Overview
Ninety percent of American adults will experience an episode of back pain
during their lifetime. Back pain is the second most common reason people visit
their family physician (just behind upper respiratory infections). On any given
day, almost two percent of the entire United States workforce is disabled by
back pain. In people under 40 years of age, back pain is the most common reason
for inability to perform daily activities.
Pain that affects primarily the back should be distinguished from spinal
conditions that result in predominant leg pain, commonly called sciatica.
Typically, sciatica is the result of a "pinched nerve" in the spinal
column. In most cases, the cause of the sciatica is clearly defined - such as
disc or arthritic spur. The cause of an episode of back pain, on the other hand,
is often more difficult to pinpoint, and may be related to the spinal discs,
joints, vertebrae, or soft tissue supports (muscles, ligaments, tendons).
Acute back pain
Most people recover from an episode of acute back pain within two weeks with
minimal medical intervention. Appropriate use of over-the-counter pain
relievers, such as acetaminophen or ibuprofen, and early resumption of normal
activities as permitted by pain, for most are simple and effective treatments.
X-rays or scans (MRI, CT scan) are rarely required.
Warning signs or "red flags" that should prompt urgent medical
evaluation include the presence of fever, worsening pain, progressive movement
of the pain from the back into the leg, and pain that is unrelieved at rest or
disturbs sleep.
Chronic persistent back pain
Most back pain resolves within a few days with simple treatment. When back
pain persists beyond 2-4 weeks, further careful medical evaluation is required.
This evaluation focuses on a careful medical history and physical examination to
identify, if possible, a precise cause of the pain. Rarely, malignancy or
infection is found. More commonly, the source of the pain is discovered to be
related to the spinal joints, discs, or supporting musculature.
In many people with back pain, an MRI is not helpful in defining the cause.
For example, the MRI provides little information as to the condition of the
ligaments, muscles, and tendons. It may demonstrate common degenerative, or
"wear and tear" changes in the discs or joints in the spine. However,
these changes are common in people who have no symptoms. It is often difficult
to know whether or not to "blame" back symptoms on a finding seen on
the MRI scan.