What can be done about chronic back pain?

Updated: September 6, 2016 - 4:05 pm

I have pain in my lower back that I cannot seem to shake. Sitting seems to make it worse. But my life is comprised of a long daily commute and eight hours sitting at my desk. I would like to get an MRI to find out what is going on. What are likely causes and cures?

 

Low back pain is very common – so common, in fact, that $50 billion is spent each year on diagnosing and treating the frustrating aches.

Sometimes back pain will strike suddenly after an awkward movement, twisting or bending; or back pain may be chronic, stemming from a previous injury. But as painful as it may feel, in most cases, back pain will improve on its own.

Most people won’t need an MRI for back pain. But, there are a few things to consider that will help determine course of treatment.

One back, many parts

The back is a complex structure made up of vertebrae, disks, the spinal cord and nerves, muscles, tendons and ligaments. Constant wear on a disk can cause it to weaken and push outward, pressing on nearby nerves. With age, the disk may wear out allowing the vertebrae to rub together forming bone spurs that may narrow the spinal canal. In other cases, sometimes the vertebrae are unstable and slip forward.

Providers can help diagnose the cause by analyzing the location of pain. For example, if pain radiates into the buttock or down the back of your leg, that could be a sign that there is pressure on a nerve.

Most back pain will improve within four to six weeks. Providers usually won’t even request imaging if pain has not been present for six weeks. But, if there are signs and symptoms of something unusual, your provider may order an X-ray or MRI sooner.

While it may seem counter intuitive, regular physical activity typically helps people with low back pain recover more quickly. Also, a firm mattress usually alleviates pain. Some of our patients also find that sleeping with a pillow beneath or between their knees helps their situation. And, do not lift anything over 15 pounds until the pain is resolved.

It’s a good idea to ice the painful area for 20 minutes twice a day. Ice reduces swelling and dulls the aching. Heat can also work well for muscle spasms. Surprisingly, you should avoid prolonged sitting because it puts more pressure on the low back than standing or walking. Many employers are offering their office employees desks that enable them to stand for all or part of the work day.

Medications like Ibuprofen, Naproxen and Tylenol can be helpful. Sometimes muscle relaxers are prescribed for short periods of time if spasms are the culprit. Many times, we’ll recommend physical therapy, where patients learn special exercises, stretches, and strengthening to help pain. Additionally, spinal manipulation performed by a chiropractor, and acupuncture are smart complementary therapies. Even massage can help muscle spasms. For severe cases, injections can be used to numb the back or reduce swelling. There are rare instances that may even require back surgery.

Pain prevention

In health care we like to say “an ounce of prevention is worth a pound of cure” — which is true for back pain too!

By staying active, stretching and doing strength training, you can often prevent back pain and injuries. If you work long hours at a desk, make it a habit to get up every 45 minutes for a brief walk or period of standing. Increasingly, employers are finding value in offering their employees stand-up desks. Lift using your legs, not your back. When you do sit, make sure you’re in an upright posture. Consider routine core workouts and maintain a healthy weight.

If you have persistent back pain, see your provider. He or she can help treat the aches, and determine if you need to be seen by a specialist. In some rare cases, back pain can be life threatening if it’s accompanied by weakness, numbness or lose of bowel and bladder control, so always check with an expert in a timely manner.

 

Michelle Napral, FNP, U of M Health Nurse Practitioners Clinic, 3rd Street & Chicago, Minneapolis