When to See a Doctor for Back Pain
Back pain is an extremely common condition, with 70-85% of adults experiencing low back pain at some point in their life. There are a variety of etiologies which can lead to back pain. Depending on the cause, patients may experience a wide spectrum of symptoms and levels of discomfort.
What Causes Low Back Pain?
The most common cause of low back pain is muscle strain. The muscles which support your spine are extremely large and powerful. When an injury occurs to these muscles, this can lead to a significant amount of pain. Other causes of low back pain include degeneration of the intervertebral discs, disc herniations, or facet joint arthritis (affecting the small joints between the bones of the spine), as well as non-spinal causes (like conditions in the abdomen).
What Symptoms Associated with Back Pain Should Prompt You to See a Doctor?
Patients who experience back pain should consult a physician if their pain persists for 1-2 weeks. Patients should seek immediate medical attention if they experience one or more of the following “red flag” symptoms associated with their back pain:
- Unexpected weight loss
- Night pain
- Night sweats
- Fevers
- Loss of bowel or bladder control
- Weakness in the arms or legs
- Severe, unrelenting pain
How do You Know if Back Pain is Muscular or Nerve Pain?
The cause of back pain drives the symptoms that patients experience. Your physician will determine a key factor during diagnosis: Is the pain isolated, axial back pain, or is there a nerve component? Patients with true axial low back pain will present with focal pain that may radiate across the back. If there is compression of the nerves, patients will more commonly have pain which radiates down their legs or have discomfort in their legs, particularly when exerting themselves.
What Can You Expect When Seeing a Physician for Back Pain? What Kind of Examinations are Used for Back Pain?
- Evaluation of low back pain will begin with a detailed history of the pain. Important points are the pain character (sharp or dull), locations (is it in one spot or does it move?), onset, intensity, how long it lasts, what makes it better, and what makes it worse.
- All patients should have an X-ray of the affected area. More advanced imaging (CT scans or MRIs) may be ordered at the discretion of your physician.
- The physical exam is another key component. Your arm and leg strength and sensation will be tested, along with your reflexes. Additionally, a number of special tests may be performed.
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What are the Treatment Options for Low Back Pain?
The treatment of low back is driven by the cause of a patient’s symptoms. Fortunately, roughly 90% of patients with low back pain will have resolution of their symptoms in 3 months, with or without treatment. Most commonly, there will be relief of discomfort within 6 weeks. The focus of conservative management for low back pain is symptom management. Conservative treatments may include:
- Physical therapy (PT) for 6 weeks in order to strengthen the lower back muscles and core muscle groups
- Weight reduction
- Muscle relaxants
- Medrol (steroid) dose packs
- NSAIDs (Ibuprofen/Advil or Motrin, naproxen/Aleve, etc.)
- Heat and cold therapy
- Acupuncture
- Activity modification
- Smoking cessation
If your back pain persists after 6 weeks of conservative management, your physician may refer you to a pain management specialist for evaluation for injections.
While there are potential surgical options for low back pain, these are only done for specific reasons and need to be discussed on a case-by-case basis.