If you've ever groaned, "Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain can range from a dull, constant ache to a sudden, sharp pain. Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Back pain is called chronic if it lasts for more than three months.

Most back pain goes away on its own, though it may take awhile. Taking over-the-counter pain relievers and resting can help. However, staying in bed for more than 1 or 2 days can make it worse.

If your back pain is severe or doesn't improve after three days, you should call your health care provider. You should also get medical attention if you have back pain following an injury.

Treatment for back pain depends on what kind of pain you have, and what is causing it. It may include hot or cold packs, exercise, medicines, injections, complementary treatments, and sometimes surgery.

Back pain is one of the most common medical problems in the United States. It can range from a dull, constant ache to a sudden, sharp pain. Sometimes it can come on suddenly – from an accident, a fall, or lifting something heavy, or it can develop slowly because of age-related degenerative changes to the spine. In some cases, inflammatory disorders or other medical conditions cause back pain.

Treatment varies depending on the cause and symptoms; however, there are steps you can take to improve your health and lower your chance of developing chronic or long-lasting back pain.

Understanding the Anatomy of the Back

There are many different structures in the anatomy of the back that work together to support your body. Problems with any one of these structures can cause back pain.

• There are four regions of the spine:
  • Cervical spine.
  • Thoracic spine.
  • Lumbar spine.
  • Sacrum and coccyx.

• Parts of the spine and back include:
  • Vertebrae – small bones stacked on top of one another, which protect the spinal cord.
  • Spinal cord – long bundle of nerves that run down the back through a canal in the vertebrae.
  • Intervertebral discs – cushion-like pads between the vertebrae that act like shock absorbers and spacers for the spine.
  • Ligaments – short bands of tough, flexible tissue that hold the vertebrae in place.
  • Tendons – cord of tissue that connects muscle to bone.
  • Muscles – a bundle of dynamic fibers that support your spine and upper body and help you move.

Back pain is one of most common reasons people see a doctor or miss days at work. Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. There are two types of back pain:

• Acute (short-term) back pain lasts a few days to a few weeks. It usually resolves on its own within a few days with self-care and there is no long-term loss of function.
• Chronic back pain is pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of back pain has been treated.

Risk factors for low back pain

• Age: The first attack of low back pain typically occurs between the ages of 30 and 50 and may become more common as you age.
• Fitness level: Back pain is more common among people who are not physically fit, as their muscles may not properly support the spine.
• Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on your back and cause pain.
• Genetics: Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that affects the spine), have a genetic component.
• Job-related factors: Job that requires heavy lifting, pushing or pulling, or twisting or vibrating the spine can injure your back, as can sitting at a desk all day, especially if you have poor posture or sit in a chair with not enough back support.
• Mental health: Anxiety, mood, and depression can influence how you perceive your back pain and stress can cause muscle tension.
• Smoking: This can restrict blood flow and oxygen to your discs, causing them to degenerate faster.
• Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.

Recommendations for keeping your back healthy

• Avoid movements that jolt or strain your back.
• Exercise regularly to keep your muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
• Maintain a healthy weight and eat a nutritious diet that promotes new bone growth.
• Use ergonomically designed furniture and equipment at home and at work.
• Switch sitting positions often and periodically walk around the office or gently stretch your muscles to relieve tension. Put your feet on a low stool or a stack of books when sitting for a long time.
• Wear comfortable, low-heeled shoes.
• Sleeping on your side with your knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.    
• Don't try to lift objects that are too heavy. Lift from the knees, keep a straight back, and objects close to the body.    
• Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

Doctors and researchers describe the types of back pain in the following ways:

• Acute back pain happens suddenly and usually lasts a few days to a few weeks.
• Subacute back pain can come on suddenly or over time and lasts 4 to 12 weeks.
• Chronic back pain may come on quickly or slowly and lasts longer than 12 weeks.

Anyone can have back pain; however, several factors increase your risk. Risk factors increase your chance of developing back pain and can include:

• Fitness level: Back pain is more common among people who are not physically fit. For example, weak back and stomach muscles may not properly support the spine. Back pain is also more likely if you exercise too strenuously after being inactive for a while.
• Weight gain: A diet high in calories and fat, combined with an inactive lifestyle, can lead to obesity. This can put stress on the back.
• Job-related risk factors: Jobs that require heavy lifting, pushing, pulling, or twisting can injure the back. A desk job may also play a role, especially if you have poor posture or sit all day in an uncomfortable chair.
• Age: Back pain becomes more common with age, particularly after the age of 45.
• Heredity: Genetics play a role in some disorders that cause back pain.

Back pain can be caused by many different things, including mechanical or structural problems with the spine, inflammatory conditions, and other medical conditions.

Mechanical/Structural Problems

Back pain can happen when mechanical or structural problems develop in the spine, discs, muscles, ligaments, or tendons in the back.

• Sprain: an injury to the ligaments that support the spine, often occurring from twisting or lifting improperly.
• Strain: an injury to a muscle or tendon.
• Degenerative disc disease: aging causes the discs between the vertebrae of the spine to break down.
• Herniated or ruptured discs: the discs compress and irritate nearby nerves. This often occurs at the lumbar level.
• Spondylolisthesis: a vertebra in the spine slips out of place.
• Spinal stenosis: a narrowing of the spinal column that puts pressure on the spinal cord and nerves.
• Fractured vertebrae.
• Scoliosis or other congenital changes to the spine.

Inflammatory Conditions

• Ankylosing spondylitis, a specific type of arthritis of the spine.
• Other types of inflammatory arthritis of the spine.

Other Medical Conditions

• Osteoporosis, which can lead to painful fractures of the vertebrae.
• Fibromyalgia, a condition of widespread muscle pain and fatigue.
• Kidney stones or infections.
• Endometriosis, which is the buildup of uterine tissue in places outside the uterus.
• Infections that involve the bones of the spine or the discs between these bones, which can cause pain.
• Tumors, in rare cases, that develop on the spine or other areas of the back.
• Pregnancy.

Back pain can range from local pain in a specific spot to generalized pain spreading all over the back. Sometimes the pain radiates away from the back to other areas of your body, such as the buttocks, legs, or abdomen. The intensity of back pain varies for each person. Depending on the type, cause, and location of your back pain, you may experience:

• Increasing pain with lifting and bending.
• Worsening pain when resting, sitting, or standing.
• Back pain that comes and goes.
• Stiffness in the morning when awakening and lessened back pain with activity.
• Pain that radiates away from the back into the buttocks, leg, or hip.

You should see a doctor if your pain does not improve after a few weeks or if any of the following symptoms happen with your back pain:

• Numbness and tingling.
• Severe back pain that does not improve with medication (see Treatment section).
• Back pain after a fall or injury.
• Back pain along with:
  • Trouble urinating.
  • Weakness, pain, or numbness in your legs.
  • Fever.
  • Weight loss that you did not intend.

Doctors use various tools to help diagnose the possible cause for your back pain, which helps determine the best treatment plan.

Medical and Family History

Your doctor will ask questions about your medical and family history to help determine if an injury or underlying medical condition is the source for the back pain. Some questions your doctor may ask:

• Can you describe your pain? (e.g. sharp, aching, burning)
• Where is the exact location of your back pain?
• When did the pain start and how long have you had the pain?
• What were you doing when you first noticed the pain?
• How severe or bad is the pain?
• What makes the pain worse or better?

Your doctor may ask you to rate your pain on a scale from 1 to 10 to gauge the severity of the pain and talk to you about your ability to perform activities of daily living.

Physical Exam

Your doctor will likely perform a physical exam, which may include:

• Examining your spine and posture to look for changes in the bony structure.
• Asking you to bend or lift your legs to determine how movement affects your pain.
• Testing your reflexes, muscle strength, and sensation.

Imaging and Blood Tests

Most people do not need additional testing; however, sometimes doctors order tests to rule out a specific cause for your pain or to confirm a cause for your back pain. Your doctor may order the following.

• X-rays only show bones and can help diagnose:
  • Broken bones or fractures.
  • Changes due to aging.
  • Changes in the alignment of the spine.
• MRI (magnetic resonance imaging) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or “slices” are analyzed by a computer to produce an image of the back. MRI can help diagnose damage or disease of the soft tissues, such as the discs, ligaments, and nerve roots in and around the spine.
• Computerized axial tomography (CAT) uses a scanner to take images of the back at different angles. The images are analyzed by a computer to create three-dimensional views of the back. As with MRI, CAT scans help diagnose problems with the spinal canal and the surrounding tissues.
• Electrophysiological tests, such as an electromyography or EMG, which helps measure the electrical activity in muscle. This test helps doctors check for problems with the muscles and nerves.
• Bone scans use small amounts of radioactive materials to help doctors see more details in the spine, such as fractures and infections.
• Blood tests help identify a possible cause for the back pain, such as inflammatory or medical disorders.

Doctors treat back pain with various options, including medications, nonsurgical treatments, and surgical treatments.

Medications

• Over-the-counter pain relievers taken by mouth or applied to the skin.
• Anti-inflammatory drugs taken by mouth to relieve pain and inflammation.
• Muscle relaxants for some types of chronic back pain from muscle tension.
• Anti-inflammatory or numbing injections for certain types of back pain that radiates or travels due to nerve compression or irritation.
• Prescription pain relievers for severe acute back pain.

Other Treatments

• Use cold packs to help relieve some back pain and hot packs to increase blood flow and promote healing in the muscles and tissues of the back.
• Avoid bedrest; instead, limit activities or exercise that cause pain. Gradually increase physical activity as tolerated.
• Get physical therapy to help strengthen the muscles that support the back, which can improve mobility, posture, and positioning. Strengthening exercises can also help decrease pain. Check with your doctor or physical therapist before starting any exercise routine.
• Lifestyle changes teach you to:
  • Move your body properly when performing daily activities, especially those involving heavy lifting, pushing, or pulling. Avoid any activities that cause or increase pain.
  • Practice healthy habits such as exercise, relaxation, regular sleep, healthy diet, and quitting smoking.
• Complementary and alternative treatments may help relieve pain. Some examples include:
  • Manipulation of the spine and nearby tissues. Professionals use their hands to adjust and massage the spine and muscles.
  • Transcutaneous electrical nerve stimulation (TENS) sends mild electrical pulses to the nerves through a device and electrodes or pads that are placed on the skin. TENS treatments are not always effective for reducing pain.
  • Acupuncture is a Chinese practice that uses thin needles that may relieve pain in some patients.

Surgical Treatments

Surgery for back pain may be suggested if all other treatments tried have not relieved your pain. However, not everyone is a candidate for surgery, even if the pain persists. The type of surgery your doctor recommends depends on the cause of your pain and your medical history. In addition, your surgeon will review the risks and possible benefits of the surgery or procedure.

• Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal column and remove the pressure on the nerves.
• Discectomy and microdiscectomy are surgeries that remove part of a herniated disc to relieve pressure on a nerve root or the spinal canal. The only difference between the procedures is a microdiscectomy uses a smaller incision than the discectomy. Doctors may also include a laminectomy.
• Spinal fusion is a surgery that helps treat degenerative disc disease and spondylolisthesis by joining two or more vertebrae in the spine that have slipped from their normal position. During this procedure, the surgeon removes the disc between the vertebrae and uses bone grafts or metal devices to secure bones together.
• Foraminotomy is a surgery that cleans out and widens the area where the nerve roots leave the spinal canal. By opening up this area, the pressure on the nerves from spinal stenosis can be relieved.
• Disc replacement surgery replaces a damaged disc with a synthetic one. This procedure is limited to patients who do not have complicating factors.
• Laser surgery uses a needle that produces bursts of laser energy to reduce the size of a damaged disc. This relieves pressure on the nerves.
• Radiofrequency lesioning of the affected nerves blocks inputs of the pain signals from entering the spinal cord.

The recovery time from surgery depends on the type of procedure and your overall health. Research shows that surgery can be helpful for people with herniated discs, spinal stenosis, and spondylolisthesis.

Different types of health care providers treat back pain, depending on the cause:

• Pain specialists, who are physicians including anesthesiologists with specialized training in evaluation, diagnosis, and treatment of all different types of pain.
• Family or primary care doctors.
• Orthopaedists, who treat and perform surgery for bone and joint diseases.
• Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
• Neurosurgeons, who perform surgery for disorders and diseases of spine, brain, and nerves.
• Rheumatologists, who specialize in treating musculoskeletal diseases and autoimmune disorders.
• Physical therapists, who specialize in movement and strengthening muscles.

More than 25 million people in the U.S. live with chronic pain. This is pain that lasts for more than three months. The most common type of chronic pain is chronic back pain.

Often, no physical cause for this pain can be found. In these cases, it may stem from brain changes that persist after an injury healed. These brain changes provide a warning for you to restrict your movement and let the body recover. But in some cases, they can cause the pain to persist long after the damage has healed.

Researchers have developed a treatment called pain reprocessing therapy (PRT) to help the brain “unlearn” this kind of pain. PRT teaches people to perceive pain signals sent to the brain as less threatening.

A research team performed the first clinical test of PRT. Participants had mild to moderate chronic back pain for which no physical cause could be found. The volunteers received one of three treatments: four weeks of intensive PRT, a harmless injection into the back, or continued standard care.

After four weeks, 66% of people who received PRT reported being pain-free or nearly pain-free. Less than 25% of people who received injections and 10% of those receiving usual care reported similar improvements. Brain scans showed that people who recieved PRT had less pain-associated brain activity.

“This isn’t suggesting that your pain is not real or that it’s ‘all in your head,’” says Dr. Tor Wager of Dartmouth College, who co-led the study. “What it means is that if the causes are in the brain, the solutions may be there, too.”

You may be able to prevent back pain from overuse or improper body mechanics. The following recommendations can help you have a healthy back and lifestyle:

• Perform regular exercise that keeps your back muscles strong. Exercises that increase balance and strength can decrease your risk of falling and injuring your back or breaking bones. Exercises such as tai chi and yoga – or any weight-bearing exercise that challenges your balance – are good ones to try. Remember to warm up before exercise or other physical activities.
• Eat a healthy diet that includes enough calcium and vitamin D, nutrients that keep your spine strong.
• Maintain a healthy weight. Being overweight can put unnecessary and injury-causing stress and strain on your back.
• Practice good posture and avoid slouching. Try to remember to support your back when sitting or standing.
• Avoid lifting heavy items whenever possible. If you do lift a heavy item, use your leg and abdominal muscles instead of your back.

Living with back pain can be challenging; however, most people find relief within 6 weeks. Remember to follow the recommendations of your health care providers. The following may make it easier for you to manage your pain and recover:

• Add exercises gradually and talk to your doctor about the types of exercises that are best for you. There may be certain activities or exercises you should avoid.
• When sitting for a prolonged period; get up, move around, and switch positions frequently.
• Wear comfortable shoes with a low heel.
• When driving long distances, try adding some support behind your back, and stop frequently to stand up and walk around.
• Sleep on your side, and place a small pillow between your knees. If you tend to sleep on your back, place a pillow under your knees. If possible, try to avoid sleeping on your stomach.
• Limit the amount you carry. Instead of carrying more items at once, make a few extra trips to avoid carrying too much weight.

Is your back hurting? You’re in good company. In any 3-month period, about 1 in 4 adults in the U.S. has at least one day of back pain, mostly in the lower back.

The back is a complicated structure. Its center is the spine, which is made up of 33 bones called vertebrae, stacked in a column. The nerves of the spinal cord run in a tunnel through the middle of those bones. Spongy discs between the vertebrae act as cushions. Ligaments and tendons hold everything together.

A lot of things can go wrong with your back. A strained muscle or a problem with a disc or a bone can cause pain. Back pain might also arise from a fracture or tumor. Much of the time, though, it’s impossible to tell what’s making your back hurt.

“We rarely find out exactly what it is,” says Dr. Gunnar Andersson, an orthopedic surgeon at Rush University Medical Center in Chicago. “As long as it stays as back pain, we are typically not that concerned.”

Your back naturally changes as you get older. Discs degenerate and arthritis may develop in the small joints of the back. Those changes may show up on an MRI or other types of imaging scans. But such changes to the back are also seen in a lot of people who don’t have back pain. So it’s hard to know if the changes are actually what’s causing the pain.

People with obesity are more likely to have low back pain, as are people who smoke. Back pain is also more common in people who don’t exercise much, or in people who are mostly inactive but have occasional bursts of exercise.

The good news is most back pain goes away by itself. For a new pain in the back, Andersson says he usually advises taking over-the-counter medications for the pain and staying away from activity that is hard on the back—lifting, carrying, bending, and twisting. “Then, wait for the problem to disappear, which it will in the great majority of people over a few weeks,” he says.

But for some people, the pain continues. If your back hurts most of the time for more than 3 months, you have chronic back pain.

What doctors do about chronic pain depends on the source of the pain. Some chronic back pain requires prolonged medical attention. If the pain comes from a fracture or tumor, those problems can be treated. Surgery can help if the pain is caused by a ruptured (herniated) disc or certain other conditions like spinal stenosis (narrowing of the spinal column, which can put pressure on the nerves) or degenerative spondylolisthesis (when one vertebra slips over another). But surgery isn’t the right choice for everyone.

There are many treatment options for back pain, so be sure to talk to your health care provider about which approach is right for you. For most people, even chronic pain eventually clears up without surgery. The most important thing, Andersson says, is not to let the pain take over. Research has shown that patients who stay active are better off. Just be sure to avoid activities that might strain the back. “It’s important not to succumb to the pain and become afraid of moving,” Andersson says. "It doesn’t seem to make much difference what you do, as long as you stay active.”

For a Healthier Back

• Stay active and maintain a healthy weight.
• Stretch before exercise or other strenuous physical activity.
• Don’t slouch when standing or sitting.
• Make sure your work surface is at a comfortable height for you.
• Wear comfortable, low-heeled shoes.
• If you must lift something heavy, don’t bend over the item; instead, keep your back straight, bend at the knees, and lift by putting the stress on your legs and hips.
• Talk with a health care provider to make sure you’re getting enough calcium and vitamin D.
• Don’t smoke.

Many people experience low-back pain over their lifetime. For those who don’t recover quickly, the discomfort can become chronic, lasting for months or even years.

NIH-funded researchers have been looking for new ways to treat long-lasting low-back pain. A new study shows that yoga may help relieve moderate to severe low-back pain. The research team recruited 320 people with chronic low-back pain from diverse backgrounds and underserved communities. More than half of the study’s participants were non-Hispanic black and earned less than $30,000 per year.

The participants were randomly assigned to three groups. The first group took 12 weekly yoga classes designed for people with low-back pain. The second group had 15 physical therapy sessions over 12 weeks. These included exercises to strengthen back and core muscles. The third group received a self-help book and newsletters to learn how to deal with back pain.

The results suggested that a structured yoga class may be an option for treating chronic low-back pain. All three groups reported improvement in physical function and pain reduction. However, people in the yoga and physical therapy treatment groups were more likely than those in the education-only group to stop taking pain relievers after a year.

“Chronic low-back pain disproportionately impacts those who are economically disadvantaged,” says research team leader Dr. Robert Saper of the Boston University School of Medicine and Boston Medical Center. “Therefore, we feel that it was important to test whether the yoga would be received well by an underserved population as well as being effective.”

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.

The NIHHEAL (Helping to End Addiction Long-term) Initiative, launched in April 2018, is a trans-NIH effort (which NINDS co-leads) that aims to prevent opioid addiction and provide more non-drug treatment options for chronic pain. Back pain is one of the most common pain conditions worldwide and is a major contributor to the prescribing and use of opioids in America. The treatment of low back pain is a specific area of focus of the Initiative. The Back Pain Consortium established through HEAL will conduct studies to better understand the mechanisms of common pain conditions such as chronic low back pain, develop improved diagnostic and treatment tools, and identify, prioritize, and test therapies that reduce the need for opioid use for millions of Americans. For more about the HEAL Initiative, see https://www.nih.gov/heal-initiative.

NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in the structure and function of certain brain regions. Other research seeks to determine the role of brain circuits important for emotional and motivational learning, and memory in this transition, in order to identify new preventive interventions. Furthermore, several studies are being conducted to identify and characterize bidirectional neural circuits that communicate between the spinal cord to brain, which are aimed at discovering and validating new interventional targets for low back pain.

Different studies are looking at the response to placebos in individuals with acute and chronic back pain. For example, one study is designed to examine brain properties for placebo response and critically assess the neurobiology of placebo pain relief for individuals with chronic pain. Another study is assessing ibuprofen plus acetaminophen compared to ibuprofen plus placebo in treating acute low back pain.

In addition to NINDS, other NIH Institutes— including the National Institute on Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Drug Abuse, and the National Center on Complementary and Integrative Health—fund research on low back pain. More information on NIH efforts on back pain research and on other disorders can be found using NIH RePORTER (http://projectreporter.nih.gov), a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and patents citing support from these projects.