Low Back Pain – A Common Problem, often Mistreated

/ Thomas Cohn, MD

low back pain minnesotaLow back pain is a very common issue – 85% of the population will experience back pain at some point in their lives. However, back pain is often treated improperly and as a result, it has become a costly problem in American society.  A lack of understanding of back pain, its causes, and usual treatment, leads to costly management.

Acute Low Back Pain

Acute low back pain is pain that has been present less than 3 months.  Most back pain can be treated conservatively.  Only rarely is back pain a serious medical emergency.  There are many structures in the back that cause pain, including:

  • Vertebral discs
  • Bones
  • Joints
  • Nerves
  • Muscles

All of these can cause pain.  Fortunately, most pain is caused by muscle strains and irritation of joints, discs or nerves.  Initially all of these are treated the same, with ice and heat, minimal rest, stretching, and then muscle strengthening of the core.

Medications should be kept simple – use Tylenol or anti-inflammatories like naproxen to manage the pain.  If pain is more severe, see a primary care physician for referral to a Physical therapist.  Very short-term use of narcotic pain medicine is useful if other medications cannot be taken but these are not advised for more than several weeks.

If Back Pain Persists

If back pain persists for more than a month, despite basic management, you should seek out an expert in low back pain.  The best medical doctors to evaluate and treat this type of pain are board certified physicians in Physical Medicine and Rehabilitation.  These physicians are experts in the musculoskeletal and nervous system.  They can guide a person through a detailed exam and diagnosis and more advanced treatments.

Surgery, MRIs, & CT Scans

Back pain is rarely a medical emergency.  If a patient has had cancer and has new onset of back pain, aggressive evaluation is necessary to determine if cancer is affecting the region.  Low back pain with loss of control of the bowels, or loss of muscle function in the legs is the other case when aggressive evaluation is necessary.

Back pain is usually relatively benign.  Most pain will resolve within weeks with conservative treatment.  Only in rare cases (such as cancer) should MRI or CT scans be obtained.

Surgery should only be considered if nerves are compromised, or bowel or bladder control is lost due to the spine being injured.