Chronic Back Pain

Back pain is common in adults. Most cased of lower back pain are acute (or temporary) and will usually get better on their own with self-care. If the pain lasts for 12 weeks or longer, then you may have chronic back pain. Learn more about treating chronic back pain.

Back pain is common. In fact, about 80 percent of adults experience back pain at some point in their lifetime. Most back pain is acute or temporary. It usually resolves on its own with self-care. If the pain lasts for 12 weeks or longer, then you may have chronic back pain.

About 20 percent of people affected by acute low back pain will develop chronic back pain. The pain may be debilitating, and it could make it difficult for you to go to work or exercise. In some cases, treatment will successfully relieve chronic back pain. In other cases, the pain will not go away despite medical and surgical treatments.

Chronic pain can range from mild to severe. Symptoms of chronic back pain include:

• A dull ache, burning, or sharp (stabbing) pain in the back
• Pain that radiates (spreads) to the buttocks and the top of the legs
• Trouble moving, especially bending, twisting, or getting up from lying down or sitting

There may be other symptoms such as stiffness, numbness, or weakness in your arms and legs. 

See a doctor immediately or go to the nearest emergency room if you have any of these symptoms:

• Trouble going to the bathroom
• Trouble controlling your urine or bowels
• Blood in your urine

Make an appointment to see your doctor if you develop any of these symptoms:

• Sudden, severe pain
• Severe back pain that gets worse over several weeks instead of getting better
• Numbness or weakness in your legs
• Fever

You may also decide to see the doctor if your back pain lasts longer than 12 weeks or keeps coming back. In most cases, there’s no magic cure for back pain. Your doctor may not even be able to tell you the exact cause of your pain. However, your doctor can make sure your back pain is not because of a serious condition and recommend treatments for controlling pain and continuing daily activities.

Not all back pain episodes require a doctor’s visit. You can often manage your pain on your own and resume your normal activities when you are ready. If the pain persists, or if the pain causes ongoing discomfort, makes it hard to sleep, or interrupts daily activities, then you should contact your healthcare provider.

The exact cause of chronic back pain may be hard to pinpoint. The pain may be a symptom of many different causes, including:

• Fractures in your spine
• Degenerated disc disease
• Bulging disc
• Herniated disc
• Spinal instability
• Stenosis or narrowing of the spinal canal
• Nerve problems
• Tumors
• Infection

Other factors that may also increase your chances of having pain include:

• Aging. The older you are, the more likely you are to have chronic back pain.
• Previous injury. An injury you had months or years ago may cause chronic back pain.
• Diseases. Arthritis, osteoporosis, and other diseases may cause chronic back pain.
• Poor physical fitness. Lack of exercise and poor posture increase your risk of back pain.
• Being overweight. Extra weight puts extra stress on your back.
• Your job or your hobby. A job or activity that requires you to lift, push, and pull on a regular basis may cause chronic back pain.
• Smoking. Studies show that smokers have more back problems than non-smokers.
• Family history and genetics. Some conditions that cause chronic back pain run in families. 

Physical exam

As part of a physical exam, your doctor will check your body and its movement. Below are some things your doctor may note.

• Weakness: Simple exercises can help test your strength.
• Range of motion: Your doctor may check your flexibility or watch you bend and twist.
• Tenderness: Your doctor may assess areas of soreness by touching parts of your body.
• Sensation and sensitivity: Your doctor may check to see that you can feel heat, cold, or a pin prick on parts of your body.
• Reflexes and motor skills: Your doctor may ask you to walk on your heels or toes, or do tests to check your body’s reactions.
• Shape, tone, and position of the spinal bones, muscles, and so on.

Laboratory tests

Sometimes back and neck symptoms can be caused — or made worse — by a systemic illness (an illness throughout your body, not just in your spine). To check for illness, your doctor may request a test of a sample of your blood or urine. In addition, if surgery or other interventions will be part of your treatment, routine laboratory tests are usually ordered first.

Imaging studies

There are several technologies that allow your spine team to take pictures of the inside of your body. Depending on what they need to see, they may suggest one of the imaging studies listed below.

• X-ray. Beams of low-dose radiation create pictures of tissues, bones, and organs on film.
• MRI. Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to create images. MRI is very useful for evaluating details of soft-tissue structures, like nerves, in and around your spine.
• CT scan. Computed tomography (CT) uses a computer and x-rays to create cross-section views (“slices”) of areas of the body. It’s especially useful for highlighting abnormal tissue and clearly showing bone detail.
• Bone density scan. This scan uses x-ray or ultrasound to measure the amount of bone in a particular area. It can detect and assess osteoporosis (thinning bones).
• Electrodiagnostic testing. The term “electrodiagnostic testing” covers a range of tests that measure electrical activity in nerves and muscles. Two common electrodiagnostic tests are the electromyogram (EMG) and the nerve conduction study (NCS). Results from these tests help your doctor assess nerve and muscle function and locate any damage.
• Other procedures. Other procedures, such as spinal injections and discography, may be useful in evaluating sources of back pain that cannot be seen on other common imaging studies. Your care team will provide information on these procedures if needed.

Your care may include 1 or more of the treatments described below:

• Education and activity. Your care team can teach you what you can do on your own to relieve pain, regain strength, and increase flexibility.
• Oral medicines (pills). Your doctor may prescribe medicines to reduce inflammation, relax muscles, and ease pain. Take all prescribed medicines exactly as your doctor or pharmacist advises — and let your doctor know about other medicines you take including over-the-counter medicines, supplements, inhalers, liquid medicines, and patches.
• Physical therapy. Physical therapy (stretching exercises, traction, counseling on body mechanics) promotes healing, relieves pain, builds strength and flexibility, and helps prevent future injuries. 
• Spinal injection. Your doctor may recommend a spinal injection to treat inflammation or ease pain. An injection can deliver medication directly to the source of your symptoms.
• Surgery. Most spine problems can be treated without surgery. In some cases, however, your spine care team may suggest surgery as a good option for relieving your symptoms. 

While chronic pain can result from some unavoidable accidents or trauma to the back as well as aging, most chronic back pain can be prevented by avoiding risky situations and practicing good back health habits.

Tips for Lowering Your Risk of Back Injury

• Practice safe driving. Always wear a seat belt or motorcycle helmet to protect yourself in case of motor vehicle accident. Make sure everyone in your vehicle does as well. Never drive if you have been drinking alcohol or using other substances. Never text while driving.
• Protect yourself when playing sports. Avoid extreme sports. Always wear protective gear. Never dive into water headfirst unless you know it is at least 9 feet (3 meters) deep or lead with your head when playing contact sports.
• Make your home “fall-proof,” and practice ladder safety. Get rid of floor clutter, wear sturdy, non-slip foot ware, and add lighting and handrails or grab bars to stairs and bathrooms.

Tips for Good Back Health

• Use good posture. Be aware of your posture, especially when you are sitting or standing for long periods. Train yourself to stand, walk, sit, and lie in ways that place the least strain on supporting muscles and ligaments.
• Get regular exercise to strengthen your back. Exercise regularly with both aerobic (such as walking, swimming, or cycling) and core-strengthening exercises. Regular activity keeps your body strong and flexible to support your back. Be sure to warm up by stretching your muscles first.

• Practice good body mechanics. The term “body mechanics” refers to how you move and hold your body. It’s one of the most important things you can do to protect your back. For example:
  • Bend your knees as you lift to make your legs do the hard work, not your back.
  • Lift only as much as you can handle comfortably.
  • Switch positions when you are standing for a long time.
  • Use good posture when sitting — keep your legs level with your hips, and put a rolled up towel or small pillow behind your low back.
• Maintain a healthy weight. Extra pounds put extra stress on your back. To lose weight, eat more fruits and vegetables, keep portions small, avoid junk food, and exercise regularly.

• Find ways to reduce or manage life stress. Unmanaged stress has also been shown to affect lower back pain. It can cause muscle tension and sometimes a back spasm.
• Don’t smoke or use tobacco. Studies show that smokers have twice as much lower back pain as non- smokers. Ask your doctor about these and other resources to help you quit:
  • Intermountain’s booklet Quitting Tobacco: Your Journey to Freedom
  • Utah Tobacco Prevention and Control program: 1-877-220-3466 www.tobaccofreeutah.org
  • Utah QuitNet: www.utah.quitnet.com

• Avoid back stress and strain during the day AND at night. Activities that require heavy lifting or twisting or that cause your body to vibrate, can place lots of stress and strain on your back. Sleep on a mattress with firm support.