Highlights

Overview:

• Back pain can be acute, subacute, or chronic, and more commonly occurs in the lower area of the back.
  • Acute back pain develops suddenly and lasts up to several weeks. Acute pain is the most common type of back pain.
  • Subacute back pain is pain that lasts up to three months.
  • Chronic back pain can begin abruptly or gradually, linger, subside and then come back, but it lasts longer than 3 months.
• With proper self-care, most acute cases resolve within 4 - 6 weeks. Two-thirds of those patients, however, will experience another episode of back pain within 12 months.

Diagnosis:

• A medical history and a brief physical examination is always necessary for both acute and chronic back pain. The main goal of a physical exam is to try and determine the source of the pain and to detect warning symptoms.
• Imaging techniques such as x-rays or scans are rarely recommended in the first month unless the health care provider suspects a serious problem such as a tumor, fracture, infection, cauda equina syndrome, or progressive neurological disease.

Treatment:

• A conservative home care program is often the first therapy regimen for new back pain (unless a serious underlying condition is suspected). The goals are to reduce any swelling and improve function. The regimen often includes periods of rest and movement, the application of ice or heat, nonsteroidal anti-inflammatory drugs (NSAIDs) and gentle exercises. A work ergonomics assessment may also be beneficial.
• Depression can accompany back pain. A combined therapy approach, including antidepressant therapy and a pain self-management program was shown to improve depression symptoms and reduce the severity of pain and disability.
• Significant improvement in perceived disability was seen in patients who engaged in a graded exercise program vs. general exercise treatment (daily walks). There was no difference in pain symptoms over time however.
• A recent review of the research showed that there is no strong evidence to support injection therapy in subacute and chronic low back pain patients. Additional research is necessary to determine if certain patients would tend to respond favorably.
• The American Pain Society updated its guidelines for low back pain interventions and surgery after an extensive and exhaustive review of the evidence. It concluded that nonsurgical interventions are quite effective and should be considered over other treatments. Eight new key recommendations warn against the use of certain surgical interventions and stress shared-decision making between doctor and patient.

Review Date: 04/07/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)