Back pain is a very common problem in people of all ages. Back pain has many causes including muscular, intervertebral disc degeneration and herniation, as well as arthritis.
Most back pain will resolve in a few days. The most common type of back pain is muscular. This is often treated with over-the-counter medications such as Tylenol, ibuprofen, and naproxen. In the past, it was recommended that patients stay in bed for a few days. We currently recommend that people continue to do as much as they can that is comfortable. Back pain that does not resolve in a few days can also be treated with prescription medications and a type of injection called trigger points.
Pain from disc degeneration or herniation usually lasts longer than a few days. It is often associated with pain down the leg or arm. This pain is called sciatica or radiculopathy. The natural history of disc herniation has shown us that 50 percent of people get better within 30 days and 90 percent of people get better within 90 days.
Initial treatment includes physical therapy and over-the-counter medication. More severe pain is treated with prescription medication and steroid injections. Prior to treatment with steroid injections, a MRI or CT myelogram is performed to determine the location of the herniation.
If the patient has progressive weakness, severe pain, or is not better after 90 days, then surgery may be considered. Typically, no rods or screws are needed for this procedure which is called a discectomy or laminectomy. Patients usually recover within 2-4 weeks after a one night stay at the hospital.
Arthritis can cause many types of back pain. If the arthritis is affecting small joints called facets in the spine, this can be treated without surgery. Treatment usually involves injections into the small joints.
Arthritis that causes narrowing of the spinal canal is called stenosis. This often causes an aching sensation in the back and down the legs. Symptoms are worsened with standing and are relieved by sitting. Physical therapy and over-the-counter medications are the first line of treatment. Steroid injections often help for a long period of time. If the patient is experiencing weakness, unsteadiness while standing, or symptoms not relieved by other treatments, surgery may be considered.