Commonly Asked Questions About Back Pain
Dr. Kevin McGuire, Co-Director of the Spine Center at Beth Israel Deaconess Medical Center
Will most back pain get better on its own?
Back pain is very common. 85 percent of Americans have acute onset of back pain at some point-a pain that puts them down for the count for 24 hours.
Fortunately, most back pain gets better on its own. I recommend reducing your activity for a day or two then slowly returning to your baseline activities. Take some over-the-counter pain medication like Motrin or Advil to stay comfortable. If the pain continues after that or is unbearable, you should see your primary care doctor. You should also see a doctor right away if the pain is in combination with trouble urinating, weakness or numbness in your legs, fever, or unintentional weight loss.
I am seven months pregnant and my back is very sore. I can't walk, sit or sleep without it hurting. Will it go away?
About half of all pregnant women will experience back pain - mostly because of hormone changes and the additional weight they are carrying. Because that weight is carried on the front of the body, it puts more strain on the lower back.
I recommend women change their position frequently - try not to stand a certain way for long periods of time. Sit with your feet slightly elevated when possible. Sleep on your side when you can to take the weight off your back. And you can always ask a friend or spouse for a back rub!
Most of the time, the back pain that results during pregnancy is temporary and goes away after the baby is delivered.
When is back surgery appropriate for chronic pain?
Surgery may be appropriate for those who are in constant pain, or if pain reoccurs frequently and interferes with your ability to live day-to-day for more than six months. Because there are always risks with surgery, it's important that all other methods of treatment have been tried and failed. Those may include pain medications and physical therapy.
The number of patients seeking surgery has risen substantially in recent years as the media has reported on newer techniques and procedures such as total disc replacement and minimally invasive procedures. But while these surgeries are exciting and can have as high as an 80 percent effectiveness rate in treating pain, they are only appropriate for very few patients. This can cause a great deal of frustration. Unfortunately, there is no magic bullet procedure when it comes to eliminating most back pain. What we try to do as specialists is devise a plan that can lessen the pain to a point where patients can function and continue to live their lives as pain-free as possible.
Why won't my doctor order an MRI? My back really hurts.
According to Dr. John Keel, Medical Director of the Spine Center at Beth Israel Deaconess, patients need to ask "How would this MRI change things for me?" As surprising as it may seem, most back pain does not require any imaging. That's because about 90 percent of acute back pain episodes resolve on their own. An MRI may not improve the outcome in these cases, and an unnecessary MRI could actually lead you down the wrong path, such as having an unnecessary procedure.
Imaging can be deceiving sometimes, as numerous studies have shown. For example, if you take 100 people who have no medical problems-- and no back pain--and you do an MRI, there will often be a "spine problem" that shows up. In fact, up to half will have a bulging or herniated disc, despite the fact that the person has no back pain.
Very sensitive tests like MRI may fool you into thinking you have found the cause of pain, when really it is not significant. On the other hand, an MRI might truly reveal the cause of pain, but then what? For most acute back pain episodes, conservative therapy for the first few weeks resolves the problem. For example, the body can absorb and heal disc herniations. In these cases, getting an MRI too early would not be helpful for the treatment plan.
In general, imaging can also expose patients to other risks, such as radiation, and imaging adds tremendously to the overall cost of health care. The bottom line--qualified spine specialists know when to order an image study and when not to. Find a doctor you trust and work together toward resolving your back pain.
Is there any way to strengthen your back to prevent pain?
There are things you can do to prevent back pain. The first and most important is to stay in shape. Get the recommended 30 minutes of exercise most days of the week-low-impact aerobic exercise like brisk walking or swimming is good for the discs that cushion the vertebrae. Also, weight-bearing exercises that test balance -even Yoga or Pilates--are also good for the spine. I suggest anyone with specific concerns work with a physical therapist or qualified personal trainer to come up with a routine that works for you.
Also, eat right, which includes foods high in calcium and vitamin D. You need to stay at a healthy weight as obesity can put stress on the back. And don't smoke. Smokers have greater incidence of low back pain and sciatica (pain that radiates down the legs).
I'm noticing that when I bend over to fold laundry or empty the dishwasher, my back just hurts. I'm only 45. Is this a sign that I will have more back trouble as I get older?
Back pain becomes more common as we age. Just like your hip and knee can wear out, your back can also wear out. The first attack of low back pain typically occurs between the ages of 30 and 40. It is also more common in people who are not physically fit. I recommend you start moving - every day. The right movement program may not solve your back pain when you bend over, but it will at least allow you to function at the highest level possible.
My husband works in construction and is always lifting heavy things. His back does get sore. Is he at risk for long-term pain?
There are occupations that are more prone to causing back pain. Any job where there is heavy lifting, pushing or pulling - especially when it involves a twisting motion, can lead to injury. I tell people that if you DO lift something heavy, keep your back straight. Never bend over the item. Bend your knees and put the stress on your legs and your hips. For anyone with a profession that involves a lot of heavy lifting, a back belt can be an important tool to prevent problems.
It's important to note that jobs involving very little exertion, such as desk jobs, can also contribute to pain - especially if poor posture is involved.
My mother fell and cracked a vertebrae. She has osteoporosis. She was given a brace but it doesn't seem to be helping. Is there any treatment for this?
There are relatively new and exciting treatments for this situation. This would involve a "minor" surgical procedure that would "augment" the cracked vertebrae with cement. It is very successful for relieving the back pain from the cracked vertebrae. It is also important that the osteoporosis be treated as directed by your PCP. The home should also be evaluated to decrease the risk of any falls, such as removing loose area rugs.
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.