Low back pain - chronic

Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.

A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.

Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:

• Heavy use from work or sports
• Injuries or fractures
• Surgery

You may have had a herniated disk, in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.

If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.

Other possible causes of chronic low back pain include:

• Curvature of the spine, such as scoliosis or kyphosis
• Medical problems, such as fibromyalgia or rheumatoid arthritis
• Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle

You are at greater risk for low back pain if you:

• Are over age 30
• Are overweight
• Are pregnant
• Do not exercise
• Feel stressed or depressed
• Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
• Smoke

Symptoms may include any of the following:

• Dull aching pain
• Sharp pain
• Tingling or burning sensation
• Weakness in your legs or feet

Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you cannot move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or on the bottom of your foot.

During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.

Other tests you have depend on your medical history and symptoms.

Tests may include:

• Blood tests, such as a complete blood count and erythrocyte sedimentation rate
• CT scan of the lower spine
• MRI scan of the lower spine
• Myelogram (x-ray or CT scan of the spine after dye has been injected into the spinal column)
• X-ray of the lumbosacral spine

Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.

Your provider may recommend measures to reduce your pain, including:

• A back brace to support your back
• Cold packs and heat therapy
• Traction
• Physical therapy, involving stretching and strengthening exercises
• Counseling to learn ways to understand and manage your pain

These other health care providers may also help:

• Massage therapist
• Someone who performs acupuncture
• Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)

If needed, your provider may prescribe medicines to help with your back pain:

• Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
• Low doses of prescription medicines
• Narcotics or opioids when the pain is severe

If your pain does not improve with medicine, physical therapy, and other treatments, your provider may recommend an epidural injection.

Spinal surgery is considered only if you have nerve damage or bone damage that is causing the back pain does not heal after a long time.

In some patients, a spinal cord stimulator can help reduce back pain.

Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:

• Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
• Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals

Some people with low back pain may also need:

• Job changes
• Job counseling
• Job retraining
• Occupational therapy

Most back problems get better on their own. Follow your provider's advice on treatment and self-care measures.

Contact your provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low

Abd OHE, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 48.

Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 50.

Malik K, Nelson A. Overview of low back pain disorders. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.