Also, for some people the goal is to use nonsurgical therapies to manage the pain and avoid major surgery, while for others surgery may represent the quickest path to pain relief.Not all treatments work for all conditions or for all individuals with the same condition, and many must try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of people with back pain (most estimates are 1–10%) require surgery. Nonmedical
Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended. Heat therapy is useful for back spasms or other conditions. A review concluded that heat therapy can reduce symptoms of acute and subacute low-back pain. Regular activity and gentle stretching exercises is encouraged in uncomplicated back pain and is associated with better long-term outcomes. Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended. These exercises are associated with better patient satisfaction, although they have not been shown to provide functional improvement. However, one review found that exercise is effective for chronic back pain but not for acute pain. Exercise should be performed under the supervision of a healthcare professional. Massage therapy may provide short-term pain relief, but not functional improvement, for those with acute lower back pain.
Most people with back pain do not experience chronic severe pain but rather persistent or intermittent pain that is mild or moderate. In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain-resolution outcomes on average after one year. In the United States, acute low back pain is the fifth most common reason for physician visits and causes 40% of missed work days. It is the single leading cause of disability worldwide. Classification
Back pain is classified in terms of duration of symptoms. Acute back pain lasts <6 weeks
Subacute back pain lasts between 6 and 12 weeks. Chronic back pain lasts for greater than 12 weeks. Causes
There are many causes of back pain, including blood vessels, internal organs, infections, mechanical and autoimmune causes. Approximately 90 percent of people with back pain are diagnosed with nonspecific, idiopathic acute pain with no identifiable underlying pathology. In approximately 10 percent of people, a cause can be identified through diagnostic imaging. Fewer than two percent of cases are attributed to secondary factors, with metastatic cancers and serious infections, such as spinal osteomyelitis and epidural abscesses, accounting for approximately one percent. Nonspecific
In as many as 90 percent of cases, no physiological causes or abnormalities on diagnostic tests can be found. Nonspecific back pain can result from back strain or sprains, which can cause peripheral injury to muscle or ligaments. Many patients cannot identify the events or activities that may have caused the strain.