Most are acute attacks
If you are having back pain, you are certainly not alone. Statistics show that in our lifetimes, about 85-90% of us will at some point have back pain severe enough to impair our activities. Fortunately, the great majority of people with back pain have acute attacks that will resolve and never come back. Unfortunately, some people are plagued by pain that persists for months or years, or pain that keeps coming back over and over. We can divide back pain into two basic categories; acute and chronic.
Acute low back pain
Acute in medicine simply means that it has occurred recently. Attacks of acute back pain can occur as a result of trauma such as a car accident, sports or work injury. They can also appear after an action as minimal as reaching for a potato chip on the couch. The pain can range from annoying to excruciating. We often call these attacks “sprains” or “strains”, thinking that probably there is an injury to muscles or ligaments. However, here is a secret that most health care providers won’t tell you: most of the time, we don’t really know what causes acute back pain. Obviously, you can sprain a muscle during an accident. But what about the potato chip scenario? Patients don’t really like when their doctor tells them that he or she doesn’t really know exactly why there is pain, so we have to tell them something, but the severe pain you can get with minimal trauma is not really well understood. Fortunately, the great majority of these types of attacks will resolve by themselves within 1-12 weeks, and we don’t really need to perform a bunch of tests right away.
What to expect with acute low back pain
If you have an attack of acute back pain, you probably won’t need the services of an Orthopaedic surgeon such as myself. Treatment for these attacks is usually performed by a patient’s family doctor.
There are a few symptoms that can be “red flags” when you have back pain – they could indicate a problem that requires urgent medical attention. These include:
- Fever, chills, sweats, or other signs of a possible infection
- Weakness in a limb
- Severe constant leg numbness
- Loss of bowel or bladder control
- Inability to stand or walk
In these cases, you may need to see a spinal surgeon earlier than would normally be necessary. You will need a test such as an MRI to see what is wrong, and possibly early surgery to correct the problem.
NO RED FLAGS
The basic principle to remember when you have acute back pain comes from the great Bobby McFerrin:
Although it can feel like the end of the world, there is an excellent chance that this pain is going to go away by itself. So, treatment is aimed toward helping you feel better while your body naturally heals this problem. Those treatments can include:
It’s not rocket science. If it hurts, don’t do it. We’re not talking strict bedrest – that has been shown in studies to be the worst thing you can do. Rest means avoiding the activities that make it worse. Take it easy and allow the inflamed part of the back to heal.
Sometimes back pain can get really bad and you may need some medication to control it. The grand majority of people can get by with over the counter medicine such as Tylenol, aspirin, ibuprofen or Aleve. Sometimes you may need stronger prescription strength versions. If the pain is really bad, then occasionally you could need either muscle relaxers or even narcotics. However, I try to avoid these addictive medications as much as possible.
Physical Therapy or Chiropractor
This will often be prescribed, although there really isn’t a whole lot of evidence that it will relieve acute attacks of back pain any faster than just waiting it out.
If acute pain is particularly bad, especially if it goes into one or both legs, sometimes injections of steroid into the spinal canal can provide some temporary relief. The steroid may wear off over time, but our hope is that the problem causing the pain will also be healing over time as well. So, after one or several injections, sometimes the pain won’t return. Sometimes it will, but at a more tolerable level.
And, the most important treatment …
It’s important to be patient. Although the above treatments can help keep you comfortable while you body is healing, there is nothing you can really do to speed things up. Attacks of back pain will heal at their own pace, and that pace varies a lot from patient to patient. Remember the Bobby McFerrin principle!
What if I’m still hurting?
If the pain persists despite a good attempt at conservative management, then it’s probably time to get more aggressive in terms of diagnosis and treatment: chronic back pain