Symptoms
Possible symptoms of acute back pain include muscle aches, tension, stabbing pain, limited mobility, and stiffness. The pain may radiate down the leg (sciatic pain), and patients may be unable to stand up straight. While acute pain is comparatively treatable, chronic back pain poses a serious quality of life and mental health problem and can lead to job loss.
Causes
A common cause of acute and simple back pain is overuse or misuse of muscles or ligaments. Often, the exact cause cannot be determined (idiopathic). In most cases, there is no serious underlying cause and the back pain goes away on its own within days or a few weeks. Back pain that lasts less than 6 weeks is considered acute. Chronic back pain is defined as pain that lasts longer than 12 weeks. Other possible and sometimes serious triggers include:
- Wear and tear, osteoarthritis.
- Damage to the intervertebral disc, herniated disc
- Vertebral fracture, osteoporosis
- Rheumatoid arthritis, ankylosing spondylitis
- Tumors
- Kidney inflammation
- Infectious diseases
- Injuries
- Pinched nerve
- Psychological/psychosomatic causes
Diagnosis
Diagnosis is made in medical treatment based on the patient’s history, physical examination and secondarily with imaging techniques. Simple muscular back pain can be self-treated during a few days. However, a visit to the physician is recommended in the following circumstances (“Red Flags,” Selection):
- Radiation of pain to the legs, paralysis or weakness in the legs.
- Sensory disturbances
- Connection with an injury
- Very severe, increasing pain
- Young or old patients
- Long morning stiffness
- Signs of infection, fever
- Disturbances in bowel or bladder function
Non-drug treatment
Bed rest is not recommended. Tolerable normal physical activity should be maintained. Keep active.
- Physiotherapy, massages, baths
- Occupational therapy, chiropractic
- Acupuncture, yoga
- Heat treatment, partly also cold
- Operation
- Longer term: reduce excess weight, strengthen back muscles, physical activity.
Drug treatment
Pain medication:
- Such as acetaminophen, ibuprofen, or naproxen are administered as 1st-line agents for acute and short-term treatment of back pain. In the presence of risk factors or longer-term treatment, nonsteroidal anti-inflammatory drugs should be combined with gastric protection (proton pump inhibitor). Longer-term regular use is problematic because of the possible side effects.
Muscle relaxants:
- Such as Tizanidine are prescribed for concomitant muscle tension. They are available only on medical prescription. For self-medication, taking high-dose magnesium supplements is an option. The use of tolperisone is controversial.
Opioids:
- Such as morphine, tramadol, fentanyl, and oxycodone are centrally analgesic and are administered when simple analgesics such as acetaminophen or NSAIDs are not sufficient.
Antidepressants:
- Such as amitriptyline and trimipramine, and some antiepileptic drugs such as carbamazepine, are used to treat chronic pain. They are not used for acute treatment. The opioids tramadol and tapentadol are concomitantly opioid and, like antidepressants, inhibit neurotransmitter reuptake.
Glucocorticoids:
- Such as methylprednisolone are injected locally epidurally as a second-line agent for chronic symptoms.
Self-medication:
- For self-medication, there are numerous preparations for external use, such as comfrey ointments, topical NSAIDs (diclofenac gel), Arnica ointments, ointments with essential oils and heat patches.
See also under the articles pain gels and pain plasters.
