Serious Low Back Pain: Causes and Treatment Options

More than 65 million Americans suffer from back pain each year. Back pain is the second most common reason that adults see a doctor, according to the American Association of Neurological Surgeons.

Most back pain occurs in the lower back because that's the part of the spine that bears the most weight. But pain can occur elsewhere in the back, as well.

The spine is made up of small bones called vertebrae. These vertebrae are divided into three sections: the cervical (neck), thoracic (upper back) and lumbar (lower back). Disks of cartilage separate and cushion the vertebrae.

Causes of Severe Low Back Pain

"Although the causes of more than 80 percent of back-pain cases are unknown, there are five major severe low-back-pain conditions," says to Salvatore Campo, M.D., a pain management specialist at Doctors Hospital in Dallas. They are:

• Herniated (slipped) disk. A damaged or bulging disc may pinch or irritate a nerve root, causing pain. Also called sciatica.

• Disk degeneration. Disks can deteriorate with age. This deterioration can lead to inflammation and irritation in the spine, causing pain.

• Lumbar spinal stenosis. Spinal degeneration narrows the area through which the spinal nerves travel. The degeneration occurs with age, because the disks dry out and shrink. If a disk then becomes inflamed from a minor injury, this can put pressure on a spinal nerve, causing pain. Spinal stenosis usually is associated with osteoarthritis of the spine.

• Osteoarthritis. Osteoarthritis can affect the cartilage in the disks, the vertebrae or both, anywhere along the spine. This condition causes pain and muscle spasms. Spinal nerves also can become pinched, which is another cause of back pain.

Treatment Options

Treatment of back pain depends on several factors. "If pain is due to an accident or injury and fever is present, a physician should be seen immediately," says Dr. Campo.

Pain not accompanied by fever or not associated with an accident or injury may not need immediate treatment.

"Wait a few days to see if the pain subsides," he says. "Physical activity should be limited, and an anti-inflammatory medication such as ibuprofen taken, along with hot showers to relax the muscles. If this doesn't help, contact your physician."

For patients suffering from chronic back pain, treatment may also include anti-inflammatory medication and muscle relaxants, physical therapy, steroid injections, traction, ultrasound, electrical stimulation, acupuncture, alternating ice packs with heating pads, massage and whirlpool therapy.

"People with back pain are also usually advised to alter their lifestyles, including losing weight; exercising for at least 30 minutes each day; doing stomach-strengthening exercises, such as sit-ups; and quitting smoking," says Dr. Campo. "In addition, patients should be aware of their posture when standing and sitting."

Bed rest is no longer recommended, although a person with low back pain should stop normal activities for several days until symptoms ease. A good night's sleep is also important in recovering from back pain. If you have trouble getting to sleep because of the pain, take a warm bath and try relaxation techniques; avoid caffeine late in the day. You may need medication to help you sleep.

Surgery may be recommended if these remedies don't work after two or three months. The most common reasons for spinal surgery are spinal stenosis and sciatica. Possible signs that surgery may be needed include:

• Leg or back pain limits normal activity, resulting in an unacceptable quality of life.

• Weakness or numbness in the legs.

• Difficulty walking or standing.

• Medication and physical therapy are ineffective.

Surgery may involve removing some of the gel-like material in the affected disk, removing a small piece of bone near the disk to allow more space without pinching a nerve, or fusing disks if several are affected or in cases of spinal degeneration.