Back pain

Most people experience back pain for a short time at some point in their lives, possibly after overdoing exercise or other activities. But persistent pain is not as common. Persistent back pain that lasts more than a month, is termed chronic back pain.

“Back pain is a painful condition involving any portion of the spine, from the base of the skull down to your tailbone,” said Brian Dalton, MD, a neurosurgeon at UPMC Hamot.

Back pain can prevent you from getting a good night’s sleep, going to work, engaging in everyday activities, and participating in hobbies that you enjoy. But while living with back pain can be uncomfortable and frustrating, it is a condition that can often be treated without surgery.

Risk Factors for Chronic Back Pain

Many people experience occasional back pain because of overuse or everyday wear and tear. For some people, however, back pain is a frequent occurrence that lasts longer than a few days. Chronic back pain can result from overuse; injuries, however, are the most common cause of back pain and often are the result of an accident, sports mishap, or work-related activity.

Other factors that may make you more susceptible to chronic back pain include:

  • Family history
  • Degenerative joint or disc disease
  • Sedentary work
  • Lifting or pulling heavy objects: “Folks with occupations that require repetitive lifting or bending will have a higher likelihood of developing chronic pain issues with their backs,” Dr. Dalton says.
  • Aging: Dr. Dalton notes that aging can bring about a loss of bone density. He recommends checking with your doctor about vitamin D supplements and exercises to keep your bones healthy and your back strong.
  • Smoking: “Smoking increases disc degeneration and overall pain scores,” Dr. Dalton says.
  • Obesity: “Obesity not only makes it more difficult to diagnose problems, but people who are obese are much harder to treat, and they will have a much higher complication rate from those treatments,” Dr. Dalton says.

Back pain stems from problems with the musculoskeletal system. Your musculoskeletal system includes:

  • Vertebrae, or the 24 bones that make up your spine
  • Discs, which provide cushioning between your vertebrae
  • Facet joints, which allow movement while stabilizing your spine
  • Muscles and ligaments that support your spine

If any part of your spinal musculoskeletal system is injured, it can lead to back pain. Discs are one of the most common causes of back pain.

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What Causes Disc Pain?

As you age, your discs can become less flexible and less able to provide cushioning between the bones of your spine. When a disc is causing pain because it isn’t functioning the way it should as a result of aging, it is called degenerative disc disease.

Aging or injury can also cause the jelly-like center of a disc to leak or bulge, resulting in a herniated or bulging disc. When disc material is out of place and presses on a nearby nerve, it can lead to nerve dysfunction or pain.

How Is Back Pain Categorized?

Back pain usually falls into two categories: radicular pain and referred pain.

Radicular pain travels along one of the nerves that exit your spine. For example, if a piece of disc material is touching the nerve that goes to your foot, it could cause your foot to hurt.

Referred pain is pain that you feel at a location other than the site of your injury. However, referred pain is not caused by compressing a nerve. For example, if you have a problem in your spine, your brain may send pain signals that cause you to feel pain in the back of your leg.

At-Home Treatments for Back Pain

Most types of back pain can be managed without surgery. In fact, research shows that approximately 90% of back pain will heal on its own within three months. Here are a few simple methods that can help to reduce most low-grade back pain:

  • Avoid the activity that caused the back pain, at least temporarily
  • Maintain good posture by standing and sitting up straight with your shoulders back and your neck and spine aligned
  • Stretch your back and legs

Dr. Dalton also recommends using anti-inflammatory medicines such as ibuprofen and applying heat or ice packs to treat occasional back pain.

“People always want to know which is better — heat or ice? The answer is simple: Use whatever works for you,” says Dr. Dalton.

Medical Treatment for Persistent Back Pain: Ways to Cope

Back pain that persists or seems to radiate to the arms or legs may require more substantial treatment.

If significant limb weakness or bowel/bladder issues develop with the onset of pain, doctors will often refer people to physical therapy. This may involve stretches and exercises that strengthen the back.

Through consultation with your doctors and physical therapists, you can learn practical information about back care, posture, body mechanics, and back exercises.

If back pain persists after these interventions, your doctor may order additional tests to determine the cause before recommending treatment options such as medicines or injections. “Only about 12% of people who slip a disc will require surgery because of persistent pain or neurological complications from the disc herniation,” says Dr. Dalton.

If you are having nerve pain that could lead to permanent damage if left untreated, or if your nerve pain has not responded to conservative treatment, your doctor may recommend nerve decompression surgery. Whether the cause is a herniated disc, a narrowing of the spine, or a bone fragment related to a fracture, nerve decompression surgery involves removing the object that is putting pressure on your nerve. If you have bone damage that needs to be repaired, your physician may recommend surgery to stabilize your spine. Spine stabilization surgery treats fractures and other types of bone damage using various techniques to hold your spine together.

How Can I Prevent Back Pain?

The best way to prevent back pain is to reduce your risk of injury by using proper body mechanics, especially when lifting heavy objects. Bending at the waist and reaching far away from your body when lifting puts a lot of pressure on your discs. You can relieve some of that pressure and lower your risk of back injury by holding heavy objects close to your body and remembering to lift with your legs.

Back pain is a common problem that affects just about everyone at some point. The good news is that there are a variety of nonsurgical and surgical treatment options that may help. If you are living with back pain, talk to your healthcare provider about which treatment may be right for you.

For more information about treating persistent, chronic back pain or to make an appointment with one of our doctors, call the UPMC Department of Neurosurgery at 412-647-3685.

If you have questions about full, in-network access to UPMC doctors and hospitals, please call our help line at 1-855-646-8762.

About Neurosurgery

The UPMC Department of Neurosurgery is the largest academic neurosurgical provider in the United States. We perform more than 11,000 procedures each year. We treat conditions of the brain, skull base, spine, and nerves, including the most complex disorders. Whether your condition requires surgery or not, we strive to provide the most advanced, complete care possible. Our surgeons are developing new techniques and tools, including minimally invasive treatments. U.S. News & World Report ranks neurology and neurosurgery at UPMC Presbyterian Shadyside as among the best in the country. We also rank among the top neurosurgery departments in the U.S. for National Institutes of Health funding, a benchmark in research excellence.