The good news is that most back pain goes away on its own. For minor complaints such as muscle strains, most doctors recommend over-the-counter painkillers, heat to relax the muscles, or ice to reduce swelling and numb pain.
In addition, it's best to keep up with daily activities as much as possible. "Doctors used to recommend bed rest for back pain . . . It turns out people get worse with bed rest," surgeon Filler says. Allowing the muscles to weaken can slow recovery -- whereas stretching and physical therapy can hasten it. A 2005 review found that patients who remained active, compared to those on bed rest, had a bit less pain and recovered a little more function.
--
Sign of trouble
A primary-care physician can evaluate back pain and make sure it doesn't signal something serious, such as an aneurysm, an ulcer, cancer or an infection. Numbness, pain that shoots down the legs (sciatica) or trouble controlling the bowel or bladder may indicate nerve damage and require medical attention. If the pain is the result of an injury or fall, one should also see a doctor to make sure nothing is broken.
When pain lasts more than three months, doctors classify it as chronic back pain. They will use a detailed history, physical exam and, sometimes, X-rays or other imaging tools to decipher what's wrong.
There are several possible treatments for back pain, but more patients find themselves on the operating table.
Surgery rates rose sharply between 1992 and 2003, from three in 10,000 Medicare patients getting back surgery in 1992 to 11 in 10,000 in 2003, according to a 2006 study in the medical journal Spine.
If a disc is damaged, a surgeon can remove the leaking or bulging material, or take out the disc entirely. For a fracture, two vertebrae can be fused with bone grafts or metal hardware to stabilize the spine.
To treat people with stenosis, surgeons can remove some of the spine to relieve pressure on nerves. Doctors can also use a laser or radio signal to burn away pain nerves or the material inside a bulging disc, a less invasive form of surgery.
Sometimes back surgery brings relief. A study funded by the National Institutes of Health, published in 2006, 2007 and 2008 found that surgical patients recovered more quickly and fully than nonsurgical patients with herniated discs, stenosis and slipped vertebrae.
