The Empowered Patient’s Guide to Lower Back Pain

The odds of getting low back pain are high—80% of the population will experience it at some point in their lives. Good thing there have never been more or better ways to treat it. Our primer gives you all the critical info you need.

The odds of getting low back pain are high—80% of the population will experience it at some point in their lives. If it becomes chronic it can ruin your quality of life and make you miserable—unable to move without pain or work (it's a top cause of job-related disability). It's also invisible making it hard to drum up understanding from co-workers, family, and friends.

THE BASICS
Lumbago. Sounds like a dance, right? Flamenco, bordello, limbo…lumbago. Well, it’s actually the Latin-derived word to describe lower back pain. And it makes sense because having lower back pain can feel like a dance of discomfort.

Standing up can cause shooting pain to radiate down your lumbar spine and into your legs. Bending over can lead to sharp, stabbing pain and back spasms that take your breath away. Sitting can hurt, and even lying down may not provide any relief—just the idea of getting into a comfortable position seems impossible. You are endlessly trying to readjust.

Oh, and the emotions. So many emotions. You may feel tired, depressed,or irritable. Your family, friends, and coworkers may not understand how much this pain affects your day-to-day life. This is living with constant back pain. Now that we know lower back pain is the worst here top experts give you the deets so you can live well despite your achin' back. 

So, What Exactly is Lower Back Pain?

Lower back pain is one of the most common health problems among adults worldwide, and one of the most prevalent causes of job-related disability: It affects 80% of the population at least once throughout their lifetime, according to studies in JAMA and Rheumatology International.1,2

While many people will only experience acute pain that lasts for two to six weeks, about one in five people will develop chronic back pain, which is defined as pain that lasts for more than 12 weeks, says the National Institute for Neurological Disorders and Stroke.3

Not only is low back pain the number one cause of activity limitation in adults younger than 45 years of age,4  but it is also the fifth most frequent reason people seek out medical care in the United States.5

Lower back pain has several causes, and it can also affect different areas of your anatomy, ranging from the spine itself to the muscles surrounding the spine.

It can be left-sided or right-sided or affect the entire area. The amount and types of physical activity you engage in, as well as your general health and physicality, are all factors that can determine the likelihood of developing a lower back injury or lower back pain.

Lower back sprains (stretching or tearing of a ligament) and strains (injury to a muscle or tendon)6 can be caused by something as simple as shoveling snow, doing yard work, or starting a new exercise routine. Usually, it is a twisting motion, overuse, or improper lifting (forgetting to “lift with your knees” and not your back) that leads to a lower back sprain or strain.

Symptoms of sprains and strains can include back spasms, cramps, a decreased range of motion (inability or difficulty standing, walking, or bending normally), and pain that increases as you move. Often this resolves with a few days of self care.

Various forms of arthritis can result in lower back pain. Symptoms of spinal arthritis can vary, but often include stiffness, swelling, weakness, a feeling of the spinal joints “grinding” during movement, and a decreased range of motion. Osteoarthritis—the wear-and-tear type of arthritis common in knees and other major joints—can affect the back, too. According to Johns Hopkins Medicine, it’s usually caused by damage to the cartilage between the spinal facet joints, creating inflammation and pain.7

Problems with intervertebral discs (the spongy areas located between the vertebrae) are a more serious cause of lower back pain, and pain that’s chronic. As we age, the intervertebral discs may wear down and lose their ability to provide cushioning. Often a result of an injury or accident, the intervertebral discs can become compressed and then bulge outward, which is known as herniation or rupture.

Another degenerative disease that can affect the lower back is lumbar spinal stenosis. This occurs when there is narrowing of the spinal cord, which leads to compression of the nerves within the spine, explains the American Association of Neurological Surgeons.8

One symptom of stenosis can be sciatica, which is named after the sciatic nerve, the largest nerve in the body. Sciatica, a form of lumbar radiculopathy, occurs when the sciatic nerve becomes pinched, most often due to a bulging disc that presses on the sciatic nerve. This results in pain that radiates along the nerve, which extends from your lower back into your pelvic area and then down the back of the thigh and leg.9

(If you have lumbar spinal stenosis, check out the video demonstration of exercises that can help in this related article.)

Women may experience lower back pain secondary to pregnancy or endometriosis. Less commonly, back pain can be the result of a more serious condition such cancer, a spinal fracture, or viral or bacterial infection.10

The Details: But Wait, Lower Back Pain Gets More Complicated

Not only is chronic back pain hard to live with, it can also be difficult for practitioners to diagnose due to the overlap of symptoms with other conditions. Traditional diagnostic methods usually begin with a full physical exam and overview of your medical history.

From there, depending on the severity and duration of the pain, your doctor may request blood work to look for signs of inflammation or infection; imaging studies such as X-rays, CT scans, or MRIs to look for structural damage; or bone or DEXA scans to check for any bone disorders or bone infections; and electrodiagnostics to check nerve function with electromyography or nerve conduction studies.11,12

Your observations can provide some of the most important clues to help your doctor make the right diagnosis. Take notes about your condition and bring them with you to your appointment so that you can precisely describe the pain you’re experiencing.

Include details about the pain, such as whether it’s burning, stabbing or aching; the time of day when your pain is at its worst and what you’re doing at that time; and the exact location or locations of the pain within the lower back region.13

What Else to Expect When Living with Lower Back Pain

Lower back pain that is chronic can affect every aspect of your life—the ability to get restful sleep, prepare healthy food, think clearly, function at work, and keep a positive mood. Many people living with long-term back pain experience irritability, depression, and anxiety, says Robert N. Jamison, PhD, professor of anesthesiology and psychiatry at Brigham and Women’s Hospital, Harvard Medical School. You might be mourning the loss of the things you used to enjoy but can no longer do, whether it be fitness activities, socializing, or just getting in and out of the shower easily. If you were already physically isolating because of the pandemic, it’s just another layer of stress being heaped on as you try to cope with the mental anguish of physical pain, Jamison explains.

The uncertainty about what’s causing your lower back pain can make it harder to live with, and not having a quick resolution can make things even more stressful. But the process of getting the right diagnosis can take time because your doctor may need to look for other conditions, including types of arthritis that affect the whole body, and not only the lumbar spine.

For example, rheumatoid arthritis, an autoimmune disorder, attacks the synovium (or lining) of joints, including the spine. Spondyloarthritis, another inflammatory disease, can affect any joints that attach to tendons and ligaments. Here are the primary subtypes of spondyloarthritis to be aware of:

●    Psoriatic arthritis. Associated with psoriasis,the autoimmune disorder that most visibly affects the skin, psoriatic arthritis can develop within the joints of the spine.

●    Ankylosing spondylitis. This is aprogressive autoimmune disease in which the body attacks its own joints. When the spine is involved, you’re likely to experienceinflammation of the vertebrae at the base of the spine andhip joints.

●    Reactive arthritis. This form ofarthritis involves inflammation of the spine or joints inreaction to something occurring within a totally different area of the body (most often stemming from pain or disease in the bowels).

Spinal arthritis can sometimes develop in reaction to diseases such as Lyme, irritable bowel syndrome, gout, and diabetes.

Still, it is possible to live a full and active life despite chronic pain. Dan Reynolds, the Grammy Award-winning singer and frontman of the band, Imagine Dragons, has lived with ankylosing spondylitis since he was in high school. Undiagnosed until his early twenties, Reynolds has found effective maintenance treatments to control his inflammation and pain, by using a combination of medication, weight training, and hot yoga.  

You don’t need to be a celebrity to find ways to quell chronic pain. Beth Kernan, a mother of three from Atlanta, Georgia, is able to lead an active life with osteoarthritis. Kernan has found that getting lumbar cortisone injections and practicing slow-paced yin yoga help her successfully manage her chronic lower back pain.

How to Treat Lower Back Pain

Lower back pain may respond to many different modalities, but it often takes trial and error—and a lot of patience—to find what works for you.

The Tried-and-True
The first line of defense is often over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and/or acetaminophen. Applying topical cold compresses, such as an ice pack, is recommended immediately after first experiencing a lower back injury or onset of pain. Heat therapy, such a heating pad, hot water bottle, or even an Epsom salt bath, can also be used to relax and soothe the surrounding muscles by helping to increase blood flow to the lower back.15

When to Call Your Doctor or Specialist
If your pain is recent, or mild to moderate but over-the-counter pain relievers and topical compresses don’t provide relief, call your primary care doctor. He or she will be able to evaluate what is causing the pain and, if appropriate, prescribe a muscle relaxant. Historically, opioids were commonly prescribed to treat pain, but due to the increasing numbers of opioid-related overdoses and deaths, many practitioners no longer view them as the best strategy for non-cancer-related pain, Jamison explains. However, doctors now can implement opioid risk assessments and monitor urine samples in order to better prevent the risk of opioid abuse, Jamison says.

Depending on your diagnosis, your doctor may refer you to a specialist, such as an orthopedist, physical therapist, or psychotherapist, as needed.

Physical therapy (PT), A Non-Invasive Treatment Option
Physical therapists are specialists in movement and exercise and can assist with tailoring an exercise program to your individual needs, according to Julie Fritz, PhD, PT, distinguished professor of the Department of Physical Therapy and Athletic Training and Associate Dean for Research, College of Health at the University of Utah Health.

Another important component of PT is education. There’s a lot of misinformation about lower back pain and what is and isn’t helpful. Having a trustworthy source of information and advice can be crucial to your recovery, Fritz adds.

Other modalities that can help alleviate muscle tension, spasming, knots, and cramps include therapeutic massage, yoga, and tai chi.18 There is also the option of Traditional Chinese Medicine (TCM), which can treat lower back pain through acupuncture and Chinese herbs. Both work by promoting circulation to remove the stagnation of blood, as well as stagnation of Qi (the natural energy that flows through the body). While TCM may not be curative, depending on the type of lower back pain you have, it can be an effective maintenance treatment for chronic cases.17

If your pain is severe, long-lasting, and associated with symptoms such as numbness or tingling in the legs, you might want to start out by seeing a spine specialist (be sure to check your insurance to see if you need a referral to be seen by a specialist).

If your pain is the result of trauma or injury, such as a spinal fracture, you need to be seen by medical professionals as soon as possible, most likely at the nearest emergency department, for an evaluation and any necessary treatment.16

What People Are Trying
Recently, researchers discovered that naltrexone, a medication used to treat addiction, can successfully treat chronic pain when used in pill form and in small doses—about one-tenth the amount used for treating addiction. While not yet FDA-approved for treating pain, some physicians prescribe it off-label for this purpose.14

A newly available non-surgical and minimally invasive outpatient treatment called intraosseous basivertebral nerve ablation, also known as Intracept, uses radiofrequency energy (heat) to disable the nerve’s ability to transmit pain signals.18 According to clinical studies, this procedure has been found to alleviate back pain significantly within the first three months post-procedure and have a 50% reduction within two years post-procedure.19

If conservative and non-pharmacologic treatments do not provide pain relief, you may want to talk to a specialist about surgical options.20 Surgeries to treat chronic lower back pain include lumbar spinal fusion, which was more widely used in the past, and artificial disc replacement, a much newer technology, according to Todd H. Lanman, MD, assistant clinical professor, Division of Neurosurgery, David Geffen School of Medicine at UCLA, Clinical Chief of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles, and owner of Lanman Spinal Neurosurgery in Beverly Hills.

Dr. Lanman notes that lumbar spinal fusions are limited in their ability to restore spinal mobility because the technique of fusing two vertebrae together doesn’t allow for movement of the disc. Artificial disc replacement can restore normal spinal mobility and is his primary choice of treatment for people who would benefit from surgery.

Dr. Lanman, whose subspecialty is called motion preservation surgery, uses Restorative Motion Surgery, a successful off-label surgical method of artificial disc replacement. Dr. Lanman has found it beneficial for patients who have had multi-level fusions in their necks and some in their lower backs.

Why Your Mental Health Matters When Dealing with Lower Back Pain

The mind-body connection plays a huge role in chronic pain. Major depression can make a person three times more likely to develop chronic lower back pain.21 People who have a history of childhood trauma often develop chronic pain, Jamison explains. We can carry traumatic events, whether big or small, with us into adulthood.

They can manifest as feelings of powerlessness, and that could keep you from addressing a pain problem early on, before it has a chance to progress into a chronic situation.22 While some people may just want to focus on the “now” and treat the pain as quickly as possible, it can be helpful to use psychotherapy to address past issues that may be contributing to the physical pain, Jamison says.

It’s important to take care of your mental health when living with chronic pain, but some people resist getting help because of what’s called provider fatigue. As Jamison explains it, you might have little or no interest or motivation to see a psychologist because you’ve already seen a host of other providers. And if you’ve tried numerous treatments and medications, all to no avail, making the effort to locate a mental health provider may feel overwhelming.

We get it. But we also can’t underscore enough how critical it is to get a referral to a mental health provider from your doctor, someone who will acknowledge your pain and help you recognize that, yes, the pain is real and valid. When you’re living with chronic pain, you need to feel empowered and know that you can take an active part in your own treatment by breaking the cycle of depression. A mental health therapist can help you recognize that you are your own best advocate when it comes to treating body and mind, Jamison explains.

Self Care

Taking time for self-care can be a huge asset when dealing with chronic lower back pain. Here are strategies that can help both physically and emotionally:

  • Practice meditation and/or mindfulness. Try using a self-guided meditation app such as Calm, Headspace, orThe Mindfulness App.
  • Make time to nurture your body, whether by taking a hot bath, practicing yoga, or gentle stretching.
  • When you’re able to do them—and here’s where a physical therapist can be invaluable—do exercises that develop core muscles, which can help to reduce lower back pain, Lanman explains.
  • Eat nutritious, well-rounded meals that fuelyour body and make you feel good. Limit your intake of processed meats, sugary items,alcohol, andotherfoods and beverages known tocause inflammation within your body.
  • Put together an arsenal of feel-good devices such as heating pads, water bottles, foam rollers, at-home portable back massagers, massage guns, and acupressure mats and use them as needed. (You can find multiple options on Amazon or aks your doctor or physical therapist for receommendations.)

What Can I Do Right Now?

1.  Tame a Lower Back Flare: Use cold compressesor ice wrapped in a towel for the first 48 hours, usually 20 minutes on, 20 minutes off. After two days,switchto heat. To prevent stiffness, limit bed rest when not sleeping to only a few hours for two to three days maximum, and consult with your physician or therapist to help determine what physical exercises and movements will be best in aiding your recovery.23  Ask about using over-the-counter NSAIDs, acetaminophen, or other medications designed totreat acute pain.

2.  Check in on Your Mental Health: Practice meditation and deepbreathing techniques to help promote calmness and relaxation. Talk to family and friends, or reach out to your physician, a therapist, or psychiatrist for help with coping with chronic pain. Join an in-person or an online support group. Check out these mental health resources for additional info and support:

3.  Find a Clinician: Using websites such as HealthGrades.com, RateMDs.com, and Vitals.com can be helpful whensearching for a specialist or primary care physician in your area. If you already have a primary care physician, ask him or herfor trusted recommendations and any neededreferral paperwork.

More and morephysicians are nowoffering telemedicine visits. While a physical exam is still needed to establish a relationship with a new clinician, going forward, you mighthave the option to usevirtual visits to monitor yourprogress. Thesecan savetime andmoney, and spare you the discomfort of traveling to and from the doctor’s office.

4.  Prep for Your Doctor Visits: Take notes ahead of your appointment—keep a pain diary that details when your pain started, how it feels, when it’s at its worst, where the pain is focused, what you have been doing to treat your pain at home, what helps, and what doesn’t help. Write down all the medications you’re taking—even over-the-counter ones—as well as any medication allergies.

5.  Get Your Questions Answered: It’s easy to forgetall thequestions you want to ask in the midst of an appointment, so write them down in advance, either in your journal or on your smartphone. They might include:

  • What do you think is the cause of my pain?
  • How is this pain going to affect my quality of life and mobility?
  • What can I do to help alleviate my back pain?
  • What are the possible side effects of medications and other treatments you’re thinking of prescribing?

Dr. Lanman says that knowledge is power, and once you understand the type of treatment you need to relieve pain, you’ll be in a better position to make the best decisions about your care. If possible, bring your spouse, a family member, or friend with you to the appointment to help you keep track of your physician’s findings and recommendations (it’seasy to quickly become overwhelmed and lose track of important information during an exam or consultation). 

Having Those Hard Conversations

When low back pain affects your work life, home life, and then some, it’s not usually possible to keep your pain to yourself. Sitting down with those close to you and having a frank conversation will let them know what you’re going through and why you may not be able to participate in everything that’s expected of you. Not having to hide your condition can mean one less thing to stress over.

These hard conversations can benefit you in another way. Compassion and validation from loved ones, friends, and coworkers can help you feel better when you’re living with chronic lower back pain. But it needs to be the right kind of help. Studies show that being around people who encourage catastrophizing or rumination can worsen any feelings of helplessness or depression you may have because of your pain.24,25

On the other hand, if you have positive social support from friends and family, you’re likely to experience less anxiety and depression. Problem is, many people living with pain feel that their loved ones don’t grasp the extent of their pain or aren’t there for them. (Lower back pain is not as easy to see as a broken arm, for instance.) Even though it might seem like another hurdle for you, try taking the time to educate those closest to you about your condition.

Let them ask questions—this will help them understand and empathize—and then let them know how they can help you.26  Be specific about the types of support you need, whether it’s simply an acknowledgement from them that they recognize you’re in pain or concrete action like working with you on mastering relaxation techniques.25,27  Because distraction is a helpful tool, you might suggest activities you can do together, like going for a walk, watching a movie, doing an at-home art project or puzzle, or making a healthy lunch.28

FAQs

How can I try to relieve lower back pain?

Start with over-the-counter NSAIDs or acetaminophen. Avoid too much bed rest—staying active is more helpful. Apply ice, then switch to heat on day three. For mild cases, try physical therapy, massage, or yoga. Contact your doctor if the pain is from a serious injury or you don’t feel better in a few days.

What can cause lower back pain?

An injury, prolonged or improperly performed physical activity (such as lifting the wrong way or muscle overuse from excessive bending), having weak core muscles, being overweight, and age can all contribute to the development of lower back pain. A more serious cause is a degenerative disease that needs specific treatment.

How can I get to sleep with lower back pain?

To ease spinal pressure, place a pillow between your knees if you’re a side sleeper or under your knees if you’re a back sleeper.29 Check your sleeping “posture”: Adjust the angle of your pillows or the positioning of your body to maintain the natural curve of your spine. Ask your doctor or PT for more specific recommendations.28

Why is my lower back pain worse in the morning?

Reasons include being immobile inbed overnight, bad sleeping posture, or sleeping on too soft a mattress. Do some gentle stretching in bed before getting up, use slow and intentional movements as you rise, and take a warm/hot shower after waking to soothe tight muscles.28

Updated on: 01/28/21
Continue Reading:
Exams and Tests to Diagnose Low Back Pain
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