Lower Back Pain: Prevent It If Possible, Treat It When Necessary

Lower back pain is a common occurrence: According to one study, 25 percent of adults in the U.S. reported having lower back pain in the prior three months. Fortunately, this type of pain often subsides after a few days or weeks, and you can take steps to prevent its recurrence. But if it does last, there are a number of treatment methods that may help ease your pain.

Preventing Pain

A healthy lifestyle can go a long way in preventing lower back pain.

“Obesity plays a role. Every extra pound of weight in the abdomen places an additional five to 10 pounds of pressure on the lumbar spine, increasing the chances of lower back pain,” says Jaspal “Ricky” Singh, MD, assistant professor of clinical rehabilitation medicine and director of the Interventional Spine Program at Weill Cornell. “Smoking also plays a role; smoking has been shown to increase the prevalence of back pain due to the obstruction of blood vessels.”

Maintaining an active lifestyle is one of the most effective ways of preventing back pain: Regular physical activity will help you lose weight or remain at a healthy weight, and strengthening your core muscles with exercise will help support your spine.

“Based on the Physical Activity Guidelines for Americans, I tell every patient to get 30 minutes of moderateintensity exercise five times a week for a total of 150 minutes,” says Dr. Singh.

Causes of Chronic Pain

Most episodes of lower back pain get better within two to six weeks, with or without treatment, but some people have chronic pain that lasts for three months or longer. Common causes of chronic lower back pain include osteoarthritis (OA), spinal stenosis (narrowing of the spinal canal), and degenerative disc disease.

OA wears away the protective layer of cartilage on the vertebrae and may be accompanied by bone overgrowth or the formation of bone spurs. “OA typically causes pain with standing, walking, and sometimes lying down, while sitting and leaning forward often provide relief,” says Dr. Singh.

With spinal stenosis, the spinal canal has narrowed due to thickening of ligaments or membranes and/or bone spurs, all of which may press on the nerves that run through the canal.

The intervertebral discs are the flexible donut-shaped structures located between the vertebrae. They function as shock absorbers and cushion the spine during motion. With age, these discs begin to dehydrate and become less flexible. This phenomenon is commonly referred to as degenerative disc disease.

When Testing Is Needed

If lower back pain does not subside or is accompanied by other symptoms, such as numbness, tingling, or weakness, diagnostic tests may be ordered.

“Depending on the patient’s history and physical exam, imaging may be necessary to rule out any potentially harmful conditions. X-rays can provide a view of the bony structure to determine if OA is present in the spine,” says Dr. Singh.

He adds that if a patient has neurologic deficits, such as weakness, balance issues, or loss of bladder/bowel control, magnetic resonance imaging (MRI) is useful in evaluating the spinal cord and soft tissues.

Treatment Options

Dr. Singh recommends physical therapy and exercise as the first line of treatment for patients with lower back pain. Having a strong core, which includes the muscles above, below, and around the abdominal area, is imperative for a healthy spine. If these muscles are strong, the spine’s structures will undergo less wear and tear.

Medications for low back pain may include acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Low doses of some types of antidepressants, such as amitriptyline (Elavil), have been shown to relieve back pain.

“In some patients, acupuncture, chiropractic care, and even spinal injections might be used if the initial treatment program does not provide significant relief,” says Dr. Singh.

If standard treatments aren’t successful, the next step is referral to a pain management specialist, who can provide interventions to localize and isolate the structures causing pain. These include epidural steroid injections, facet and sacroiliac joint injections, and ablation, which uses radiofrequency waves to disrupt pain signals.

For lower back pain, surgery is a last resort. There are many types of surgery, but typically, they have one of two purposes: decompression for patients who have a disc or bone pressing on a nerve, and fusion surgery, which stabilizes a weak area in the spine. Dr. Singh notes that there are no guarantees that surgical intervention will provide lasting pain relief.

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