Guide To Back Pain: How To Deal With It And More!

What are the main causes of back pain?

There are many reasons why people develop back pain. It is important to remember that back pain is a complaint and not a precise diagnosis so the challenge is to identify the specific cause of your back pain. Most conditions are diagnosed with MRIs (magnetic resonance imaging), CT scans (computed tomography), ultrasound, or x-rays. These imaging studies are used to identify abnormal tissues, although occasionally the abnormalities may be too small to detect. There are four main categories of back pain. These are in order of likelihood; mechanical, emotional, acquired injuries, tumors and infections.

Mechanical

Muscle spasms are the most common mechanical condition that occurs in the back and everyone suffers from fleeting to severe muscle spasms in the back at some point in their life. We do not see patients in the doctor’s office unless the spasm pain is very severe or unrelenting. Muscle spasms can be caused by chronic muscle overload and fatigue or can be a symptom of an underlying problem. If the muscle spasm becomes a chronic problem, it can result in thickening of the muscle and fascial tissues. Doctors can easily identify muscle and fascial thickening by using ultrasound imaging.

Disc degeneration is the most common diagnosis that is found on imaging studies. It is a mechanical condition that occurs when there is wear and tear of the shock-absorbing discs between the vertebral bones of the spine. As the intervertebral discs wear down, there is more impact on the bones which start to grind together. As this happens, the hole that the nerve passes through called foramina, from Latin foramen “hole, opening, or aperture”, also narrows, which increases your risk of back pain and nerve pain or sciatica. This process begins after the age of 35 and is found in everyone by the age of 65, though you may never feel any pain from it. I have even seen disc degeneration occur in children beginning in their early teens due to excessive physical activities, so keep this in mind as your kids engage in sports.

Finally, a disc herniation is another example of a mechanical condition that is seen clinically.  Disc herniations are associated with mild to moderate degrees of disc degeneration.  And like disc degeneration, disc herniations can occur at either a single or multiple levels.  Disc herniations occur when a tear forms in the outer portion of the disc called the annulus fibrosis. This allows the gelatinous interior of the disc (called the nucleus pulposus) to herniate or ooze out, like your favorite toothpaste, into the central canal that houses the spinal cord and nerves. If there is a lot of gel that squeezes out, it can compress the nerves resulting in significant weakness, numbness and tingling. Furthermore, your immune system does not realize that the gel is part of your body. It thinks it is a foreign substance like a splinter so it begins attacking and mounting an immune response. The attack begins with increased blood flow and the release of chemicals that try to breakdown the gel, which also causes inflammation. The pain that you experience is this inflammation. If it is minor then you may only experience slight lower back pain, but if there is a tremendous amount of inflammation then you may not only have severe pain but it may also travel down the leg, a condition commonly referred to as sciatica. Disc herniations are more commonly found in people aged 30 to 50 years old and are most likely due to repetitive activities such as bending forward, lifting and twisting or sitting for long periods of time. If any family members or relatives have this condition, you have a much greater chance of having it.  It is also related to smoking, so it may prove imperative for you to quit in order to achieve an optimal recovery.

Emotional

The second most common cause of back pain occurs when you are emotionally stressed. When this occurs, your back muscles instantly tighten, your flexibility decreases and you put additional strain on your spine as well as the many muscles surrounding your spine. If this is severe or goes on for a very long period of time, it can result in chronic back pain. Unfortunately, not only is this area poorly understood, but there has been very little research completed to further our understanding of our emotions as they relate to our physical health.

Acquired Injuries

Acquired injuries, the third most common cause of back pain, can be some of the simplest or the most dangerous causes of back pain. Muscle strains which are micro-tears of the muscles, happen quite often and can resolve on their own. Ligament injuries, micro-tears of the ligaments, can heal on their own as well, however if your ligaments have loosened due to over-stretching or even more simple activities such as slouching, although not dangerous, it can lead to chronic back pain. Fractures, on the other hand, can be very dangerous as they can result in spinal instability which can lead to a spinal cord injury or death. The most common causes of fractures are falls, osteoporosis or high-speed injuries. Believe it or not, some fractures can occur without your knowledge and are incidentally found when imaging your back for other reasons.

Acquired diseases make up the largest number of diagnoses of back pain. These include scoliosis, an abnormal S-shaped curve of your spine, and kyphosis which is an abnormal forward hunch. Spondylosis is simple arthritis of the spine that occurs due to wear and tear. Spondylolysis is a fracture of the small joints in the back. With this type of fracture the bony segments of the spine at that level can slip and become misaligned which is called spondylolisthesis. As arthritis gets worse in the lower back you may develop spinal stenosis – a condition describing a narrowing of the canals that the nerves transit through. Rheumatoid arthritis can loosen the ligaments in the spine resulting in accelerated arthritis and inflammation. Other factors that do not directly affect the spine but can cause back pain include kidney stones, pregnancy, endometriosis and fibromyalgia.

Tumors and Infections

Tumors and infections are the most dangerous causes of back pain as they can be fatal if not treated. These include infections of the bone (osteomyelitis) or infections of the disc (discitis). Infections can result from prior surgery or procedures or from an infection brewing in the body such as chronic gingivitis or phlebitis or more dangerous infections such as tuberculosis. Tumors can sneak up at any time and can grow within the spinal cord such as an ependymoma and astrocytoma or grow outside the spinal cord such as a meningioma or schwannoma. Tumors can arise from cancers that begin in other parts of the body such as the breasts, lungs, kidneys, colon and prostate, and ultimately spread or metastasize to the spine. With most of these conditions, back pain is associated with, what doctors call red flag symptoms to signify their importance such as fevers, chills, night sweats and/or unintentional weight loss.

What does it mean when I have back pain?

Think of back pain as a message from your body telling you that you have not been kind to your back and that you probably over did it somehow. Unfortunately, the pain may not tell you the whole story regarding the reason for your pain or the exact location of your pain. A majority of my patients do not know the reason they have back pain. They cannot recollect a specific injury, event or even the year it started. All they know is that it came on gradually.  On the other hand, a minority of my patients will know exactly what activity they were doing when the pain began but are not sure why. For instance, they may have bent over to pick up a paper clip or simply got out of bed, which they have done millions of times before. Often very repetitive activities will eventually result in back pain. Your back pain may be due to years of poor posture or may have occurred after a recent recreational activity that you were not prepared for, such as a fitness boot camp or an outdoor adventure race. If your back pain is limiting your basic, day-to-day activities, you should see your doctor.

What is back pain a symptom of?

Back pain is a symptom, not a diagnosis. Your spine has to sustain and transmit a great deal of force during normal everyday activities, so when it is overloaded, you eventually develop back pain. There are also many conditions that may result in back pain as well which include inflammatory arthritis, hypothyroidism, cancer, and gastrointestinal problems. So remember to think of back pain as a symptom of a problem that you need to figure out.

How long will my back pain last?

Luckily our bodies are very resilient when it comes to back pain. Half of all back pain episodes will completely resolve within two weeks and up to 80% of all back pain episodes will resolve within six weeks. The remaining 20% of patients may have pain that lasts for months to years or even a lifetime. You do not want to be in the last group. Unfortunately, you cannot predict the duration or severity of back pain as you wait for it to heal. If it is severe, however, and has not resolved within six weeks, it is best to see your doctor for an evaluation and treatment.

How can I tell if my back pain is from my muscles or spine?

With back pain, it is hard to differentiate muscle pain from spine pain. With any inflammatory process the pain begins as a dull ache and can progress to a very sharp, excruciating pain. Any inflammation in the area can cause the muscles to reflexively spasm as your body attempts to stabilize the injured area. This explains why with an existing back problem your hamstrings and calves will be very tight despite extraordinary attempts to stretch them. Some advice; do not work hard to stretch them; you will fail. You really cannot tell the difference between basic muscle spasms or muscle spasms due to an underlying problem such as disc degeneration, a herniated disc or a fracture. My usual recommendation to my patients is: if you had a specific event that may have caused muscle damage and if your back improves within several days, it is most likely a muscle spasm or strain since muscles have great blood flow and they can heal very fast; if on the other hand you do not heal very quickly, it is most likely due to an injury of the structures that do not have great blood flow such as the discs, tendons, ligaments or nerves. Bones have great blood flow but take 8 to 12 weeks to heal and often result in severe back pain with muscle spasms, making it difficult to sit upright.

Dangerous Causes Of Back pain

Can low back pain be caused by a tumor?

Yes, there may be tumors that can originate in the spine or metastasize to the spine. Tumors that grow in the spine include an ependymoma and astrocytoma. Tumors that grow outside the spinal cord include a meningioma and schwannoma. Tumors can spread to the spine from the breast, lung, colon and prostate, and kidney. Although this is very rare, the treatment for back pain caused by tumors focuses on the tumor first and is very different than standard treatments. MRI is used to rule out tumors before many treatments are started.

How does cancer cause back pain?

Cancer can begin many years before and is usually painless as it spreads. The spine is an excellent target for metastases from the breasts, lungs, kidneys, colon, and prostate because there is a robust network of blood vessels into the spinal vertebral bodies and the surrounding spinal column. This allows a daughter cancer cell to take up residence within the spine and grow. Tumors can also arise directly from the spinal cord, the nerve roots from the spinal cord or the surrounding tissues. If they grow in the spinal cord, they are most likely an ependymoma and astrocytoma. If they grow outside of the spinal cord, they are most likely a meningioma or schwannoma. At first, all cancer cells are too small to affect the normal function of the spine but as they grow, they can cause vertebral body compression fracture(s), and compression of the nerves. Once this occurs you will develop typical back pain; except your symptoms will also include a loss of appetite, significant weight loss, fevers, chills, and night sweats. As the tumor expands further, you may experience a loss of balance, loss of bowel or bladder control and paralysis, which is a surgical emergency called cauda equina syndrome.

Although rare, I have diagnosed patients with primary cancers of the spine which present as back pain with mild fevers at night. More commonly, I have diagnosed metastatic cancer in patients who were previously cancer-free for many years. One patient comes to mind whose metastatic tumor was missed by a radiologist who reviewed the MRI at first, but then identified it once I called and inquired about a patchy area that did not look like a disc herniation. I have also had patients who reported unknown weight loss who then died within weeks from cancer. If you think you may have cancer it is important to communicate this to your doctor.

Should I be worried if my back pain is worse at night?

Back pain can be worse at night following a long day due to muscle spasms or the lack of daytime distractions. In some cases, back pain that is much worse at night may also be a sign of cancer. Cancer is usually painless as it expands, unless it begins to expand in the bone or compress a nerve. Once this occurs you will develop typical back pain; except your symptoms will also include a loss of appetite, significant unintentional weight loss, fevers, chills, and night sweats.

What should I do if my back pain wakes me up at night?

If you do not feel rested in the morning, due to frequent awakenings at night as a result of back pain you should see your doctor for help right away. After several days, poor sleep will magnify your pain so sleep is important and your doctor may be able to provide you with medicine to help you sleep at night. Some other tips that may help you sleep include stretching while lying on your back by bringing your knees to your chest several times before turning out the light, sleeping in a fetal position with a pillow between your legs, or elevating your legs with several pillows if you sleep on your back. Do not sleep with a heating blanket as I have seen many burns as a result.

What causes back pain after a fall?

Common causes of back pain after a fall include muscle strains or spasms, ligament sprains, fractures, disc herniations or trauma to your abdominal organs. You should see your doctor right away if you have had a fall that knocks the wind out of you or makes you unconscious to rule out more serious problems such as damage to your internal organs, bleeding in the brain (epidural or subdural hematoma) or a traumatic brain injury.

What is pulsating back pain?

Pulsating back pain is bad as it may be due to a ruptured or soon to rupture aortic aneurysm. Your aorta is one of the largest blood vessels in your body and lies just in front of your spine. It carries blood away from your heart to your lower body and legs. If the aorta is close to rupturing you may sense this as a pulsating back pain. It is important that you see your doctor immediately if you feel this sensation as a ruptured aortic aneurysm may lead to death within minutes.

Do-It-Yourself Treatments

What are simple things I can do to ease my back pain?

Moving more during the day is probably the most important thing you can do. It will keep your muscles flexible and bring more blood flow to the area to assist in healing any problem areas so you can recover faster.

Pay attention to your posture ideally keeping your ears over your shoulders when sitting or standing.  When sitting make sure your lower back is supported. Also when standing tall, make sure your shoulders remain over your hips as well.

Muscles tend to get very stiff, so you can help them by releasing any emotional tension and spend time relaxing. Consider a regular massage or hot bath. If you feel the pain is severe, ice can help relax any muscle spasm, when applied wrapped in a towel for about 20 minutes every hour as needed. Heat is best for soothing arthritis pain, again for 20 minutes every hour. Strengthen your core and pelvic girdle muscles with Pilates or consider a regular swim several times per week.

Carry large objects close to the body and remember to ask for help if you feel the load is greater than you feel comfortable carrying. Also avoid lifting and twisting activities which can worsen your back pain.

Mattresses that are not supportive or too soft can worsen your back pain so think about purchasing a firm mattress that supports your preferred sleeping position and body type.

Over-the-counter pain medications can take the edge off a pain complaint, but should not be used as a replacement for proper ergonomics and posture. If you find that there is no resolution of your pain after several weeks, please see your doctor.

Could you tell me ways to rid myself of back pain?

The most important thing you can do to rid yourself of simple back pain is to treat your spine with respect. This means you should maintain good posture and proper weight for your frame. You should consider frequent breaks if you have to sit for long periods of time. You should not smoke or lift heavy objects repetitively and make sure you work in an ergonomically appropriate environment. You should always keep your core muscles and back flexible and strong by practicing yoga and Pilates, respectively. Finally remember to relax and take a break to minimize muscle tension. Unfortunately, our modern lifestyle conspires to disrupt every one of these important rules so try to respect your spine as best as you can.

How effective are high-tech treatments for back pain?

The effectiveness of any back pain treatment is based on the precision of your diagnosis. Although some high-tech treatments can be very helpful for select individuals, identifying the perfect candidate for a treatment can be very challenging. You may have seen advertisements for laser spine surgery or cold laser treatments as well as for specialized chiropractic treatments, and epidural steroid injections. When I’ve spoken to patients about these treatments some patients have had remarkable success whereas others have seen no improvement whatsoever. Think of high-tech treatments as another set of tools that are available and consider them if your back pain has not improved with standard treatments first.

How do I get rid of my back pain without going to the hospital?

If your back pain is not severe, there is no reason to go to the hospital, but if it is severe to a point that you cannot find a comfortable position, then your best option is to see your doctor. Unfortunately outside of normal business hours, your only option is to go to the local urgent care center or emergency room.

Simple things you can do at home include relaxing, lying on the floor while propping your legs up on a chair to unload your back, trying over-the-counter nonsteroidal anti-inflammatory medications as well as trying an ice pack or warm compress.

Is there any equipment that helps deal with back pain?

There is a plethora of equipment that may be helpful for your back pain. You need to find the equipment that works best for you. Some equipment includes a proper mattress, office chair, zero gravity chair, standing desk, lumbar roll, inversion table, therapy ball, back brace, Theracane®, transcutaneous electrical stimulation device (TENS) unit, foam roller, ice pack, heat wrap and portable massage machines.

How do I stop back pain while working at my desk?

If you have no other option than to sit at your desk for long periods of time it is important to have a proper chair sized on your body frame. You should sit with your butt as far back in the seat pan as possible to support your thighs and to firmly press your back against the lumbar support. If there is no lumbar support you should use a rolled up coat or purchase a cushion and place it behind your lower back. As you sit down you should first push off the arm rests to stretch your spine then slowly sit back down to keep your spine stretched out on the back rest before your lower your butt to the seat pan. Remember to relax your arms and roll your shoulders back. Finally, remember to do several chin tucks throughout the day to stretch the muscles in the back of your neck and upper back. Remember your body needs regular motion to function properly so don’t forget to take 5 minute breaks every hour.

What is the best seat cushion for low back pain?

The best seat cushion for lower back pain is one that provides a stable surface to limit the amount of motion or instability while sitting. It is supportive but not too firm and does not tilt too far forward or backwards. Ideally it uses a material that keeps you cool like mesh and fits your body type comfortably. It is best to test out different cushions to see which one works best for your body type and task.

What is the best way to sit if I have back pain?

You should only sit for a short period of time with an upright posture keeping your forearms parallel to your thighs which should be parallel to the floor. Your feet should be firmly planted on the floor. You should keep your items and keyboard at arm’s length to limit slouching. If you sit in an office chair, it is important to be able to recline your chair up to 135° which allows your back to take a break. I personally recommend using a standing desk to have the option of sitting or standing throughout the day. If you are fatigued after sitting in your chair for a while, take a big break and lie on the floor for several minutes, please do not slouch into your chair for even a couple of seconds. Finally do not cross your legs, because this increases your propensity to slouch and places a great deal of force on the spine.

To avoid back pain, what is the right way to bend over?

When you bend forward only at the waist, it places extreme pressure on the lower back. You should consider squatting down while keeping your back erect. It is important to have flexible hamstrings so that when you bend forward you can partially offload the strain on your lower back through your hips. Most importantly do not bend and twist as this is one of the most common causes of disc herniations.

What type of mattress is best if I have back pain?

Your best option is a firm mattress that balances back support and comfort. Typically a foam mattress provides better support than a coil spring mattress. A pillow top does not provide any additional support as it compresses down. Remember to choose a mattress that is most comfortable for your sleeping style. It may take several days to several weeks before you know if your mattress is effective for your back pain so inquire about the return policy at the store.

How can heat wrap therapy or a heating blanket help my back pain?

Heat is most helpful for soothing muscle spasms related to arthritis. It is important to wrap the heat wrap in a towel and use it for 20 minutes every hour to limit your risk of burns. I’ve seen several patients get burned from a heating blanket, so it is important to never sleep with a heating blanket or make sure that the timer is on. One of my patients fell asleep with his heating blanket and suffered a burn that resembled grill marks on a steak, it took many months to heal.

What supplements can I take for bad back pain?

There are number of different supplements that can be used as natural alternatives to nonsteroidal anti-inflammatory medications.

Omega-3 fatty acids, most commonly found in fish oil, increase cell wall flexibility and have anti-inflammatory effects. It is important to read labels carefully and to choose a reputable brand. Flaxseed oil is a vegetarian alternative to fish oil however it does not appear to be as effective as fish oil. You should be careful if you take blood thinners as fish oil can also act as a blood thinner. You should not use “marine oil” as it is an inferior alternative to omega-3 fatty acids.

Vitamin D supplementation should be considered if your serum levels are below 50 ng/ml.  Vitamin D deficiency has been shown to be associated with chronic low back pain as well as persistent chronic pain and other inflammatory and autoimmune diseases.

Turmeric (Curcuma longa) acts as a potent anti-inflammatory but be careful as it can also increase your risk of bleeding if you take blood thinners.

Devil’s claw (Harpagophytum procumbens) may also be helpful as an anti-inflammatory. It may also increase your risk of bleeding. Furthermore, care should be taken if you have a history of gallstones or a heart condition.

Magnesium gluconate has been shown to be helpful with muscle spasms particularly leg cramps at night, migraines and diffuse pain complaints such as those associated with fibromyalgia. It is thought that 40% of US population has a magnesium deficiency. If you take too much magnesium it can cause diarrhea and is the active ingredient in the laxative, Milk of Magnesia®

Hydrolyzed collagen which is the main components of cartilage has been shown to speed up wound healing and help with back pain.

Methylsulfonylmethane (MSM) can be helpful for pain associated with osteoarthritis

S-Adenosylmethionine (SAMe) can be helpful for osteoarthritis. You should not use this if you are on prescription antidepressants.

Bromelain has been shown to have anti-inflammatory properties that may be helpful for arthritis. It is an enzyme derived from pineapple.

Capsaicin topical cream (Capsicum frutescens) – Capsaicin is the main component in hot chili peppers (also known as cayenne). When it is applied to the skin, it reduces the chemical called substance P that can promote inflammation and pain. Pain reduction generally starts three to seven days after starting the ointment.

What ointments are best for back pain?

There are several ointments that are available to help with back pain but no one single ointment is best for specific types of back pain; so it is important to trial several types to see which works best for you. The most commonly used ointments are the cool mentholated ointments that provide a welcomed cool distraction from your pain. Ointments that contain capsaicin, which is the ingredient that makes chili peppers hot, causes a burning sensation which can also be distracting. Willow bark or salicylate is the raw material that aspirin was originally made from and can deliver a lower dose of salicylate which can be helpful with fewer side effects compared with aspirin. Arnica Montana gel which is produced from the sunflower family appears to have some anti-inflammatory effect and is most helpful for bruising or soft tissue damage.

There are also prescription strength anti-inflammatory ointments that can deliver local anti-inflammatory medication to the injured tissues with a lower risk of stomach upset compared with pills. They can be also combined with muscle relaxants and nerve calming agents for a greater effect.

Ointments can be helpful for superficial problems or to calm pain from problems with deeper tissues such as joints, but they should not be considered a cure.

Will soaking in apple cider or Epsom salts help my back pain?

Soaking in apple cider vinegar or Epsom salts may be helpful for back pain.

Soaking in apple cider vinegar acts as a detoxifier and is helpful for muscle aches and pains following physical activities. It also can draw excessive uric acid from the body, which is the cause of gout. It can be helpful for not only gout and joint pains but can also help with arthritis, tendinitis or bursitis. To soak effectively you add 2 cups of pure apple cider vinegar to a tub of hot water. You should stay in the bath for approximate 45 minutes then towel dry with no showering for at least 8 hours.

Soaking in Epsom salts (magnesium sulfate) allows you to absorb magnesium and sulfur through the skin and can be helpful for alleviating the discomfort associated with sprains and strains as well as acts to detoxify the body. It can also be helpful for cardiovascular problems and can lower blood pressure. To soak effectively, you need to dissolve 2 cups of Epsom salts in a regular sized bath tub filled with warm water. You can soak for up to 30 minutes then rinse and towel dry. You should take care in getting out of your bathtub as soaking in Epsom salts can lower your blood pressure resulting in dizziness and unsteadiness.

Can I take vitamin D tablets for back pain?

Research suggests that most people in western countries have low levels of vitamin D that may contribute to chronic back pain. It is most important to have your vitamin D level checked first before you start supplementation to determine how much vitamin D supplementation you need as it is based on your diet, level of sun exposure and ability of your stomach to absorb the vitamin. It will take several months before you should see any improvement in your back pain from taking vitamin D. Although uncommon, high levels of vitamin D can result in high levels of calcium which can lead to several symptoms including muscle cramps. A better way of getting your daily allowance of vitamin D is to spend some time in the sun daily without sunscreen.

What books would you recommend for back pain?

Over the years I’ve had many patients describe books that they have read that have been effective for their back pain. The best books I have not only heard about but read are:

  1. Healing Back Pain by John Sarno M.D.
  2. 8 Steps to a Pain-Free Back by Esther Gokhale
  3. Treat Your Own Back by Robin McKenzie P.T.
  4. Pain Free: Revolutionary Method for Stopping Chronic Pain by Pete Egoscue

What are suggestions for a good exercise DVD for back pain?

The Anat Baniel Method offers a DVD with six 30- to 40-minute exercise sessions to help reduce your back pain. You can also try the Melt Method by Sue Hitzmann, MS, CST, NMT which focuses on stretching the fascia or the smooth fibrous tissue that surrounds all your muscles.

What should I do if I think that my emotional problems are the cause of my back pain?

I have noticed that many of my patients who have back pain also report anxiety, depression or are severely stressed in some way. Emotional difficulties may be caused by your pain or are the cause of your pain.  I always discuss the importance of stress and its possible contribution to back pain during a visit, but it is very hard to determine if emotional problems are the cause or result of your pain. In the parts of the world where religious or spiritual meditation is common, it is more acceptable. Although I do not prescribe meditation or psychological therapy as a treatment, I feel that physical therapy, yoga and Pilates are partially helpful due to the quiet focus needed to do the tasks which mimic mediation.

Cognitive behavioral therapy which involves 10 to 20 meetings with a therapist can also be helpful for back pain.  It works to identify and stop negative thoughts so you may replace them with healthy positive thinking; this helps to calm your mind and body. Some doctors believe that repressed rage can cause back pain, and simply accepting and dealing with the rage can also lead to resolution of your back pain.

Antidepressant medications have become popular in the past ten years as adjuvant pain medications. Some medications that are part of the antidepressant category include tricyclic antidepressants  such as nortriptyline (Pamelor®); serotonin and norepinephrine reuptake inhibitors (SNRIs) such as milnacipran (Savella®) and duloxetine (Cymbalta®) and selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil®), sertraline (Zoloft®) and the medication that inaugurated the class and became a cultural phenomenon 40 years ago, fluoxetine (Prozac®).  These medications can take up to six weeks before you will notice any difference. When you start to feel better, you will most likely become more active, move your muscles which will not only distract you from the pain, but probably help with the pain as well. Unfortunately, I have never been able to successfully treat a patient with only antidepressant medications.

Would a chair massage help soothe my back pain?

A chair massage may be very helpful for back pain but unfortunately it is most likely not going to fix the source of your pain. If your pain is worsened with a chair massage it may suggest an underlying injury such as a disc herniation which will need to be treated.

How should I lift things to prevent back pain?

Research has demonstrated that if you do not have back pain, lifting should be accomplished by equally extending your back, hips and knees which uses the greatest number of muscles to support the load. This decreases muscle fatigue and allows you to lift a greater load. If you have back pain, you need to protect your back, so you should always lift an object by first keeping the load close to your body, then using your knees rise up while keeping your back straight. You should never lift and twist, as this is one of the most common causes of acute and sudden back pain. You should also ask for help if you think the load is too heavy. You should never lift items repetitively as the repetitive nature can break down your intervertebral discs faster, resulting in back pain. Finally, if you have to carry a load you should first chart the proposed course out to make sure there is nothing around that you may bump into or worse, trip and fall.

Will yoga help back pain?

Yoga can be very helpful for back pain caused by muscle stiffness and it is the most structured back exercise program available. It is mostly a stretching program, but it also strengthens certain muscles as well. You need to be careful, as yoga can also be a cause of back pain such as an acute disc herniation. My patients who have been injured while doing yoga, report the onset of pain when their yoga teacher placed them into a certain position or pushed down on their back.

Is the McKenzie method effective for back pain relief?

The McKenzie method can be very helpful for back pain due to a herniated disc. The evaluation takes you through different provocative loading movements to assess which increases or decreases your pain to determine the best treatment approach. For instance, you may be asked to perform single repetitive back flexion or extension movement until you develop pain. Once a directional preference is identified then certain exercises are prescribed that should be done on a daily basis with the hope that you begin to centralize or shrink, towards your spine, the borders of your pain until your pain disappears.

What is better for back pain – active or passive therapy?

Active therapy, in the form of strengthening and stretching is a much better treatment option than passive therapy which is usually in the form of massage, ultrasound, TENS, and hot or cold packs. Most of my patients like passive therapy options because the treatments feel good at the time of the treatment but these do not result in long-term success.

Why should I do exercises at home for my back pain?

Exercise is the most important foundation that all other back pain treatments are built upon. It is the most common initial treatment that is used when you develop back pain. The greatest amount of research has been done and a great deal of evidence exists to support exercise. There is no specific exercise program for specific types of back pain. To maximize the effects of exercise, it is important to include equal parts of stretching, to loosen any tight muscles, and strengthening, to strengthen muscle that are weak due to pain, injury or weakness. It is important to exercise at least 4-5 times per week because physical therapy is usually only scheduled 1-2 times per week. The more often you do your exercises, the better the chances of success. Several of my patients have exercised up to twice a day with great improvement. If you have pain that worsens with physical therapy, stretching or strengthening or you find that you are unable to stretch or strengthen the targeted muscle groups, it is a sign that there is underlying pathology that will need to be treated first before you will achieve the benefits of exercise.

How does stretching my hamstrings help with back pain?

Hamstring flexibility allows your hip joints to become flexible, which absorbs some of the force from your lower back when you move or bend forward. If you have a disc herniation you may find that no matter how hard you stretch, it makes no difference whatsoever in your hamstring flexibility. This phenomenon is a protective reflex to protect your back if you have an injury. This cannot be overcome until you treat your back problem.

How often must someone do stretching exercises for back pain?

If you do stretching exercises for back pain you should plan to do them at least 2 to 3 days per week; ideally you may also do them every day. Make sure you stretch the muscle groups slowly to feel a slight discomfort but not pain. You should continue breathing normally and should not hold your breath. Do not bounce at the end of the stretch. You should hold the stretch for at least 10 to 30 seconds and repeat the stretch at least 4 times. It can take at least 15 minutes to stretch all the major muscle groups. You may stretch all at once or do them piecemeal throughout the day

What exercises can I do for back pain?

These simple exercises are the routine exercises that you initially learn in physical therapy. They can be very helpful for back pain if your pain is more functional but they can be very painful if there is an underlying disc herniation or bony problem. It is good to do these exercises daily as you can tolerate them and refrain from doing the exercises that exacerbate your pain. If you find these exercises helpful you should progress to further challenging exercises after several months. The goal of these exercises, are not only to awaken your muscles, but to strengthen your muscles as well.

Pelvic rock

1.Stand in a comfortable position with your hands on your hips.
2. Then gently rock the top of your hips forward while arching your back
3.Return to the starting position.
4.Gently rock the top of your hips backward while flattening your back.
5.Return to the starting position.
6.Repeat 5 to 10 times.

Backward Bend

1.Stand straight and tall with your feet pointing forward about a shoulders-width apart with your knees slightly bent.
2.Place your hands on your lower back with your palms on your hip bones.
3.Lengthen up your spine by gently pushing down on your hips.
4.Bend backward, over your hands, while keeping your neck straight.
5.Hold this position for 2-5 seconds depending on comfort.
6.Return to standing.
7.Repeat 5 to 10 times.

Wall Squat

1.Stand with your feet a shoulder length apart, about one foot away from the wall
2.Gently lean and flatten your back against the wall
3.Slowly slide down until your knees are slightly bent.
4.Hold for 5 to 10 seconds.
5.Slide back up to the starting position.
6.Repeat 5 to 10 times.

Cat-Camel

1.Start by supporting yourself on your hands and knees on a stable surface.
2.Relax and droop your head.
3.Round your back towards the ceiling until you feel a stretch.
4.Hold for 15 to 30 seconds.
5.Slowly let your back sag towards the floor while lifting your buttocks and head toward the ceiling.
6.Hold for 15 to 30 seconds.
7.Repeat 5 to 10 times.

Bird Dog

1.Start by supporting yourself on your hands and knees on a stable surface.
2.Keep your back straight and tighten your stomach muscles by bringing your belly button to your spine
3.Raise one leg off the floor and holding it out straight behind you.
4.If you can, then raise your opposite arm in front of you as well.
5.Hold this position for 3-10 seconds, then lower your arm and leg slowly and repeat with the other arm and leg. As you get stronger you should strive to hold the position for 30 seconds.
6.Repeat 10 times with each arm and leg.

Hip Flexor Stretch

1.Start by facing forward and slowly kneeling down on one knee with your other knee pointing forward over your foot.
2.Slowly bend your waist backwards until you feel a stretch in the front of your upper thigh of your kneeling leg.
3.Hold this position for 30 seconds
4.Switch positions to stretch the other leg.
5.Repeat 5 times on each side.

Double Knee-to-Chest

1.Lie on your back with your knees bent 90 degrees and your feet resting on the floor.
2.Bring one or both knees to your chest using your hands for support
3.You should feel a gentle stretch within your back muscles.
4.Hold this stretch for 15 to 30 seconds.
5.Lower your feet to the floor.
6.Rest for 15 seconds.
7.Repeat 5 to 10 times.

Piriformis Stretch

1.Start by lying comfortably on your back.
2.Bend your right knee to 90 degrees keeping your right foot flat on the floor.
3.Rest your left ankle on your right knee.
4.Hold on to your right thigh and gently pull your thigh towards your chest until you feel a stretch in your left buttock.
5.Hold this position for 15 to 30 seconds.
6.Lower your right leg back to the starting position.
7.Repeat with the other leg
8.Repeat 5 to 10 times on each side.

Bridging

1.Start by lying comfortably on your back with your knees bent about 90 degrees and your arms on your stomach.
2.Tighten your stomach muscles by bringing your belly button to your spine
3.Lift your hips off the floor until your shoulders, hips, and knees are all inline by tightening your buttocks and pushing your heels into the floor.
4.Hold this position for 10 seconds and then slowly lower your hips to the floor and rest for up to 10 seconds.
5.Repeat 5 to 10 times.

Clamshell

1.Lie on your side with your hips and knees bent while keeping your feet together using your upper arm to support yourself.
2.Raise your upper knee towards the ceiling while keeping your feet together remembering to use your arm to keep your pelvis still.
3.Hold for 5 to 10 seconds.
4.Slowly lower your knee back down.
5.Repeat 5 to 10 times on each side.

Pelvic Tilt

1.Lie on the floor comfortably on your back with your knees bent at 90 degrees.
2.Slowly contract your abdominal muscles by bringing your belly button to the spine while pressing your back to the floor and rocking your hips and pelvis back.
3.Hold for about 5 seconds.
4.Repeat 5 to 10 times.

Curl-Ups

1.Lie on your back comfortably on the floor with your knees bent 90 degrees and your feet flat on the floor.
2.Cross your arms over your chest.
3.Slowly contract your abdominal muscles by bringing your belly button to the spine and raise your shoulders off the floor.
4.Keep your head relaxed.
5.Hold this position for 1 to 5 second.
6.Slowly lower your shoulders down to the floor.
7.Repeat 5 to 10 times.

Press-Ups or Back Extensions

1.Start by lying on your stomach, while supporting your upper body on your forearms.
2.Press your elbows down into the floor while you raise your shoulders and upper back off the floor.
3.Arch your back as comfortably as you can by relaxing your muscles but do not raise your hips or pelvis off the floor.
4.Hold this position for 15 to 30 seconds.
5.Repeat 5 to 10 times.

Hamstring Stretch

1.Lie on your back in a doorway, with both legs through the open door.
2.Slide your right leg up the wall and straighten your knee.
3.Keep your knees straight and your back flat on the floor.
4.You should feel a comfortable stretch in your hamstring.
5.Hold for 1 to 8 minutes.
6.Repeat with your other leg.
7.Repeat 5 times for each leg.

Front Plank

1.Position yourself on the floor on your elbows and knees.
2.Raise your knees off the floor by straightening your legs while you support your body on your elbows and toes.
3.Hold for 5 to 60 seconds.
4.Return to the starting position.
5.Rest for 10 seconds.
6.Repeat 5 to 10 times.

Side Plank, Beginner

1.Lie on your side with your knees bent, and support your upper body on your elbow.
2.Raise your hips off the floor to align them with your shoulders and knees.
3.Hold for 5 to 60 seconds.
4.Rest for 10 seconds.
5.Repeat 5 to 10 times.

Side Plank, Intermediate

1.Lie on your side, and support your upper body up on your elbow.
2.Lift your hips off the floor while keeping your legs straight.
3.Hold for 5 to 60 seconds.
4.Rest for 10 seconds.
5.Repeat 5 to 10 times.

Rest Position

1.Start by lying comfortably on your back on the floor.
2.Use a towel roll under your neck or a book under your head and a pillow under your knees for support.
3.Extend your arms comfortably out to the side.
4.Relax and remain in this position for 5 to 10 minutes.
5.Repeat as needed throughout the day to lengthen your spine and relax your back muscles

What You Need To Know When Seeing Your Doctor

When looking for a doctor or treatment for back pain what should I be looking for?

You should look for physicians or surgeons that have experience in treating back pain with fellowship training or extensive research in the field. You should get a referral from a friend or colleague who has had a good experience with the doctor you plan on having a consultation with. More and more people are using online review services to identify physicians which may be helpful as well. Finally when meeting a new doctor you should make sure that you feel comfortable talking to them and that they listen and address your questions and concerns. You should refrain from using doctors who promise you 100% success, as I have never seen a doctor who also moonlights as a fortuneteller. Finally, remember that you are looking for a partner to work with you towards your goal.

What kind of doctor should I see for back pain?

If this is your first episode of back pain you should see your primary care doctor or chiropractor as most back pain episodes will resolve. Your primary care doctor can provide you with medications to decrease the intensity of your pain and physical therapy to stretch and strengthen your muscles. If you have no luck after 6 weeks you should consider seeing a physiatrist (physical medicine and rehabilitation doctor) with fellowship training in pain management or sports medicine who can offer far more advanced nonsurgical options. You could also see an osteopathic doctor who can manipulate the problem area to relax the muscles as well. If none of these options have been helpful and you have been found to have a specific surgical lesion that correlates with your pain, consider seeing a neurosurgeon or orthopedic surgeon for a surgical consultation. If you are considering surgery, it is important to get at least a second or even third opinion.

What can my primary care doctor do to fix my back pain?

Your primary care physician can assess you for rare but dangerous conditions like fractures, tumors or infections. They can provide you with medications and get x-rays if needed. Most importantly they can reassure you and monitor your progress. If you do not improve then they can give you a referral to a physical therapist or other specialist they have had good experience with in the past.

What can my physiatrist or pain management physician do to fix my back pain?

Your physiatrist or pain management physician can further explore the possible causes of your pain. They can do a thorough kinematic physical examination, ultrasound evaluation and nerve test as well as order imaging such as x-rays, MRIs or CT scans. They can then do targeted interventions such as trigger point injections, nerve hydrodissection, fascial releases, epidural steroid injections, spinal cord stimulation, or procedures to regenerate damaged tissues such as prolotherapy, platelet-rich plasma, fat aspirates or bone marrow aspirate concentrate procedures. There are several advantages of using ultrasound which include the ability to see tissues at the painful site at a much finer resolution than MRI and its ability to perfectly guide and tailor the interventions which makes a profound difference. I often interrogate the tissues with an ultrasound-guided block to see if I can reproduce the characteristic pain which can confirm a diagnosis.

What can my chiropractor do to fix my back pain?

Your chiropractor can do a functional and kinematic physical examination and order tests such as x-rays. The treatment approach includes hands on spinal manipulation, active release technique, stretching exercises to attempt to restore joint mobility. You should be careful and refrain from high velocity manipulations if you have a great deal of arthritis, spinal cord compression, inflammatory arthritis or take blood thinning medications.

Should I see a physical therapist or chiropractor for back pain?

Although physical therapists and chiropractors go through different training programs they often participate in similar advanced professional training which can make them difficult to tell apart. My best advice is to use a trusted person in the community first and if you don’t have significant relief to consider the other healthcare practitioner.

Why does the doctor have to ask so many questions about my back pain?

Pain is a very difficult problem to work with because everyone has a slightly different perception of pain. Often, when patients go to the doctor they often feel better during the visit. Doctors sometimes need to repeat questions to get a clear understanding of the complaint. We often ask about the location, any radiating pain away from the lower back, and possible causes for the pain which most of my patients report as unknown. Also, we need to understand the severity, aggravating and relieving factors as well as ask about weakness, numbness or tingling. Successful or failed prior treatments also provide a clue as to the severity of the underlying cause of your back pain.

What questions do I ask the doctor who is treating my back pain?

It is imperative to understand your diagnosis.  Thus, do not hesitate to ask your doctor to explain the nature of the diagnosis that you have been given.  It is also important to ask about the expected general prognosis as well as what day to day changes you can make to not only help alleviate your current symptoms but also to prevent recurrence or overall worsening of your condition.

How is back pain diagnosed objectively?

The great majority of back pain diagnoses are found in the history of presenting symptoms and confirmation is obtained during the physical examination, imaging studies or other tests as well as your response to various treatments. I have found that there is no one test that is most helpful in diagnosing back pain.

What can a doctor’s exam tell me about my low back pain?

A doctor’s physical exam is a very important piece of the puzzle when forming a diagnosis.  Information can be gathered regarding changes in your gait pattern as well as any neurological deficits.  Biomechanical and anatomic asymmetries may also be found that can play a role in understanding what may have predisposed you to developing low back pain. Your doctor may use an ultrasound machine to look for possible causes of back pain. Low back pain is a complex symptom with a broad range of possible causes.  The physician is able to test these different structures with provocative maneuvers in an effort to clarify the cause of your back pain.  A proper diagnosis is not only essential to tailoring an appropriate treatment plan, but also indicates the urgency of the situation (i.e. benign findings versus serious red flags that need immediate attention or close monitoring).

Will back pain usually require x-rays?

Unless you have suffered an injury or fall, x-rays are usually not helpful. X-rays allow doctors to look at your bones, and unless you have a fracture or severe arthritis, it will probably not be helpful. Most back pain is most commonly caused by soft tissue injuries of the discs, nerves, ligaments, muscles or fascia, so I rarely order x-rays. If your back pain persists, then an MRI may be advisable.

How effective is an x-ray at diagnosing the cause of back pain?

Back pain can be caused by a variety of structures.  These structures can be grossly divided into two large categories: hard tissues versus soft tissues.  Hard tissues include the various bones and joints within the spine whereas the soft tissues encompass tissues as superficial as the skin as well as muscle, fascia, ligament, disc, nerve and organ tissue.  The efficacy of an x-ray in diagnosing the cause of back pain really depends on what the physician thinks may be the cause of your pain, based on your history and physical examination.  X-rays are a good imaging modality when investigating the possibility of a fracture, bone slippage, bone lesion or joint arthritis. Even with positive findings, x-rays may not be able to diagnose the cause of your back pain.

Should I get an MRI for my back pain?

MRIs are a wonderful tool for reviewing your underlying bony and soft tissue spinal anatomy. Sometimes it allows us to see the underlying source of pain whereas other times it comes back normal which always leads to patient frustration because their pain is not validated. MRIs are very good to rule out infection or tumors, as well as, to use in planning for an epidural steroid injection or surgery. Do not get an MRI right away if you just developed back pain, unless you have severe weakness, numbness or tingling, as well as, bowel or bladder incontinence.

I have back pain and I have had two MRIs and nothing was found, what should I do?

If you have an MRI of the lumbar spine and it comes back negative, you should be very, very happy. This means that your spinal anatomy or structure is in fine working order with no signs of wear and tear or nerve compression, as well as no signs of tumors, masses, or fractures. This generally rules out the most common serious causes of lower back pain and suggests that a possible diagnosis may include problems with your hips, sacroiliac joints or ligaments or functional problems such as improper walking, posture, or ergonomics. Do not think that if your MRI is negative that your pain is imagined and only in your head.

 

How can I interpret my MRI?

An MRI can be very easy to understand if you know where to look and radiologists who do this for a living make it look very easy. This is a very simple guide to help you understand your MRI pictures and how they correlate with your symptoms. I will start with the length-wise sagittal views, or what I call the baguette views as they are easier to follow. Then I will review the axial or cross-section views that I call the sliced bread view.

  1. Central canal- Start with the lengthwise image (sagittal images) and look at the middle of the central canal where the nerves float in the protective cerebral spinal fluid. Make sure you look at the picture where the central canal is white as it highlights as well as borders the structures that we are interested in such as the bones, ligaments and nerves of the spine. Anything that encroaches into the smooth linear central canal can be a potential problem such as the figure on the right which demonstrates severe spinal stenosis of the central canal.
  2. Vertebral body- Next look at the 5 vertebral bodies that stack up and form the lumbar spine or the spine within the lower back. They are numbered top down from one to five. Their function is to support and protect the delicate nerves that pass through to the pelvis and lower legs. They should have a general square shape. If they look triangular, it indicates a fracture (inset).
  3. Alignment- Look at the alignment of the posterior borders of the five vertebral bodies (red line). The picture on the left demonstrates a normal spine with a smooth line connecting the posterior borders. Any irregularity of that line by the vertebral bodies as demonstrated in the pictures on right represents excessive bone, ligament or disc wear-and-tear in the segment which causes greater motion and instability. This is called spondylolisthesis. This instability places greater stress on the discs which makes them degenerate faster resulting in a greater risk of disc herniation, nerve irritation, arthritis and pain.
  1. Intervertebral Discs- Look between the vertebral bodies for the intervertebral discs. They are numbered from L1-2 to L5-S1 based on their location between the vertebral bodies. Discs have a great deal of fluid within them which allow them to act as shock absorbers but over time the discs can begin to dry out and degenerate.
  2. Disc degeneration- A normal intervertebral disc has significant white signal internally (figure A) which represents normal fluid.  As the intervertebral disc degenerates, the normal white signal is lost (figure B). Without the fluid, the disc begins to narrow and degenerate further (figure C). With loss of the interior supporting fluid, the thick collagen walls of the disc begin to bulge outwards into the central canal from the excessive pressure (figure D). The excessive pressure continues until the disc wall tears open and the remaining fluid within the disc squeezes out into the central canal (figure E). If a little material squeezes out it can result in a mild disc herniation. If a great deal of fluid squeezes out it is called a disc extrusion which can migrate (figure F). Basically the more material that is squeezed into the central canal, the greater the chance of severe pain, weakness, numbness and tingling.
  3. Nerves- On both sides of the spinal column; you will find narrow keyhole-shaped canals called foramen. The foramen allow individual nerves to exit from the spine. Since the foramen are narrower than the larger central canal, a small disc herniation is more likely to pinch or irritate a nerve.

 

  1. Axial views- The axial images or sliced bread views provide a clearer picture of a specific intervertebral disc and the adjacent nerves. A normal disc (figure A) provides ample room for the nerves to pass through. Any type of disc herniation (figure B) narrows the normally roomy canals causing the transiting nerves to become irritated or compressed which results in symptoms. A small disc herniation (figure C) may not produce any symptoms but a large disc herniation (figure D) may result in severe pain, weakness, numbness or tingling.
  2. Spinal stenosis- The normal central canal is usually quite big (figure A) and houses and protects the descending nerves. Narrowing of the central canal is known as spinal stenosis (figure B). The condition occurs when the intervertebral disc (figure C), ligamentum flavum (figure D) and facet joints (figure E) undergo extensive wear-in-tear and degenerate. As they degenerate, they expand into and narrow the central canal which results in nerve compression. The resulting nerve compression can cause progressive pain, weakness and numbness.

What do doctors do to treat back pain?

The most difficult thing that doctors do to treat back pain is first, establish a diagnosis which is usually part of a short list of several possible diagnoses. Once a possible diagnosis is established, they can provide you with medications to make you more comfortable and provide non-aggressive treatment options such as physical therapy. Doctors will also educate you on possible contributing factors such as posture or sporting activities that may be contributing to your back pain. If your symptoms do not abate, your doctor may also get blood tests or imaging studies such as serum inflammatory markers, x-rays, MRI, or CT to rule out more severe causes of your back pain. If you’re not responding, your doctor will refer you to other back specialists that they have had good patient feedback from, and follow your progress thereafter. Most importantly, your doctor should keep you out of trouble and provide reassurance, and work with you to prevent your back pain from returning.

Doctors who specialize in back pain can provide you with a much more precise diagnosis. Advanced treatment options including trigger point injections, epidural steroid injections, joint blocks, nerve rhizotomy, fascial barbotage, platelet-rich plasma, prolotherapy or subcutaneous perineural injection series, spinal cord stimulation, discectomy, laminectomy or spinal fusion.

When should I consider back surgery?

If your pain is not alleviated with non-operative treatment approaches and there is an identifiable lesion on your imaging tests, you may be a candidate for surgery. There are several other reasons that make you a candidate for back surgery. These include severe weakness, numbness or tingling, or bowel or bladder incontinence. Other reasons include the inability to walk, a spine tumor or a mass, or to stabilize the spine following an injury or other trauma. Surgeons are more likely to do surgery if you have leg pain as it is usually due to a disc herniation, whereas back pain does not have the best surgical outcomes.

When does someone NEED surgery for chronic back pain?

You need surgery if your imaging studies (x-ray, MRI, CT) demonstrate a problem with your spine that needs to be operated on urgently. These include tumors or masses compressing your spinal cord or nerve roots, a fracture of certain parts of your vertebral body, or a ligament disruption causing spinal misalignment. Symptoms may include severe weakness, numbness or tingling, or bowel or bladder incontinence. Other reasons include the inability to walk, a spine tumor or a mass, or an unstable spine following an injury or other trauma. If you notice, I did not mention severe pain. If you do have severe pain it is first important to identify the cause before considering spinal surgery, as once you have had surgery, it is permanent; you cannot undo the surgery.

When should I have an epidural injection?

An epidural steroid injection should be considered if you have severe back or leg pain that correlates with imaging findings and you are not able to do physical therapy, or if you have done physical therapy and have had minimal improvement. Epidural steroid injections can be repeated up to three times within a short period of time and should not be repeated for six months to allow your body to clear out the systemic effects of the corticosteroid. If you find that you need to have a repeat series of three epidural steroid injections frequently, you should consider alternative treatments such as platelet lysate epidural injections, regenerative treatments into the disc herniation or surgery.

Common Medications Used For Back Pain

Should I get medications for my pain right away or should I tough it out?

Using medications for your back pain is a personal choice that is dictated by the severity of your pain and your ability to comfortably complete your normal daily activities. If you are suffering from nerve pain, the pain may be so severe that you will request medication right away. Nonsteroidal anti-inflammatory medications and prednisone (a potent, steroidal anti-inflammatory) work to quickly decrease inflammation and pain which may allow you to feel better faster although this effect may be temporary. Other medications like muscle relaxants or opioid pain medications may also allow you to function more comfortably such as allowing you to get to work or to participate in family life without being a grouch, but it is important to recognize that they also do not “heal” your problem – but rather function as a band aid.  During a time of severe pain, there is nothing wrong with a band aid

I am having back pain, what tablets should I take?

If you’re having back pain and would like to try an oral medication you should start with a nonsteroidal anti-inflammatory medication such as ibuprofen, naproxen, or aspirin to decrease the pain. Many of my older patients try acetaminophen and some people believe it can be very, very helpful, while others see no effect at all. If you are older, you should try naproxen first as it has a lower risk of stomach problems compared to the other medications.

Is ibuprofen suitable for back pain relief?

Ibuprofen is an over-the-counter nonsteroidal anti-inflammatory medication that some people find very helpful for pain. It is important to take no more than the maximum number of tablets indicated on the bottle as ibuprofen can increase your risk of stomach irritation or ulceration as well as bleeding; so it is important to take it after meals. Some doctors will also recommend a proton pump inhibitor to protect your stomach while you take ibuprofen, but often it can cause other problems such as poor absorption of calcium which can result in osteoporosis later in life. If ibuprofen is not helpful after several days it will most likely not be helpful with continued use. If you find it helpful but it does not completely relieve your pain or if you have taken it for weeks to months without improvement, you should see your doctor.

Is naproxen (Naprosyn®) good for back pain?

I think of naproxen as the most powerful anti-inflammatory medication available over-the-counter. It is best for older patients as it has the lowest risk of stomach bleeding and stomach ulcers.

Can I take diclofenac (Voltaren®) for my back pain if I am diabetic and hypertensive?

Diclofenac (Voltaren®) is a very strong prescription strength nonsteroidal anti-inflammatory medication that is in the same class as over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen; since it is stronger, you have a greater risk of side effects. Severe or longstanding diabetes is always associated with kidney problems so adding a prescription nonsteroidal anti-inflammatory medication may cause further kidney problems or kidney failure in rare cases. Nonsteroidal anti-inflammatory medications have also been associated with high blood pressure. In this case I recommended that you consult with your doctor first before starting diclofenac or any other nonsteroidal anti-inflammatory medications.

If ibuprofen and acetaminophen aren’t helping my back pain what will?

You may need to see your primary care doctor or see a back specialist to consider imaging so that you may get a more precise diagnosis. Your doctor may also suggest non-pharmaceutical options like acupuncture, massage, TENS (transcutaneous electrical nerve stimulation), physical therapy, biofeedback, cold, heat, or an inversion table.

What is better for back pain, naproxen (Aleve®), ibuprofen (Advil®), or acetaminophen (Tylenol®)?

You should see what works best for you but beware of the side effects and do not take these any of these medications for more than several weeks without consulting your doctor.

Are muscle relaxants good for relieving back pain?

Muscle relaxants can be good for relieving back pain but they are most helpful for allowing people with pain to sleep. cyclobenzaprine (Flexeril®) 10 mg at night or every six hours can be helpful but it may cause you to retain urine if you have prostate problem. carisoprodol (Soma®) 350 mg every 8 hours and diazepam (Valium®) 5 to 10 mg at night or every six hours can both be habit forming so they should not be used for a long periods of time. Unfortunately all these medications may cause sleep disruption when you discontinue taking them.

Can Tylenol #3® get rid of back pain?

Tylenol #3 is a combination medication with acetaminophen (Tylenol®) and a mild pain medication, codeine. It is thought that the combination medication can be more effective than either medication alone. Codeine is known to cause nausea and/or vomiting in many patients and is the primary reason that many of my patients discontinue it. It will most likely not get rid of your back pain but will make you feel better about it.

Can I take tramadol (Ultram®) for back pain while I’m taking sertraline (Zoloft®)?

Taking tramadol (Ultram®) with sertraline (Zoloft®) is not a good idea as you may develop a dangerous condition called serotonin syndrome. Tramadol is a weak mu opioid analgesic that is indicated for moderate to severe pain but can also be helpful for depression. Depression is thought to be due to low levels of the neurotransmitters norepinephrine and serotonin within nerve endings. Tramadol inhibits the reuptake of norepinephrine and serotonin from nerve endings increasing the neurotransmitters within the nerve endings which decreases the symptoms of depression. Sertraline is a selective serotonin reuptake inhibitor so it also inhibits the reuptake of serotonin in the nerve endings. When there is an abnormally high amount of serotonin within the nerve endings you may develop a condition called serotonin syndrome which is associated with headache, chest pain, psychosis, confusion, severe sweating, tremors, very high blood pressure, high fever, seizures or unconsciousness. Serotonin syndrome may also be caused by combining your medications with certain herbal supplements or illegal drugs.

What is the best painkiller for back pain?

There is no single best pain killer. Some people swear by certain medications and others find no medication helpful. You should think of pain medication as a tool to decrease the pain to at least allow you to function in everyday life. It is very rare to hear my patients report that their painkillers have completely relieved their pain. You should be aware that some pain medications, mostly the ones based on morphine, can cause drowsiness, decrease your usual sharp thinking or result in terrible constipation.

Can I take leftover Percocet for back pain?

Generally it is not recommended to take expired Percocet or other medications as they are often not as effective for pain control.

Why would my doctor continue prescribing Vicodin for back pain if it is so bad for me?

Vicodin as a medication is not bad for you if taken properly and for the right reason. Although it is a morphine derivative and has had negative coverage in the media recently, it can be very helpful as a pain reliever to allow you to function in your everyday life. You should be aware of the most common side effects of Vicodin are drowsiness nausea, vomiting and constipation. If you take Vicodin for a long period of time your body may get used to it, a condition called tolerance that can result in flu-like symptoms with sudden discontinuation of the medication. If it is slowly decreased then discontinued, you have a much lower risk of withdrawal symptoms. Although Vicodin can be addictive if taken for pleasure, addiction is very, very uncommon if taken to control your pain. The long term effects of Vicodin use have not been firmly established, so it is important to consider it a short term pain medication.

Is there a stronger pain medication than morphine for back pain?

Morphine has been mentioned in literature going back thousands of years ago so it remains the quintessential pain medication that all other pain medications are measured against. Medications that are stronger than morphine include methadone and dilaudid (10 times stronger than morphine) and fentanyl (100 times stronger than morphine). Even though these medications are so much stronger than morphine they still may not be 100% effective in treating your back pain but they can help a great deal if used properly.

What do doctors think is the top pain medication for back pain?

The top pain medication prescribed by doctors is hydrocodone (Vicodin®); this is probably due to drug regulatory laws rather than for its effectiveness. Unfortunately identifying the top pain medication for back pain is a process of trial and error with a goal not only for effectiveness but also with the fewest number of reported side effects. This approach is best described in the World Health Organization Pain Ladder approach that was first published about 30 years ago and has guided pain management ever since. I start with a simple nonsteroidal anti-inflammatory medication that is either over-the-counter or prescription strength and if this is not helpful then I proceed to prednisone which is a corticosteroid, if I think that inflammation is the underlying cause of pain, or a muscle relaxant. If this is still not effective than I will try a weak opioid pain medications such as Tramadol (Ultram®), oxycodone (Percocet®), hydrocodone (Vicodin®) and add adjuvant pain medications such as antidepressants sertraline (Zoloft®) or duloxetine (Cymbalta®) and/or anti nerve agents such as pregabalin (Lyrica®), neurontin (gabapentin®), topiramate (Topamax®). If there is still no significant effect, I will try a stronger opioid medications such as morphine (Avinza®), hydromorphone (dilaudid®), methadone or Fentanyl (Duragesic®).

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