Back Pain

About 80 percent of Americans experience pain in their lower back at some point in their lives, according to the National Institutes of Health (NIH). Most back pain is acute, which means it lasts a few days to a few weeks. But about 20 percent of people affected by acute low back pain develop chronic low back pain, meaning their pain lasts 12 weeks or longer.

By working with a pain management specialist, you can find approaches that relieve your chronic back pain and restore your quality of life.

What causes back pain?

Back pain can be triggered by an accident, heavy lifting, other strenuous activity, age-related changes to the spine, or certain medical conditions. These are some of the more common sources of back pain:

• Sprains and strains. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendons or muscles.
• Intervertebral disk degeneration. The normal process of aging causes the usually rubbery disks to lose their cushioning ability.
• Herniated or ruptured disks. Intervertebral disks become compressed. Herniation is when this compression causes the disks to bulge outward.
• Radiculopathy, including sciatica. A spinal nerve route is compressed, inflamed, or injured. Pressure on the nerve root results in pain, numbness, or a tingling sensation that radiates to other areas of the body that are served by that nerve.
• Spondylosis. Normal wear and tear in the joints, disks, and bones causes general degeneration of the spine.
• Spondylolisthesis. A vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
• Spinal stenosis. Narrowing of the spinal column puts pressure on the spinal cord and nerves.
• Skeletal irregularities. Scoliosis, a curvature of the spine, does not usually cause pain until middle age. Lordosis is an abnormally accentuated arch in the lower back.
• Arthritis. This includes osteoarthritis, rheumatoid arthritis, and spondylitis, an inflammation of the vertebrae.

Why should I see a pain management specialist?

Pain management specialists work with patients to diagnose pain and treat it safely and effectively with as few side effects as possible. These treatments do not have to involve medications. In fact, pain management is usually more successful when a comprehensive approach is used. Pain management specialists understand the full range of pain relief options, including how to use them in combination to achieve a successful outcome.

How is the cause of back pain diagnosed?

Your doctor will consider information that includes the following:

• Patient characteristics. For example, advanced age is linked to arthritis. Obesity puts stress on the back and increases the likelihood of disk degeneration. Weightlifting or participation in other activities could be a factor.
• Patient history. The physician asks questions to determine if there was an accident or other specific trigger for an injury that is causing the pain. The physician will also ask where and when you feel the pain and how long you have been experiencing it.
• Results of a physical examination. The examination focuses on the pain’s location. This includes determining whether the pain is axial (confined to the lower back) or radiating (travels to the buttocks, legs, and feet).
• Results of imaging and other tests. Options include X-ray, magnetic resource imaging (MRI), computerized tomography (CT), ultrasound, and bone scans.

What are the special considerations for sciatica?

Sciatica is caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. Symptoms include pain that travels down this nerve from your back through the buttocks and down one leg, sometimes even to your foot.

Sciatica usually stems from compression in the spine. But your doctor should also consider whether it might be caused by a tiny muscle called the piriformis, located in the buttocks near the top of the hip joint. The piriformis is right under the sciatic nerve and can cause similar problems if it spasms. A pain management specialist can diagnose this issue and relieve the muscle tension with an injection.

What treatments can provide pain relief?

It is best to consider and use multiple treatments for back pain, including promising new approaches such as high-frequency spinal cord stimulation and dorsal root ganglion stimulation. The options below are based on information from ASA pain management specialists, ASA-associated studies, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the National Institute of Neurological Disorders and Stroke (NINDS).

• Physical therapy. Exercises and stretches can strengthen core muscle groups that support the lower back, improve mobility and flexibility, and promote proper posture.
• Behavior modification. Learning how to move your body properly during daily activities — especially those involving heavy lifting, pushing, or pulling — can help relieve and prevent back pain. Adopting healthy habits, such as exercise, relaxation, regular sleep, and proper diet, can also help.
• Complementary approaches. Yoga, acupuncture, and massage are among the approaches that have shown some benefit.
• Spinal manipulation and mobilization. Chiropractors administer these techniques, which have been shown to provide small to moderate short-term benefits, according to NINDS.
• Epidural spinal injections. A steroidal anti-inflammatory drug is injected into a spinal region called the epidural space. While the relief is short-term, multiple injections can enable you to function well over a long period of time.
• Nerve block injections. An anesthetic and a steroid are injected into a specific nerve root of the spine.
• Radiofrequency ablation. A pain medicine specialist inserts a needle into the nerve responsible for the pain and zaps it using an electric current created by radio waves. This short-circuits the pain signals.
• Transcutaneous electrical nerve stimulation. These treatments send low-voltage electric signals from a small device to the painful area through pads attached to your skin. This may provide short-term relief, whether by interrupting pain signals to the brain or by stimulating the production of endorphins, the body’s natural painkillers.
• Intrathecal pumps. This implanted pump lets you push a button to deliver local anesthetics, narcotics, and other pain medications to your spinal cord. This can bring relief while avoiding the side effects that often come with taking these drugs by mouth.
• Low-frequency spinal cord stimulation. A small pacemaker-like device is implanted under the skin to deliver electric pulses to the spinal cord. This produces a sensation often perceived as tingling or buzzing, which masks your perception of pain.
• High-frequency spinal cord stimulation. Early data are promising on the effectiveness of higher-frequency pulses to provide pain relief without the tingling or buzzing sensation experienced with low-frequency stimulation. Higher-frequency pulses may also provide more effective pain relief.
• Dorsal root ganglion stimulation. This alternative to spinal cord stimulation disrupts pain signals by specifically targeting the nerves responsible for the pain. In a study presented at the ANESTHESIOLOGY® 2018 annual meeting, researchers reported promising results.
• Medications. Muscle relaxants, analgesics such as acetaminophen and aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen can help. Researchers are exploring the effectiveness of neuropathic drugs such as gabapentin. Opioids usually are not effective for managing chronic back pain; in most cases, their use should be confined to treating severe pain for a few days after an injury, if necessary.
• Surgery. Surgery is usually considered a last resort after more conservative approaches have failed. But earlier or immediate consideration of surgery is warranted for some conditions. The Made for This Moment back surgery page provides details on surgical options and pain management considerations.

Anesthesiologists are committed to patient safety and high-quality care, and have the necessary knowledge to understand and treat the entire human body.