Back Pain

Back pain is one of the most common health problems, affecting most people at some point in their lives. It can range from a dull, constant ache to a sudden, sharp pain. Back pain can occur in the upper, middle, or lower back, with lower back pain being most common.

Most back pain is acute (lasting a few days to a few weeks) and improves with self-care. However, some cases are chronic (lasting more than 3 months) and may require medical treatment. Understanding the cause and proper management is important for recovery.

Back pain can vary in location, intensity, and characteristics:

Types of Pain:

• Sharp, stabbing pain: Sudden, intense
• Dull, aching pain: Persistent, constant
• Burning sensation: Nerve-related
• Muscle spasms: Involuntary muscle contractions

Location:

• Lower back (lumbar): Most common
• Upper back (thoracic): Less common
• Middle back: Can occur
• Neck (cervical): Can extend to back

Associated Symptoms:

• Stiffness
• Difficulty standing straight
• Pain radiating to legs (sciatica)
• Numbness or tingling
• Weakness in legs
• Difficulty walking

Call Emergency Services (112 in Sweden) if:

• Back pain after severe injury (fall, accident)
• Back pain with loss of bladder or bowel control
• Back pain with numbness in saddle area
• Back pain with severe weakness in legs
• Back pain with fever and other signs of infection
• Severe, sudden back pain

For most acute back pain:

1. Stay Active (within limits):

   • Gentle movement is better than bed rest
   • Avoid activities that worsen pain
   • Light walking if possible
   • Don't stay in bed for more than 1-2 days

2. Ice and Heat:

   • Ice: First 48 hours (20 minutes, several times daily)
   • Heat: After 48 hours (warm compress, heating pad)
   • Helps reduce inflammation and muscle tension

3. Over-the-Counter Medications:

   • Acetaminophen for pain
   • NSAIDs (ibuprofen, naproxen) for pain and inflammation
   • Follow dosing instructions
   • Don't use long-term without doctor approval

4. Maintain Good Posture:

   • Sit and stand straight
   • Use ergonomic chair
   • Support lower back
   • Avoid slouching

5. Sleep Position:

   • Sleep on side with knees bent
   • Or on back with pillow under knees
   • Use firm mattress
   • Avoid stomach sleeping

6. Gentle Stretching:

   • When pain allows
   • Don't overstretch
   • Gentle range-of-motion exercises
   • Stop if pain worsens

7. Avoid Heavy Lifting:

   • Don't lift heavy objects
   • Use proper technique if must lift
   • Bend knees, not back
   • Get help for heavy items

• Back pain after severe injury
• Loss of bladder or bowel control
• Numbness in saddle area
• Severe weakness in legs
• Back pain with fever and infection signs
• Severe, sudden back pain

• Back pain lasting more than a few weeks
• Severe back pain
• Back pain not improving with self-care
• Back pain with leg pain, numbness, or weakness
• Back pain affecting daily activities
• Back pain with other concerning symptoms
• Recurrent back pain
• Questions about treatment

• Mild to moderate back pain
• Recent onset (few days)
• Improving with self-care
• No concerning symptoms
• No neurological symptoms

Evaluating back pain may involve:

1. Medical History and Physical Exam:

   • Description of pain
   • When it started
   • What makes it better/worse
   • Physical examination
   • Neurological assessment

2. Imaging Tests (usually not needed for acute pain):

   • X-rays: Show bone structure
   • MRI: Detailed images of soft tissues, nerves
   • CT scan: Detailed bone and tissue images
   • Usually only if symptoms persist or severe

3. Blood Tests (if infection or other cause suspected):

   • Complete blood count
   • Inflammatory markers
   • Other tests as needed

4. Nerve Tests (if nerve damage suspected):

   • Electromyography (EMG)
   • Nerve conduction studies

Treatment depends on the cause and duration:

Acute Back Pain:

• Self-care (ice, heat, medications)
• Stay active
• Usually resolves in days to weeks
• Physical therapy if needed

Chronic Back Pain:

• Physical therapy
• Exercise program
• Medications (may include stronger options)
• Injections (in some cases)
• Alternative therapies
• Surgery (in some cases)

Medications:

• Over-the-counter pain relievers
• Prescription medications if needed
• Muscle relaxants (short-term)
• Topical medications
• Antidepressants (for chronic pain)

Physical Therapy:

• Strengthening exercises
• Stretching
• Posture training
• Core strengthening
• Education

Other Treatments:

• Chiropractic care (for some)
• Massage therapy
• Acupuncture
• Injections (epidural, etc.)
• Surgery (last resort, for specific conditions)

Prevent back pain by:

• Exercise Regularly: Strengthens back and core muscles
• Maintain Healthy Weight: Reduces stress on back
• Use Proper Lifting Technique: Bend knees, not back
• Maintain Good Posture: When sitting and standing
• Use Ergonomic Furniture: Supportive chair, proper desk height
• Quit Smoking: Smoking can contribute to back pain
• Sleep on Firm Mattress: Supports spine properly
• Stay Active: Regular activity maintains back health

Back pain can result from:

Muscle or Ligament Strain:

• Overstretching or tearing
• Sudden movements
• Poor lifting technique
• Most common cause

Bulging or Ruptured Discs:

• Discs cushion vertebrae
• Can bulge or rupture
• May press on nerves
• Causes pain, sometimes leg pain

Arthritis:

• Osteoarthritis of spine
• Can cause pain and stiffness
• More common with age

Skeletal Problems:

• Scoliosis (curvature)
• Other structural issues
• Can cause pain

Osteoporosis:

• Weak bones
• Compression fractures
• Can cause severe pain

Other Causes:

• Kidney problems
• Infections
• Tumors (rare)
• Other medical conditions

• More common with age
• Often arthritis-related
• Higher risk of fractures
• May have multiple causes
• May need more comprehensive treatment

• Very common
• Often work-related
• May be injury-related
• Lifestyle factors important

• Higher risk
• Posture important
• Regular breaks needed
• Exercise crucial

Most acute back pain improves within a few days to a few weeks with self-care. If pain persists more than 3 months, it's considered chronic and may need medical treatment.

No. While you should avoid activities that worsen pain, staying in bed for more than 1-2 days can actually make back pain worse. Gentle movement and light activity are better.

Most acute back pain doesn't need imaging. Tests are usually ordered if pain persists, is severe, or if there are concerning symptoms like neurological problems.

Yes. Regular exercise, especially core strengthening and flexibility exercises, can help prevent back pain and reduce recurrence.

Most people don't need surgery. Surgery is usually only considered for specific conditions like herniated discs with nerve compression, spinal stenosis, or other structural problems that don't respond to other treatments.