Back pain is one of the most common reasons to seek medical care, says Santaram Vallurupalli, M.D., an OU Health orthopedic surgeon and assistant professor with the University of Oklahoma Health Sciences Center in Oklahoma City.
“Back pain is mostly non-specific, and less than 1% of people with back pain have risk of serious spine disease,” says Vallurupalli. “The most common reason for acute back pain is musculoskeletal in nature, i.e., due to muscular strain, disk degeneration, poor posture, loss of core and back strength, and spinal joint arthritis.”
He says acute back pain that’s limited to the lower back usually resolves with rest, over-the-counter medication and an early return to regular activities. Tylenol and anti-inflammatory medications can help with pain control, and individuals with poor posture and/or a weak core can benefit from physical therapy.
When back pain begins, it can be difficult to discern whether it’s an injured muscle, disc or both that’s causing discomfort.
Leslie Chan, M.D., an anesthesiologist with Ascension St. John Pain Management in Tulsa, says muscle pain tends to be more acute, often tender to the touch or most noticeable during movement, and may resolve over time.
“However, disc pain can be a deep, aching pain, not typically accompanied by local tenderness to touch, and may persist more long term,” he says. “Disc injury may also present with radiating pain going down the extremity, that is worse when the person bends over or strains, and there may be associated weakness, numbness and tingling in the extremity.”
Patricia Jumelle, M.D., an anesthesiologist and colleague of Chan, says it is a medical emergency if a patient suddenly experiences an acute loss of bowel or bladder control, numbness across the groin or progressive weakness of any kind.
Vallurupalli describes chronic back pain as a complex problem that’s harder to treat.
“It needs a multi-modality approach with serious commitment from patients and physicians,” he says. “Physical therapy, cognitive behavioral therapy, meditation, dietary commitments, lifestyle modifications, interventional procedures … these can all help cope with chronic low back pain – and rarely is surgery needed and would improve chronic low back pain.”
Pinched Nerves and Disc Pain
If back pain is associated with leg pain, like that involving the sciatic nerve, then the cause is usually due to pinched nerves and disk-related problems.
“Most of these patients do well with prescription medications, physical therapy and/or epidural steroid injections and 80% of patients can have complete resolution of symptoms within three months,” he says. “Only 20% of the patients with radiculopathy/nerve pain would need surgery. If leg pain is associated with weakness, those patients most likely benefit from early surgery.”
He says spinal stenosis, a common problem in the elderly due to a lack of space for the nerves in the spinal canal, can be treated by surgery and can improve weakness and functional ability to stand and walk.
“Modern spinal surgery is highly successful, safe and life changing in cases of radiculopathy, stenosis, deformity, fractures, tumors and infections and other indications when surgery is needed,” says Vallurupalli.