify movements during an episode of back pain to avoid flaring pain symptoms while staying active.

Surgical and other procedures

Procedures used to treat back pain may include:

• Cortisone shots, also called injections. If other measures don't relieve pain that radiates down the leg, an injection of cortisone plus a numbing medicine might help. A cortisone injection into the space around the spinal cord helps decrease inflammation around the nerve roots, but the pain relief often lasts only a month or two.
• Radiofrequency ablation. In this procedure, a fine needle is inserted through the skin near the area causing the pain. Radio waves are passed through the needle to damage the nearby nerves. Damaging the nerves interferes with pain signals to the brain.
• Implanted nerve stimulators. Devices implanted under the skin can deliver electrical impulses to certain nerves to block pain signals.
• Surgery. Surgery to create more space within the spine is sometimes helpful for people who have increasing muscle weakness or back pain that goes down a leg. These problems can be related to herniated disks or other conditions that narrow the spaces where nerves pass through the spine.

Alternative medicine

A number of alternative treatments might ease back pain. Always discuss the benefits and risks with your healthcare professional before starting a new alternative therapy. Alternative treatments may include:

• Acupuncture. A practitioner of acupuncture inserts thin sterilized needles into the skin at specific points on the body. A growing body of scientific evidence indicates that acupuncture can be helpful in treating back pain.
• Chiropractic care. A chiropractor manipulates the spine to ease pain.
• Massage. For back pain caused by tense or overworked muscles, massage might help.
• Transcutaneous electrical nerve stimulation, also known as TENS. A battery-powered device placed on the skin delivers electrical impulses to the painful area. Studies have shown mixed results on whether TENS works to treat back pain.
• Yoga. There are several types of yoga, a broad discipline that involves practicing specific postures or poses, breathing exercises, and relaxation techniques. Yoga can stretch and strengthen muscles and improve posture. People with back pain might need to adjust some poses if they make symptoms worse.

Preparing for your appointment

If your back pain persists despite home treatment, see your healthcare professional. Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Key personal information, including mental or emotional stressors in your life.
• Your symptoms, and when they began.
• All medicines, vitamins and other supplements you take, including doses.
• Questions to ask your provider.

Take a family member or friend along, if possible, to help you remember the information you receive.

For back pain, questions to ask your healthcare professional include:

• What is the most likely cause of my back pain?
• Do I need tests?
• What treatment approach do you recommend?
• If you're recommending medicines, what are the possible side effects?
• I have other medical conditions. How can I best manage them together?
• How long will I need treatment?
• What self-care measures should I try?
• What can I do to prevent back pain from coming back?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• Have you ever injured your back?
• Is the pain constant?
• Does the pain affect your ability to function? How?
• Do you have other symptoms besides back pain?
• Do you do heavy physical work?
• Do you exercise regularly? What types of activities do you do?
• How often do you feel depressed or anxious?
• Do you sleep well?
• What treatments or self-care measures have you tried so far? Has anything helped?