Low back pain - chronic
Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - lowLow back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.
Low back pain that is long-term is called chronic low back pain.
Causes
Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of the pain cannot be found.
A single event may not have caused your pain. You may have been doing many activities, such as lifting the wrong way, for a long time. Then suddenly, one simple movement, such as reaching for something or bending from your waist, leads to pain.
Many people with chronic back pain have arthritis. Or they may have extra wear and tear of the spine, which may be due to:
- Heavy use from work or sports
- Injuries or fractures
- Surgery
You may have had a herniated disk, in which part of the spinal disk pushed onto nearby nerves. Normally, the disks provide space and cushion in your spine. If these disks dry out and become thinner and more brittle, you can lose movement in the spine over time.
Herniated disk
A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves...
If the spaces between the spinal nerves and spinal cord become narrowed, this can lead to spinal stenosis. These problems are called degenerative joint or spine disease.
Spinal stenosis
Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) wher...
Other possible causes of chronic low back pain include:
- Curvature of the spine, such as scoliosis or kyphosis
Scoliosis
Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone's spine naturally curves a b...
ImageRead Article Now Book Mark ArticleKyphosis
Kyphosis is a curving of the spine that causes a bowing or rounding of the back. This leads to a hunchback or slouching posture.
ImageRead Article Now Book Mark Article - Medical problems, such as fibromyalgia or rheumatoid arthritis
Fibromyalgia
Fibromyalgia is a condition in which a person has long-term pain that is spread throughout their body. The pain is most often accompanied by fatigue...
ImageRead Article Now Book Mark ArticleRheumatoid arthritis
Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It is a long-term disease. It can also aff...
ImageRead Article Now Book Mark Article - Piriformis syndrome, a pain disorder involving a muscle in the buttocks called the piriformis muscle
You are at greater risk for low back pain if you:
- Are over age 30
- Are overweight
Overweight
Overweight and obesity mean having a weight than is higher than what is healthy for a given height. A person may be overweight from extra muscle, bo...
ImageRead Article Now Book Mark Article - Are pregnant
- Do not exercise
- Feel stressed or depressed
Stressed
Snake bites occur when a snake bites the skin. They are medical emergencies if the snake is venomous. Venomous animals account for a large number of...
ImageRead Article Now Book Mark ArticleDepressed
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
ImageRead Article Now Book Mark Article - Have a job in which you have to do heavy lifting, bending and twisting, or that involves whole body vibration, such as truck driving or using a sandblaster
- Smoke
Symptoms
Symptoms may include any of the following:
- Dull aching pain
- Sharp pain
- Tingling or burning sensation
- Weakness in your legs or feet
Low back pain can differ from person to person. The pain may be mild, or it can be so severe that you cannot move.
Depending on the cause of your back pain, you may also have pain in your leg, hip, or on the bottom of your foot.
Exams and Tests
During the physical exam, the health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.
Other tests you have depend on your medical history and symptoms.
Tests may include:
- Blood tests, such as a complete blood count and erythrocyte sedimentation rate
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
ImageRead Article Now Book Mark ArticleErythrocyte sedimentation rate
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures the level of certain protei...
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CT scan of the lower spine
CT scan of the lower spine
A computed tomography (CT) scan of the lumbar spine makes cross-sectional pictures of the lower back (lumbar spine). It uses x-rays to create the im...
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MRI scan of the lower spine
MRI scan of the lower spine
A lumbar magnetic resonance imaging (MRI) scan uses energy from strong magnets to create pictures of the lower part of the spine (lumbar spine). An M...
Read Article Now Book Mark Article - Myelogram (x-ray or CT scan of the spine after dye has been injected into the spinal column)
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X-ray of the lumbosacral spine
X-ray
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray waves through the body. The images...
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Treatment
Your back pain may not go away completely, or it may get more painful at times. Learn to take care of your back at home and how to prevent repeat episodes of back pain. This can help you continue with your normal activities.
Take care of your back at home
Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficult...
Your provider may recommend measures to reduce your pain, including:
- A back brace to support your back
- Cold packs and heat therapy
- Traction
- Physical therapy, involving stretching and strengthening exercises
- Counseling to learn ways to understand and manage your pain
These other health care providers may also help:
- Massage therapist
- Someone who performs acupuncture
- Someone who does spinal manipulation (a chiropractor, osteopathic physician, or physical therapist)
If needed, your provider may prescribe medicines to help with your back pain:
- Aspirin, naproxen (Aleve), or ibuprofen (Advil), which you can buy without a prescription
- Low doses of prescription medicines
- Narcotics or opioids when the pain is severe
If your pain does not improve with medicine, physical therapy, and other treatments, your provider may recommend an epidural injection.
Epidural injection
An epidural steroid injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around...
Spinal surgery is considered only if you have nerve damage or bone damage that is causing the back pain does not heal after a long time.
In some patients, a spinal cord stimulator can help reduce back pain.
Other treatments that may be recommended if your pain does not improve with medicine and physical therapy include:
- Spinal surgery, only if you have nerve damage or the cause of your pain does not heal after a long time
- Spinal cord stimulation, in which a small device sends an electric current to the spine to block pain signals
Some people with low back pain may also need:
- Job changes
- Job counseling
- Job retraining
- Occupational therapy
Outlook (Prognosis)
Most back problems get better on their own. Follow your provider's advice on treatment and self-care measures.
When to Contact a Medical Professional
Contact your provider if you have severe back pain that does not go away. Call right away if you have numbness, loss of movement, weakness, or bowel or bladder changes.
References
Abd OHE, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 48.
Dixit R. Low back pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 50.
Malik K, Nelson A. Overview of low back pain disorders. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 24.
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Herniated disk
Animation
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Spinal stenosis
Animation
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Spinal stenosis - illustration
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.
Spinal stenosis
illustration
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Backaches - illustration
Although stress can cause backaches it is wise to watch out for other signs that may indicate a more serious condition. Pain which radiates to the buttocks, arms or legs, and weakness or numbness in the arms and legs should not be ignored.
Backaches
illustration
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Spinal stenosis - illustration
Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.
Spinal stenosis
illustration
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Backaches - illustration
Although stress can cause backaches it is wise to watch out for other signs that may indicate a more serious condition. Pain which radiates to the buttocks, arms or legs, and weakness or numbness in the arms and legs should not be ignored.
Backaches
illustration
Review Date: 4/27/2023
Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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