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Sharp shooting back pain: 5 signs your back pain might be an emergency | Back and Spine | Orthopaedics and Rehab

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Back and Neck Pain | Cedars-Sinai

Not what you’re looking for?

What is back and neck pain?

Back pain can range from a mild,
dull, annoying ache to persistent, severe, disabling pain. Pain in your back can limit
your ability to move. It can interfere with normal functioning and quality of life.
Always talk with your healthcare provider if you have persistent pain.

Neck pain occurs in the area of the
cervical vertebrae in your neck. Because of its location and range of motion, your
neck
is often left unprotected and at risk for injury.

Pain in your back or neck area can
come on suddenly and intensely. Chronic pain lasts for weeks, months, or even years.
The
pain can be constant or come and go.

What causes back and neck pain?

Even with today’s technology, the
exact cause of back and neck pain is hard to find. In most cases, back and neck pain
may
have many different causes. They include:

  • Overuse, strenuous activity, or
    improper use, such as repetitive twisting or heavy lifting
  • Trauma, injury, or fractures
  • Breakdown of vertebrae, often caused
    by stresses on the muscles and ligaments that support your spine, or the effects of
    aging
  • Infection
  • Abnormal growth, such as a tumor or bone spur
  • Obesity, which puts extra weight on
    your spine and pressure on your disks
  • Poor muscle tone or muscle weakness in
    the back and belly (abdomen)
  • Muscle tension or spasm
  • Sprain or strain
  • Ligament or muscle tears
  • Joint problems, such as arthritis
  • Smoking
  • Slipped disk (protruding or herniated
    disk) and pinched nerve
  • Osteoporosis and compression fractures
  • Problems of your vertebrae and bones
    that you were born with (congenital)
  • Abdominal problems, such as an aortic
    aneurysm

What are the symptoms of back and neck pain?

Symptoms linked to back pain may
include:

  • Dull, burning, or sharp pain in your
    back.  The pain can be limited to a single spot or cover a large area.
  • Leg numbness or tingling above or below your knee
  • Stiffness or aching that occurs
    anywhere along your spine from your neck to your tailbone
  • Sharp, shooting pain that spreads from
    your low back to your buttocks, down the back of your thigh, and into your calf and
    toes
  • Consistent ache in the middle or lower
    part of your back, especially after standing or sitting for a long period

Loss of bladder and bowel control
with weakness in both legs are symptoms of a serious condition that needs medical
attention right away.

Symptoms linked to neck pain can
be:

  • Arm numbness or tingling
  • Headaches
  • Shoulder pain
  • Sharp shooting pain or a dull ache in your neck

Pain that occurs suddenly in your
back or neck from an injury is acute pain. Acute pain comes on quickly and may leave
sooner than chronic back or neck pain. This type of pain should not last more than
6
weeks.

Pain that may come on quickly or
slowly and lingers for 3 months or more is chronic pain. Chronic pain is less common
than acute pain.

How are back and neck pain diagnosed?

Your healthcare provider will ask
about your health history and do a physical exam. They may also do X-rays of the
affected areas, as well as an MRI. This allows a more complete view. The MRI also
makes
pictures of soft tissues such as ligaments, tendons, and blood vessels. The MRI can
help
spot infection, tumor, inflammation, or pressure on your nerve. Sometimes a blood
test
may help diagnose arthritis, a condition that can cause back and neck pain.

How are back and neck pain treated?

In many cases, acute back or neck
pain may simply improve with some rest. Over-the-counter medicines such as acetaminophen
or ibuprofen may also help with the discomfort. Try to move gently during this period,
so that you won’t become stiff and lose mobility.

If you have chronic pain of your
back and neck, try several remedies before considering surgery. These include:

  • Hot or cold packs as advised by your
    healthcare provider
  • Certain exercises to strengthen back
    and belly muscles and ease pain, such as stretching and flexing. Your healthcare
    provider can show you these exercises. Physical therapy can also help you find the
    correct exercises.
  • Aerobic exercise may help with your
    overall fitness and strength.
  • Certain anti-inflammatory medicines or
    muscle relaxants may be used, as advised by your provider.
  • Sometimes your provider may suggest a
    brace or corset for extra support.
  • Shots (injections) for pain relief in
    the area
  • Nerve block. This eases pain signals
    from the affected nerve.
  • Acupuncture
  • Osteopathic manipulation

How are back and neck pain managed?

Acute back pain usually gets better
without special treatment. Using acetaminophen or ibuprofen as directed will decrease
pain and help you rest. Surgery and special exercises are generally not used with
acute
pain.

For severe, disabling, or chronic
back and neck pain, rehabilitation programs can be designed to meet your needs. The
type
of program will depend on the cause and the type and severity of your pain, injury,
or
disease. Your active involvement is key to the success of rehab programs.

The goal of back and neck rehab is
to help you manage disabling pain. It’s also important to return you to your highest
level of functioning and independence, and improve your quality of life. The focus
of
rehab is on easing pain, improving movement. It also focuses on limiting any additional
damage, and increasing your functional ability.

To help reach these goals, back and
neck rehab programs may include:

  • Exercise programs to improve range of motion, increase muscle strength, improve flexibility
    and mobility, and increase endurance
  • Help with assistive devices that keep
    you independent
  • Education and counseling
  • Pain management methods
  • Help to quit smoking
  • Gait (walking) and movement retraining
  • Stress management
  • Nutritional counseling
  • Ergonomic assessments and work-related injury prevention programs
  • Job counseling

What are possible complications of neck and back pain?

Complications of back and neck pain may include: 

  • Loss of
    productivity.
    Back pain is the most common reason for disability in working
    adults.
  • Nerve
    damage.
    If your back pain is from a herniated disk, pressure on the spinal
    nerves may cause a variety of problems, such as weakness, numbness, or severe
    shooting pain that travels from the back to the leg.
  • Depression. Back or neck pain can disrupt all aspects of life. This includes
    work, physical exercise, social activities, and sleep. The anxiety and stress caused
    by the change in movement and pain can lead to depression.
  • Weight
    gain.
    Loss of movement and inability to exercise can lead to weight gain and
    the loss of muscle strength.

It is a good idea to see a
healthcare provider if you have numbness or tingling, or if your pain is severe and
does
not get better with medicine and rest. If you have trouble urinating, weakness, pain,
or
numbness in your legs, fever, or unintentional weight loss, call your healthcare
provider right away.

Can I prevent neck and back pain?

The following may help to prevent back and neck pain:

  • Practice correct lifting techniques.
    Don’t lift heavy items. When you do lift something, bend your legs, keep your back
    straight, and then slowly lift your body and the object.
  • Wear a seat belt in motor vehicles in case of a collision.
  • Use telephones, computers, and other
    equipment correctly.
  • Maintain correct posture while
    sitting, standing, and sleeping.
  • Exercise regularly. Learn
    back-strengthening exercises to keep your back and belly muscles strong. Warm up with
    stretching exercises before doing exercises.
  • Do exercises that improve your
    balance.
  • Don’t smoke.
  • Stay at a healthy weight.
  • Reduce emotional stress that may cause
    muscle tension.
  • Get enough vitamin D and calcium in
    your diet.

When should I call my healthcare provider?

See your healthcare provider if you have:

  • Loss of bladder or bowel control with
    weakness in either leg.  These symptoms need attention right away.
  • Severe back or neck pain that does not decrease with medicine and rest
  • Pain after an injury or a fall
  • Weakness, numbness, or tingling in your legs or arms
  • Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider
  • Unintentional weight loss

Key points about back and neck pain

  • Back and neck problems range from
    minor aches to severe, disabling pain.
  • Often, the reason for your pain can’t
    be found.
  • See a healthcare provider if you have
    numbness or tingling, severe pain that does not improve with medicine and rest,
    trouble urinating, weakness, pain, or numbness in your legs, fever, unintentional
    weight loss, or pain after a fall.
  • Often, back and neck pain will improve
    over time. See your healthcare provider if your pain is not decreasing.
  • Use prevention strategies to keep yourself healthy and injury-free.
  • For severe, disabling, or chronic back pain, consider an individualized rehabilitation
    program.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells
    you.
  • At the visit, write down the name of a
    new diagnosis and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you.
  • Know why a new medicine or treatment
    is prescribed and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that
    visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewer: Joseph Campellone MD

Medical Reviewer: Marianne Fraser MSN RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Sciatica, shooting leg pain | Cincinnati, OH Mayfield Brain & Spine

Overview

Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg. The pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs or muscle strain (Fig. 1). You play an important role in the prevention, treatment, and recovery of leg pain. It typically improves with rest, physical therapy, and other self-care measures. Chronic pain may be helped with surgery.

Figure 1. The sciatic nerve is formed from the spinal nerves L4 to S3. The two sciatic nerves travel through the pelvis and down the back of each leg. Each nerve divides into a peroneal and tibial nerve to provide feeling and muscle control of the legs and feet.

Types of leg pain

Leg pain ranges from mild to severe and can be acute or chronic.

Acute sciatic pain occurs suddenly and usually heals within several days to weeks. The severity relates directly to the amount of tissue injury. The source of pain may be in the spinal joints, discs, nerves, or muscles and ligaments.

Chronic sciatic pain persists for more than 3 months and its source may be hard to determine. Chronic pain may be felt all the time or worsen with certain activities. Contributing factors may include nerve damage, tissue scarring, arthritis, or mental effects of pain. People with chronic symptoms may be referred to a pain specialist (see Pain Management).

What are the symptoms?

Classic sciatic pain starts in the low back and buttocks. It affects one leg traveling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling (pins-and-needles) can occur in your leg and foot. This usually is not a concern unless you have weakness in your leg muscles or foot drop.

Sitting usually causes the most pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may actually feel better than sitting or standing for too long.

Seek medical help immediately if you have extreme leg weakness, numbness in the genital area, or loss of bladder or bowel function. These are signs of a condition called cauda equina syndrome.

What are the causes?

Sciatica can be caused by a number of conditions that irritate or compress the sciatic nerve:

  • Piriformis syndrome: Tightening or spasm of the piriformis muscle can compress the nerve.
  • Trauma: A sports injury or fall can fracture the spine or tear a muscle and damage nerves.
  • Herniated disc: The gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress nerves.
  • Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord and nerves.
  • Osteoarthritis: As discs naturally age they dry out and shrink. Small tears in the disc wall can be painful. Bone spurs can form. The facet joints enlarge and ligaments thicken.
  • Spondylolisthesis: A weakness or stress fracture in the facet joints can allow a vertebra to slip out of position and pinch the nerves.

Leg pain can also be caused by a joint problem in the hip or sacroiliac joint. This type of referred pain is quite common, but is not sciatica.

How is a diagnosis made?

A careful medical exam will attempt to determine the type and cause of your spine problem and the treatment options. A diagnostic evaluation includes a medical history and physical exam. Sometimes imaging scans (e.g., x-ray, CT, MRI) and tests to check muscle strength and reflexes are used.

What treatments are available?

Healing begins with self-care and nonsurgical strategies (Fig. 2). The goal is to correct the problem, restore function, and prevent re-injury.

Figure 2. Exercise, strengthening, stretching and ideal weight loss are key elements to your treatment. Make these a part of your life-long daily routine.

Self care: Sciatica often resolves with rest, ice or heat, massage, pain relievers, and gentle stretches. Reduce muscle inflammation and pain using an ice pack for 20 minutes several times a day during the first 48 to 72 hours. Thereafter, a warm shower or heating pad on low setting may be added to relax the muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If self-care treatments aren’t working within the first couple of days, see your doctor. (See Self Care for Neck and Back Pain).

Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen, can bring relief. A muscle relaxant may be prescribed for spasms. If pain is severe, an analgesic may be prescribed that can be taken with the NSAID or muscle relaxant.

Steroids can reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) tapered over a five-day period or by injection directly into the painful area (see epidural steroid injections and facet injections). Steroids may provide immediate pain relief within 24 hours.

Physical therapy: For most leg pain, we recommend a nearly normal schedule from the onset. Physical therapy can help you return to full activity as soon as possible and prevent re-injury. Physical therapists will show proper lifting and walking techniques, and exercises to strengthen and stretch your lower back, leg, and stomach muscles. Massage, ultrasound, diathermy, heat, and traction may also be recommended for short periods. Patients may also benefit from yoga, chiropractic manipulation and acupuncture.

Surgery: Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or severe pain that has not resolved after a reasonable course of nonsurgical treatment. Surgery for a herniated disc, called a discectomy, removes the portion of the disc compressing the spinal nerve. People with stenosis may benefit from a decompression of the nerves.

Recovery and prevention

A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time.

Prevention is key to avoiding recurrence:

  • Proper lifting; avoid sitting for long periods
  • Good posture during sitting, standing, moving, and sleeping
  • Regular exercise with stretching and strengthening
  • An ergonomic work area
  • Good nutrition, healthy weight and lean body mass
  • Stress management and relaxation
  • No smoking

Sources & links

If you have questions, please contact the Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Spine-health.com
Spineuniverse.com

Glossary

acute: a condition of quick onset lasting a short time, opposite of chronic.

cauda equina syndrome: compression of the end of the spinal cord (cauda equina) causing low back pain, numbness in the saddle area (groin), extreme leg weakness, difficulty controlling bladder or bowel function; an emergency condition – if left untreated can cause paralysis.

chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.

sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.

radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg.


updated > 9.2018
reviewed by > Banita Bailey, RN, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

Low Back Pain Fact Sheet

If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.

Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.

There are two types of back pain:

  • Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
  • Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.

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What structures make up the back?

The lower back—where most back pain occurs—includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.

Other regions of vertebrate are cervical (in the neck), thoracic (upper back), and sacral and coccygeal (below the lumbar area) segments.

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What can cause lower back pain?

Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of mechanical causes of low back pain include:

Congenital

  • Skeletal irregularities such as scoliosis (a curvature of the spine), lordosis (an abnormally exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine), and other congenital anomalies of the spine.
  • Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.

Injuries

  • Sprains (overstretched or torn ligaments), strains (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles)
  • Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.

Degenerative problems

  • Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
  • Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
  • Arthritis or other inflammatory disease  in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.

Nerve and spinal cord problems

  • Spinal nerve compression, inflammation and/or injury
  • Sciatica (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg.
  • Spinal stenosis, the narrowing of the spinal column that puts pressure on the spinal cord and nerves
  • Spondylolisthesis, which happens when a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column
  • Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward
  • Infections involving the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis
  • Cauda equina syndrome occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
  • Osteoporosis (a progressive decrease in bone density and strength that can lead to painful fractures of the vertebrae)

Non-spine sources

  • Kidney stones can cause sharp pain in the lower back, usually on one side
  • Endometriosis (the buildup of uterine tissue in places outside the uterus)
  • Fibromyalgia (a chronic pain syndrome involving widespread muscle pain and fatigue)
  • Tumors that press on or destroy the bony spine or spinal cord and nerves or outside the spine elsewhere in the back
  • Pregnancy (back symptoms almost always completely go away after giving birth)

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What are the risk factors for developing low back pain?

Anyone can have back pain. Factors that can increase the risk for low back pain include:

Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.

Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.

Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.

Genetics: Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine), have a genetic component.

Job-related factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Working at a desk all day can contribute to pain, especially from poor posture or sitting in a chair with not enough back support.

Mental health: Anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.

Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.

Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.

Psychological factors: Mood and depression, stress, and psychological well-being also can influence the likelihood of experiencing back pain.

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How is low back pain diagnosed?

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.

Tests include:

Blood tests  are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.

Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.

Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:

  • electromyography (EMG) assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body.
  • evoked potential studies involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
  • nerve conduction studies (NCS) also use two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage.

Diagnostic imaging tests allow specialists to see into the body without having to perform exploratory surgery. Imaging includes:

  • Computerized tomography (CT) can show soft tissue structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.
  • Magnetic resonance imaging (MRI) creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected
  • X-ray imaging can show broken bones or an injured or misaligned vertebra.

Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.

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How is back pain treated?

Acute back pain usually gets better on its own. Acute back pain is usually treated with:

  • Medications designed to relieve pain and/or inflammation  
    • analgesics such as acetaminophen and aspirin
    • non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be sold over the counter; some NSAIDS are prescribed by a physician 
    • muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles   
    • topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
  • Heat and/or ice may help ease pain, reduce inflammation, and improve mobility for some people   
  • Gentle stretching (not vigorous exercise) upon advice by your healthcare professional

Exercising, bed rest, and surgery are typically not recommended for acute back pain.
Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.

Step 1 Early treatments

Medications may include:

  • Analgesics and NSAIDS
  • Opioid drugs prescribed by a physician (opioids should be used only for a short period of time and under a physician’s supervision, as opioids can be addictive, aggravate depression, and have other side effects)  
  • Anticonvulsants—prescribed drugs primarily used to treat seizures—may be useful in treating people with sciatica
  • Antidepressants such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain (prescribed by a physician)

Self-management:

  • Hot or cold packs
  • Resuming normal activities as soon as possible may ease pain; bed rest is not recommended
  • Exercises that strengthen core or abdominal muscles may help to speed recovery from chronic low back pain. Always check first with a physician before starting an exercise program and to get a list of helpful exercises.

Step 2 Complementary and alternative techniques include:

  • Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them (by twisting or passing a low-voltage electrical current through them), which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
    • Behavioral approaches include:
    • Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature; people regulate their response to pain by using relaxation techniques   
    • Cognitive therapy involves using relaxation and coping techniques to ease back pain
  • Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device which places electrodes on the skin over the painful area that generate electrical impulses designed to block or modify the perception of pain    
  • Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions  
  • Spinal manipulation and spinal mobilization are approaches in which doctors of chiropractic care use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques may provide small to moderate short-term benefits in people with chronic low back pain but neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.

Spinal injections include:
Trigger point injections can relax knotted muscles (trigger points) that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point(s) can lessen or relieve pain.    

Epidural steroid injections into the lumbar area of the back are given to treat low back pain and sciatica associated with inflammation. Pain relief associated with the injections tends to be temporary and the injections are not advised for long-term use.

Radiofrequency ablation involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain. Also called a rhizotomy, the procedure can relieve pain for several months.

  • Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction but the back pain tends to return once the traction is released.

Step 3 More advanced care options

Surgery
When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

  • Vertebroplasty and kyphoplasty for fractured vertebra are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.   
  • Spinal laminectomy (also known as spinal decompression) is done when a narrowing of the spinal canal causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae are removed, along with any bone spurs, to relieve pressure on the nerves.     
  • Discectomy and microdiscectomy involve removing a herniated disc through an incision in the back (microdiscectomy uses a much smaller incision in the back and allows for a more rapid recovery). Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.    
  • Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can narrow the space where the spinal nerve exits and press on the nerve. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
  • Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves.   
  • Radiofrequency denervation uses electrical impulses to interrupt nerve conduction (including pain signaling). Using x-ray guidance, a needle is inserted into a target area of nerves and the region is heated, which destroys part of the target nerves and offers temporary pain relief.  
  • Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.     
  • Artificial disc replacement is an alternative to spinal fusion for treating severely damaged discs. The procedure involves removing the disc and replacing it with a synthetic disc that helps restore height and movement between the vertebrae.  
  • Interspinous spacers are small devices that are inserted into the spine to keep the spinal canal open and avoid pinching the nerves. It is used to treat people with spinal stenosis.

Implanted nerve stimulators

  • Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
  • Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
  • Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

Rehabilitation programs
Rehabilitation teams use a mix of healthcare professionals from different specialties and disciplines to develop programs of care that help people live with chronic pain. The programs are designed to help the individual reduce pain and reliance on opioid pain medicines. Programs last usually two to three weeks and can be done on an in-patient or out-patient basis.

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Can back pain be prevented?

Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture.
Recommendations for keeping one’s back healthy

  • Exercise regularly to keep muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
  • Maintain a healthy weight and eat a nutritious diet with sufficient daily intake of calcium, phosphorus, and vitamin D to promote new bone growth.
  • Use ergonomically designed furniture and equipment at home and at work. Make sure work surfaces are at a comfortable height.
  • Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. Put your feet on a low stool or a stack of books when sitting for a long time.
  • Wear comfortable, low-heeled shoes.
  • Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.    
  • Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.    
  • Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.

The NIH HEAL (Helping to End Addiction Long-term) Initiative, launched in April 2018, is a trans-NIH effort (which NINDS co-leads) that aims to prevent opioid addiction and provide more non-drug treatment options for chronic pain. Back pain is one of the most common pain conditions worldwide and is a major contributor to the prescribing and use of opioids in America. The treatment of low back pain is a specific area of focus of the Initiative. The Back Pain Consortium established through HEAL will conduct studies to better understand the mechanisms of common pain conditions such as chronic low back pain, develop improved diagnostic and treatment tools, and identify, prioritize, and test therapies that reduce the need for opioid use for millions of Americans. For more about the HEAL Initiative, see https://www.nih.gov/heal-initiative.

NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in the structure and function of certain brain regions. Other research seeks to determine the role of brain circuits important for emotional and motivational learning, and memory in this transition, in order to identify new preventive interventions. Furthermore, several studies are being conducted to identify and characterize bidirectional neural circuits that communicate between the spinal cord to brain, which are aimed at discovering and validating new interventional targets for low back pain.

Different studies are looking at the response to placebos in individuals with acute and chronic back pain. For example, one study is designed to examine brain properties for placebo response and critically assess the neurobiology of placebo pain relief for individuals with chronic pain. Another study is assessing ibuprofen plus acetaminophen compared to ibuprofen plus placebo in treating acute low back pain.
In addition to NINDS, other NIH Institutes— including the National Institute on Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Drug Abuse, and the National Center on Complementary and Integrative Health—fund research on low back pain. More information on NIH efforts on back pain research and on other disorders can be found using NIH RePORTER (http://projectreporter.nih.gov), a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and patents citing support from these projects.

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2680
913-906-6000 or 800-274-2237

American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, IL 60018
847-823-8125

American Academy of Physical Medicine & Rehabilitation
9700 West Bryn Mawr Avenue
Suite 200
Rosemont, IL 60018
847-737-6000

American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008-3852
847-378-0500 or 888-566-2267

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
800-533-3231

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
301-495-4484 or 877-226-4267; 301-565-2966 (TTY)

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“Back Pain Fact Sheet”, NINDS, Publication date March 2020.

NIH Publication No. 20-NS-5161

Back to Back Pain Information Page


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Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

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Low Back Pain: Causes, Diagnosis & Treatments

Overview

What is lower back pain?

Low back pain can result from many different injuries, conditions or diseases — most often, an injury to muscles or tendons in the back.

Pain can range from mild to severe. In some cases, pain can make it difficult or impossible to walk, sleep, work or do everyday activities.

Usually, lower back pain gets better with rest, pain relievers and physical therapy (PT). Cortisone injections and hands-on treatments (like osteopathic or chiropractic manipulation) can relieve pain and help the healing process. Some back injuries and conditions require surgical repair.

How common is lower back pain?

Around four out of five people have lower back pain at some point in their lives. It’s one of the most common reasons people visit healthcare providers.

Some people are more likely to have lower back pain than others. Risk factors for lower back pain include:

  • Age: People over 30 have more back pain. Disks (soft, rubbery tissue that cushions the bones in the spine) wear away with age. As the disks weaken and wear down, pain and stiffness can result.
  • Weight: People who are obese or carry extra weight are more likely to have back pain. Excess weight puts pressure on joints and disks.
  • Overall health: Weakened abdominal muscles can’t support the spine, which can lead to back strains and sprains. People who smoke, drink alcohol excessively or live a sedentary lifestyle have a higher risk of back pain.
  • Occupation and lifestyle: Jobs and activities that require heavy lifting or bending can increase the risk of a back injury.
  • Structural problems: Severe back pain can result from conditions, such as scoliosis, that change spine alignment.
  • Disease: People who have a family history of osteoarthritis, certain types of cancer and other disease have a higher risk of low back pain.
  • Mental health: Back pain can result from depression and anxiety.

Symptoms and Causes

What are the symptoms of lower back pain?

Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.

Pain may be sharp or dull and achy, and it may radiate to your bottom or down the back of your legs (sciatica). If you strain your back during an activity, you may hear a “pop” when it happened. Pain is often worse in certain positions (like bending over) and gets better when you lie down.

Other symptoms of lower back pain include:

  • Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
  • Posture problems: Many people with back pain find it hard to stand up straight. You may stand “crooked” or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
  • Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.

What causes lower back pain?

Many injuries, conditions and diseases can cause lower back pain. They include:

  • Strains and sprains: Back strains and sprains are the most common cause of back pain. You can injure muscles, tendons or ligaments by lifting something too heavy or not lifting safely. Some people strain their back by sneezing, coughing, twisting or bending over.
  • Fractures: The bones in the spine can break during an accident, like a car crash or a fall. Certain conditions (such as spondylolysis or osteoporosis) increase the risk of fractures.
  • Disk problems: Disks cushion the vertebrae (small spinal bones). Disks can bulge from their position in the spine and press on a nerve. They can also tear (herniated disk). With age, disks can get flatter and offer less protection (degenerative disk disease).
  • Structural problems: A condition called spinal stenosis happens when the spinal column is too narrow for the spinal cord. Something pinching the spinal cord can cause severe sciatic nerve pain and lower back pain. Scoliosis (curvature of the spine) can lead to pain, stiffness and difficulty moving.
  • Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain. Ankylosing spondylitis causes lower back pain, inflammation and stiffness in the spine.
  • Disease: Spine tumors, infections and several types of cancer can cause back pain. Other conditions can cause back pain, too. These include kidney stones and abdominal aortic aneurysm.
  • Spondylolisthesis: This condition causes the vertebrae in the spine to slip out of place. Spondylolisthesis leads to low back pain and often leg pain as well.

Diagnosis and Tests

How is lower back pain diagnosed?

Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.

Your provider may order:

  • Spine X-ray, which uses radiation to produce images of bones.
  • MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
  • CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
  • Electromyography (EMG) to test nerves and muscles and check for neuropathy (nerve damage), which can cause tingling or numbness in your legs.

    Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain (such as ankylosing spondylitis). Urine tests check for kidney stones, which cause pain in the flank (the sides of the low back).

Management and Treatment

What are the treatments for lower back pain?

Lower back pain usually gets better with rest, ice and over-the-counter pain relievers. After a few days of rest, you can start to get back to your normal activities. Staying active increases blood flow to the area and helps you heal.

Other treatments for lower back pain depend on the cause. They include:

  • Medications: Your provider may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription drugs to relieve pain. Other medications relax muscles and prevent back spasms.
  • Physical therapy (PT): PT can strengthen muscles so they can support your spine. PT also improves flexibility and helps you avoid another injury.
  • Hands-on manipulation: Several “hands-on” treatments can relax tight muscles, reduce pain and improve posture and alignment. Depending on the cause of pain, you may need osteopathic manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief and restore function.
  • Injections: Your provider uses a needle to inject medication into the area that’s causing pain. Steroid injections relieve pain and reduce inflammation.
  • Surgery: Some injuries and conditions need surgical repair. There are several types of surgery for low back pain, including many minimally invasive techniques.

Prevention

Can I prevent lower back pain?

You can’t prevent lower back pain that results from disease or structural problems in the spine. But you can avoid injuries that cause back pain.

To reduce your risk of a back injury, you should:

  • Maintain a healthy weight: Excess weight puts pressure on vertebrae and disks.
  • Strengthen your abdominal muscles: Pilates and other exercise programs strengthen core muscles that support the spine.
  • Lift the right way: To avoid injuries, lift with your legs (not your back). Hold heavy items close to your body. Try not to twist your torso while you’re lifting.

Outlook / Prognosis

What is the outlook for people with lower back pain?

The outlook depends on the cause of pain. Most people with back strains and sprains recover and do not have long-term health issues. But many people will have another episode within a year.

Some people have chronic back pain that doesn’t get better after several weeks. Older people with degenerative conditions such as arthritis and osteoporosis may have symptoms that get worse over time. Surgery and other treatments are effective at helping people with a range of injuries and conditions live pain-free.

Living With

When should I see my healthcare provider about lower back pain?

Lower back pain usually gets better with rest and pain relievers. Back pain that doesn’t go away may be a sign of a more serious condition.

See your provider if you have:

  • Pain that doesn’t get better after about a week of at-home care.
  • Tingling, numbness, weakness or pain in your buttocks or legs.
  • Severe pain or muscle spasms that interfere with your normal activities.
  • Fever, weight loss, bowel or bladder problems or other unexplained symptoms.

A note from Cleveland Clinic

Millions of people live with low back pain. Stiffness, pain and limited movement can have a major impact on quality of life. But you may be able to avoid lower back pain by maintaining a healthy weight and staying active. Talk to your provider if back pain doesn’t go away or if you’re unable to do the activities you enjoy. Several treatments can relieve pain, help you move better and get more out of life.

Back Pain

Is this your child’s symptom?

  • Pain or discomfort in the upper, mid or lower back
  • Minor muscle strain from overuse and back injury are included

Causes of Back Pain

  • Strained Back Muscles. New backaches in teens are mostly from strained back muscles (muscle overuse). The pain is mostly in the lower back and near the center. There are 200 muscles in the back that allow us to stand upright.
  • Work Triggers. Carrying something too heavy or lifting from an awkward position can cause back pain. Bending too far backward or sideways can cause back pain. Digging in the garden for too long causes overuse of back muscles.
  • Exercise. New exercises or changes in an exercise routine can cause back pain. This is also called muscle overuse.
  • Back Packs. In school-age children, heavy backpacks have become a common cause. They also can cause shoulder and neck pains. Children who have not gone into puberty are at greater risk. Reason: They lack the muscle mass.
  • Kidney Infection (Serious). Pain is on one side in the middle of the back. Other symptoms are fever and pain when passing urine.
  • Kidney Stone (Serious). Pain is on one side of the mid-back and shoots into the lower belly. The pain is extremely severe. The urine has blood in it.
  • Sciatic Nerve Pain (Serious). Sciatica is pain caused by a pinched nerve in the lower back. Sciatica gives a burning pain in one buttock. The pain shoots into the back of the leg on that side. The most intense pain can be in the lower leg and foot. Leg weakness, numbness or tingling can also occur. A ruptured disk causes the pressure on the nerve. Sciatica is rare in children but common in adults.

Symptoms of Back Pain

  • Strained back muscles cause most of these symptoms:
  • The pain is in the middle or lower back
  • The pain is made worse by bending
  • The muscles near the spine are tender to the touch
  • The muscles may be tight (in spasm)

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

When to Call for Back Pain

Call 911 Now

  • Pain starts after major injury (such as a car crash or football). Caution: do not move your child until a spine board is put on.
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Severe pain
  • Pain shoots into the buttock or back of the thigh
  • Tingling or numbness (loss of feeling) in the legs or feet
  • Blood in urine
  • Pain or burning when passing urine and fever
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Pain or burning when passing urine, but no fever
  • Fever
  • Walks different than normal for more than 3 days
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Age is less than 5 years old
  • Pain in the upper back
  • Cause is not clear (no history of overuse or twisting)
  • Cause is bending backwards (such as in gymnastics)
  • Back pain from overuse (exercise or work) lasts more than 2 weeks
  • Back pains are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Strained back muscles (from exercise or work) present less than 2 weeks

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Strained Back Muscles

  1. What You Should Know About Back Pain:
    • Most new lower back pain is caused by lifting heavy objects. Lifting while the back is twisted is a common cause. Muscle overuse from exercise also causes strained back muscles.
    • Pain is not the only symptom. Walking a little bent over or stiff may occur for a few days.
    • Here is some care advice that should help.
  2. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
    • Reason: Helps back pain and muscle spasms.
  3. Cold Pack for Pain:
    • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
    • Put it on the sore muscles for 20 minutes.
    • Repeat 4 times on the first day, then as needed.
    • Reason: Helps with the pain and muscle spasms.
    • Caution: Avoid frostbite.
  4. Use Heat After 48 Hours:
    • If pain lasts over 2 days, put heat on the sore muscle.
    • Use a heat pack, heating pad or warm wet washcloth.
    • Do this for 10 minutes, then as needed.
    • Reason: Increase blood flow and improve healing.
    • Caution: Avoid burns.
  5. Sleep on the Side:
    • Sleep on the side with a pillow between the knees.
    • If your child only sleeps on the back, put a pillow under the knees.
    • Avoid sleeping on the stomach.
    • The mattress should be firm. Do not sleep on a waterbed.
  6. Activity:
    • Avoid any sports or work that increase the pain.
    • Avoid lifting or jumping until well.
    • After 48 hours, start gentle back stretching exercises.
    • Complete bed rest is not needed.
  7. Prevent Backpack Pain:
    • Limit the weight of what is carried. It needs to less than 15% of body weight. That means a 100-pound (45 kg) child should not carry more than 15 pounds (7 kg).
    • A sign of carrying too much weight is having to lean forward when walking.
    • Buy a well-made backpack with wide, padded shoulder straps.
    • Never carry the pack on just one shoulder. Reason: causes shoulder and neck pain.
  8. What to Expect:
    • New back pain without a reason most often goes away in a few days.
    • Back pain from muscle overuse (strained back muscles) goes away in 1 to 2 weeks.
  9. Call Your Doctor If:
    • Pain becomes severe
    • Walks different than normal for more than 3 days
    • Pain starts to shoot into the leg
    • Fever occurs
    • Pain lasts more than 2 weeks
    • You think your child needs to be seen
    • Pain gets worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Symptoms, Causes, Risk Factors & Complications

The middle back consists of the thoracic spine (bony structures called vertebrae surrounding the nerves of the spinal cord). Between the vertebrae are spongy sacs of cartilage called discs that act as cushions and provide a range of motion to the back. Muscles, tendons and ligaments provide additional support. Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions.

A common cause of mild to severe pain in the thoracic spine is a sudden movement during sports activities or home improvement projects. People who normally lead a relatively sedentary lifestyle are at increased risk of these types of strains and sprains.

Middle back pain can also be due to more serious conditions, such as fibromyalgia, spondylitis (infection or inflammation of the spinal joints), or a herniated disc. A bulging disc can put pressure on the nerve roots coming out from the spine, resulting in middle back pain.

In addition, a problem in another part of the body, such as the heart or digestive organs, can radiate to the middle back. This is called referred middle back pain.

Diseases and disorders that can cause middle back pain

Middle back pain can be due to diseases and disorders of the bones and tissues in the back including:

  • Osteoarthritis
  • Osteomyelitis (infection or inflammation of the bones)
  • Osteoporosis (thinning and weakening of the bones)
  • Paget’s disease (abnormal bone tissue loss and reformation)
  • Spinal degeneration (degenerative disc disease, also called spondylosis)
  • Spinal stenosis (narrowing of the spinal canal, creating pressure on the spinal cord or nerves)
  • Spondylitis (infection or inflammation of the spinal joints)

Structural causes of middle back pain

Middle back pain can be due to injury or misalignment of the bones and tissues in the back including:

  • Herniated disc
  • Kyphosis (abnormal curving of the upper spine and humpback)
  • Muscle spasm
  • Scoliosis (sideways curve of the spine)
  • Spinal tumor or cancer (the tumor can be noncancerous, also known as benign)
  • Spine fracture
  • Sprains and strains due to overuse or injury

Other possible causes of middle back pain

Middle back pain can also be due to systemic problems or problems affecting other body systems, which can be serious or life threatening in some cases. These include:

What are the risk factors for middle back pain?

Although anyone can experience middle back pain, there are certain risk factors that make you more likely to experience it. Middle back pain can occur at any age, but it most often begins between 30 and 50 years of age. The activities associated with this age group, along with the increasing age of the spine and associated tissues, are the most influential factors in back pain. Risk factors include:

  • Advanced age
  • Congenital (present at birth) or acquired back deformities (such as kyphosis, an abnormal curving of the upper spine and humpback)
  • Family history of back pain or disease (such as degenerative disc disease)
  • Obesity
  • Poor posture
  • Pregnancy
  • Sedentary lifestyle
  • Smoking
  • Stress and anxiety
  • Weak abdominal (core) muscles

What are the potential complications of middle back pain?

The complications associated with middle back pain depend on the underlying disease, disorder or condition. For example, middle back pain resulting from a degenerative condition, such as spondylosis, can lead to inactivity and its associated complications.

You can best treat middle back pain and minimize the risk of complications by following the treatment plan you and your health care professional design specifically for you. In many cases, this may include physical therapy and basic self-care measures, such as rest and nonprescription pain relievers.

In some cases the degree and duration of your pain may become overwhelming and affect your everyday living.
Treatment and pain management for all types of back pain is an area of ongoing research. Contact your doctor to learn about your treatment options.

Over time, middle back pain can lead to complications including:

  • Absenteeism from work or school
  • Chronic pain
  • Disability
  • Permanent nerve damage (due to a pinched nerve) including paralysis
  • Poor quality of life

Back problems – Muscle, bone and joint injuries

Most back problems start for no obvious reason, which can be very frustrating. The spine is strong and back problems are rarely due to any serious disease or damage.

Back problems can cause a range of symptoms, including:

  • stiffness
  • muscle spasms
  • hot, burning, shooting or stabbing pains in your back and sometimes into one or both of your legs
  • pins and needles due to nerve irritation

In many cases, new or flare-up of long-standing back problems should begin to settle within 6 weeks without the need to see a healthcare professional.

For most back pain problems, you’ll not normally need an X-ray or MRI scan.

When to get professional advice

Speak to your pharmacist as soon as possible if you:

  • feel generally unwell
  • have back pain that starts when you’re ill with other problems – such as rheumatoid arthritis or cancer
  • feel unsteady when you walk

Cauda equina syndrome

Cauda equina syndrome is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you’ll need to be seen by an emergency specialist spinal team.

Phone 111 or attend your local A&E as soon as possible if you have:

  • difficulty passing or controlling urine
  • numbness or altered feeling around your back passage or genitals – for example when wiping after toileting
  • pins and needles around your back passage or genitals – for example when wiping after toileting
  • sudden or newly worsening leg pain which extends below the knee in both legs
  • new-onset difficulty controlling bowel incontinence

What causes back problems?

Although most back problems start for no obvious reason, back pain can be caused by:

  • staying in one position too long
  • lifting something awkwardly
  • a flare-up of an existing problem

Can this cause problems anywhere else?

Your back problem may cause hot, burning, shooting, or stabbing pains into one or both of your legs. You may also get pins and needles – this can be due to nerve irritation.

Self-help

Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health. Exercising can really help your back and reduce the pain you feel.

Being physically active can:

  • maintain your current levels of fitness – even if you have to modify what you normally do, any activity is better than none
  • keep your other muscles and joints strong and flexible
  • prevent a recurrence of the problem
  • help you aim for a healthy body weight

Try not to:

  • brace or hold yourself still – your back is designed to be mobile
  • sit down or rest for too long – resting in bed doesn’t help back pain, and often makes it harder to get going again

If you have to sit or rest, try to change positions regularly and find one that reduces any pain in your back or legs.

Exercises to help with back pain

Pain treatments

The following can help to reduce the pain:

  • Pain medication – this can help you move more comfortably, which can help your recovery
  • Heat or ice packs
  • TENS machine – this is a small battery-operated machine that stimulates the skin to help reduce the level of pain you feel

You can buy a TENS machine online or from a local pharmacy.

Speak to your pharmacist about treating back pain. It’s important to take medication regularly.

More about taking painkillers

Stay positive

It’s easy to start worrying about all the possible things that could be wrong, but research has shown that most back pain settles with time.

Keeping as active as possible helps you to cope better and recover more quickly.

Consider your posture

Although your posture doesn’t need to be perfect, resting in poor positions can affect your back problem. Try and move often so you don’t get stuck in a poor position for long.

Work

It’s recommended you stay at or return to work as quickly as possible during your recovery. You don’t need to be pain and symptom-free to return to work.

Help and support

If, after following our advice, your back problem hasn’t improved within 6 weeks a referral from your local health professional to a physiotherapist may be of benefit.

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90,000 Acute back pain

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  • Updated: 18 June 2020

Back pain has many causes.These can be various injuries sustained when lifting weights, falling, or hitting. Back pain can be caused by muscle spasms caused by cold – in such cases, they say “chilled back.” But do not take pain lightly, as it can be a harbinger of serious disorders occurring in the body.

Back pain has many causes. These can be various injuries sustained when lifting weights, falling, or hitting. The cause of back pain can be muscle spasms caused by cold – in such cases, they say “chilled back.”But you should not take pain lightly, as it can be a harbinger of serious disorders occurring in the body – chronic diseases, inflammatory processes and even neoplasms.

The most common causes of acute back pain are muscle spasms or compression of the nerve endings of the spinal cord by a herniated disc, or by the processes of the vertebrae. Traction or traction of the spine affects both of these causes and contributes to the stretching of spasmodic muscles, unloading of the intervertebral discs, release from compression of the nerve endings of the spinal cord.

Unfortunately, it is rather difficult to get to the hospital in case of acute pain. Especially for such cases, the Stolitsa-Medical Medical Center provides a home visit service for a neurologist. In his arsenal there is a quick and easy way to relieve back pain syndromes – paravertebral blockade. This is an injection into the area as close as possible to the pinched nerve root. The injection includes both pain relievers and medications with a therapeutic effect in order not only to eliminate the symptoms, but also to act on the cause of the pain.This type of local therapy has worked well and enjoys well-deserved popularity in neurological practice.

In addition, a neurologist will not only help get rid of discomfort, but will also be able to find out the most likely causes of pain. This is especially important when it comes to a chronic disease, because usually, as soon as the pain goes away, the patient tries to quickly return to normal life and forget about the illness. Without an accurate diagnosis, the cause of the pain will remain undetected, and the disease can affect other organs, up to the irreversible loss of their functions.Therefore, one should not rush, it is better to go through the entire course of examination and treatment. This will help the body to fully recover and exclude relapses and complications of the disease.

For each patient, the doctors of the Stolitsa-Medical center draw up a plan of drug therapy, give recommendations on adherence to the regimen. If the pain turned out to be a symptom of a complex disease, then you should think about continuing treatment in a medical institution, such as the Stolitsa-Medical rehabilitation center.Here, with the help of special diagnostic equipment, doctors will confirm or clarify the diagnosis and will be able to follow the course of treatment. For a speedy recovery, the rehabilitation center uses professional massage, physiotherapy, physiotherapy exercises and exercises on specially designed simulators.

It also happens that in case of back diseases, surgical intervention is required. However, such cases are relatively rare and can often be prevented with timely treatment.That is why in case of acute pain, you should immediately consult a specialist.

The main thing is to remember that the back never hurts “just like that”. Do not self-medicate. Only a timely visit to a doctor will help you save both money and health!

Sources

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  • Su X., Qian H., Chen B., Fan W., Xu D., Tang C., Lu L. Acupuncture for acute low back pain: a systematic review and meta-analysis. // Ann Palliat Med – 2021 – Vol – NNULL – p .; PMID: 33894708
  • Manniche C., Stokholm L., Ravn SL., Andersen TA., Brandt L., Rubin KH., Schiøttz-Christensen B., Andersen LL., Skousgaard SG. Prevalence of long-term opioid therapy in spine center outpatients the spinal pain opioid cohort (SPOC). // Eur Spine J – 2021 – Vol – NNULL – p .; PMID: 33893870
  • Kerautret Y., Guillot A., Eyssautier C., Gibert G., Di Rienzo F. Effects of self-myofascial release interventions with or without sliding pressures on skin temperature, range of motion and perceived well-being: a randomized control pilot trial.// BMC Sports Sci Med Rehabil – 2021 – Vol13 – N1 – p.43; PMID: 33888163
  • Duan WX., Wang WG., Xia L., Xue C., Yu B., Ren K., Yi W., Liang HL., Dong XC., Zuo J., Liu JC., Yu SQ., Yi DH. Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: lessons from the first registry of aortic dissection in China. // Chin Med J (Engl) – 2021 – Vol134 – N8 – p.927-934; PMID: 33879755
  • Delitto A., Patterson CG., Stevans JM., Freburger JK., Khoja SS., Schneider MJ., Greco CM., Freel JA., Sowa GA., Wasan AD., Brennan GP., Hunter SJ., Minick KI., Wegener ST., Ephraim PL., Beneciuk JM., George SZ., Saper RB. Stratified care to prevent chronic low back pain in high-risk patients: The TARGET trial. A multi-site pragmatic cluster randomized trial. // EClinicalMedicine – 2021 – Vol34 – NNULL – p.100795; PMID: 33870150
  • Gordon-Williams R., Trigo A., Bassett P., Williams A., Cone S., Lees M., Brandner B. An Interactive Pain Application (MServ) Improves Postoperative Pain Management.// Pain Res Manag – 2021 – Vol2021 – NNULL – p.8898170; PMID: 33868524
  • Heide ES., Chaudhari A., Pirverdian A., Lai S., Courtney A. Failure of IVIG in steroid-responsive autoimmune glial fibrillary acidic protein astrocytopathy: A case report. // Mult Scler Relat Disord – 2021 – Vol51 – NNULL – p.102933; PMID: 33866078
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Low back pain: causes and treatment

Low back pain: causes and treatment

One of the most common pain syndromes associated with the lower back. According to some experts, pain in the lower back is a kind of retribution for mankind for walking upright, when the greatest load falls on the lumbar spine, which bears the main burden of the mass of the human body.Physical inactivity, unhealthy diet, obesity, stress also have a detrimental effect. For many, back pain (lumbodynia) is so common that it becomes part of everyday life. It can arise only once and disappear without a trace, or it can return again and again, causing considerable suffering.

Many of us at least once, but worried about the pain in the lower back. Statistics say that this kind of pain occurs in 90% of the population. The lower back can hurt with diseases of the gastrointestinal tract, kidneys, genitals, accompany menstruation in women.But most often such pains are caused by osteochondrosis – degenerative-dystrophic changes in the spine. And among all the numerous pain syndromes of osteochondrosis, back pain occupies a leading position.

Pain in the lower back can be of a different nature – aching, arising after a long static load when sitting or during sleep, or sharp shooting, which occurs with sudden movement or is caught in an uncomfortable position. All of them are associated with pinching of the nerve roots, and also spasm, swelling and irritation of muscles and ligaments in the lumbar spine, which occur with osteochondrosis.

Causes of back pain

The lumbosacral spine is subject to maximum loads, and the intervertebral discs (spacers between the vertebrae) wear out much faster here. There are many causes of osteochondrosis in the lower back, but two main ones are: heavy, prolonged static load and a sharp maximum load, which usually occurs when bending over with heavy lifting. Here are some numbers. According to biomechanics, in the supine position, the intervertebral discs experience a pressure of 50 kg, in the standing position – 100, in the sitting position with a straight back without support – 150, and sitting hunched over – 220.

And now calculate how much you sit in a day … And how much of this time hunched over, with a round back … in only 10 kilograms (a couple of bags with groceries) – 200 kg, and if it tilts even lower, at an angle of 70 °, then the load will increase to 300 kg. For example, according to biomechanical data, when a person lifts a 50 kg gravity in the forward tilt position, the load on the spine is 700 kg.Now answer yourself the question: Do you lift heavy things? And from the floor? And with a tilt and turn?

Back pain can be divided into primary and secondary. As you know, the spine is a series of vertebrae interconnected by elastic tissues – muscles and ligaments. They (in addition to bone tissue) contain nerve endings and can become a source of back pain.

The causes of primary back pain are caused by pathology of the spinal column – dystrophic and functional changes in the joints of the vertebrae, intervertebral discs, muscles, tendons, ligaments.

Secondary syndrome of pain in the lower back is associated with traumatic lesions of the spine, tumor and infectious processes, diseases of internal organs, osteoporosis and other pathologies. This is a kind of alarm signal about malfunctions in the body. Particularly common causes of persistent low back pain are benign and malignant diseases of the pelvic organs (endometriosis, uterine fibroids, dysmenorrhea, lesions of large vessels, kidneys, chronic prostatitis, some diseases of the nervous system).

There are 5 most common causes of low back pain:

Osteochondrosis (dorsopathy) is the most common source of lower back pain. Examination reveals degenerative diseases of the spine – osteoarthritis, osteoarthritis, osteoporosis. The height of the intervertebral discs decreases, which leads to disturbances in the mechanical balance between the structures of the spinal column – hence the constant, quite tolerable, but periodically increasing pain in the lower back.

Muscle spasm . Did you experience acute lower back pain while performing intense and excessive physical activity that is unusual for you? A predisposing factor is a prolonged static incorrect body position (at the computer, squatting, bent in half during summer cottage work). As a result, muscle spasm develops, limiting the mobility of a certain part of the spine. Tightened muscles become a source of suffering, triggering a vicious cycle of low back pain – muscle spasm – pain.This condition can persist for a long time and causes many unpleasant minutes. Attention! For persistent low back pain, especially if it begins quickly and acutely, consult a doctor to identify the underlying diseases and develop a modern and correct treatment.

Hernia of the intervertebral disc , compressing the roots of the spinal cord, is especially common in men over 40 years of age. The first symptom of trouble is lumbodynia in combination with a number of additional signs: pain along the root from the buttock to the foot when coughing, sneezing and laughing, difficulties in bending and unbending the spine in the lumbar region (this is especially evident when putting on socks and shoes), increased unpleasant sensations when raising a straight leg lying on your back.This back pain is often referred to as the outdated term “sciatica” or the colloquial word “lumbago”. The pain intensifies in an upright position and subsides in a horizontal position.

Spinal instability is a common problem in middle-aged women. Manifested by back pain, aggravated by prolonged physical activity and standing. At the same time, there is a feeling of fatigue and a desire to lie down. The disease is caused by damage to the disc or intervertebral joint and often occurs against a background of moderate obesity.It is difficult for such patients not to bend, but to straighten, to make “extra” movements.

Narrow spinal canal. The most common symptom is pain at rest combined with pain when walking. It spreads along the root from the buttocks to the feet, while it always hurts, even lying or sitting, to the point that it is impossible to sit on the “sore” buttock. The syndrome of a narrow spinal canal is a consequence of degenerative changes, proliferation of bone and articular structures of the spine, which leads to infringement of the roots of the spinal nerves.

Also, you have a real chance to experience back pain on your own skin if:

– Are overweight

– Are fond of summer cottage work

– Spend a lot of time behind the wheel of a car or computer

– Lead a predominantly sedentary (office worker) or stand-up (salesperson, waiters, street signer, surgeon) lifestyle

– Excessively exercising yourself in the gym or fitness club.Be extremely careful if you have recently started training

– Do dynamic physical labor with a sharp change in body position (especially if your specialty is associated with heavy physical activity)

Additional risk for women:

– Are you pregnant or recently gave birth

– Have reached postmenopause, which leads to the development of osteoporosis

What to do with back pain:

And now, based on the above reasons, the same promised tips for those who want to reduce chronic lumbar discomfort , as well as prevent the occurrence of back pain.

1. Spend less time sitting. And if you still have to, then sit in the correct position.

2. If you are sitting for long periods, be sure to take breaks every hour in order to do several movements (extensions, bends, simple walking, etc.).

3. Do not lift heavy objects. If you do have to lift them, use the rules for lifting heavy things.

4. Tuck up your abdominal muscles as if zipping tight pants.The abdominal muscles support the lumbar spine and by straining the abdomen, you slightly relieve the load on the lower back.

5. Exercise regularly for the spine and for strengthening the muscle corset. Strong muscles will help you relieve excess stress on your lower back in any position. A flexible spine will help avoid squeezing blood vessels and nerve endings.

Also, in case of back pain, the doctor will usually recommend:

– A specialist can prescribe muscle relaxants to relieve muscle spasm, as well as diuretics and vascular drugs to reduce swelling of the nerve root and improve blood circulation in the affected area …

– Rest for 2–5 days. As a rule, we are talking about bed rest on a hard, flat surface.

– Take pain relievers and anti-inflammation medications – non-steroidal anti-inflammatory drugs. The most effective are ketoprofen, diclofenac, ibuprofen and others. They are available in tablets, injection solutions and ointments.

– Wear a special bandage if necessary.

– Take a course of physiotherapy to consolidate the positive effect when your health improves.Physiotherapy procedures (magnetotherapy, electrophoresis, phonophoresis), as well as massage and physiotherapy exercises relieve muscle tension, improve blood circulation and stop the inflammatory process

– To resort to local therapy with ointments and gels containing analgesic, anti-inflammatory or warming components.

Recently, doctors have at their disposal double-acting agents – analgesics and muscle relaxants (relaxing muscles), which is very important in the treatment of pain syndrome in the pathology of the musculoskeletal system and muscle spasm.This is Katadolon (flupirtine), which has a triple effect – analgesic, muscle relaxant and neuroprotective (protection of nerve cells from damage). In fact, we are talking about a fundamentally new approach to the treatment of back pain.

Whatever the cause of lower back pain, it is impossible to determine it yourself with certainty. If the back does not give rest either day or night, it is better to consult a specialist in a timely manner, who will tell you the tactics of treatment. All these tips will help you to prevent and reduce discomfort in the lumbar spine.But if you have acute pain in the lower back and sacrum, do not postpone the visit to the doctor. Give the final diagnosis to a specialist! Low back pain has a variety of causes, not necessarily associated with a pathology of the spine. In case of back pain and lumbago, it is recommended to undergo a computer tomography (shows the condition of the bone tissues of the spine) and magnetic resonance imaging (allows you to assess the condition of soft tissues) tomography. As a rule, the majority of patients recover within 2-3 months, only a small number of patients with complaints of lumbodynia reveal serious diseases.

Pain in the buttock

Pain in the buttock often appears as a result of pinching of the sciatic nerve by the piriformis muscle – a group of muscle fibers that begin in the sacrum region inside the pelvis and are attached by the lower tendon end to the femur. This muscle is responsible for external rotation of the thigh and foot. Piriformis syndrome often accompanies degenerative changes in the discs of the lumbosacral region with the formation of a picture of radiculitis.

Doctors of the “Osteomed Clinic”St. Petersburg almost daily observe manifestations of piriformis syndrome, since lumbar osteochondrosis is the most common problem of the spine in patients, regardless of their gender or age. And although pain in the buttock itself is not dangerous, it signals other disorders that need immediate correction. Experienced specialists conduct examinations and advise patients on this matter after making an appointment.

Causes of piriformis syndrome

Pain in the buttock occurs with sciatica – irritation of the sciatic nerve, which is most often observed with lumbosacral osteochondrosis and its consequences – disc protrusion, disc herniation or the proliferation of osteophytes in the vertebral bodies, as well as with spondylosis and spondylolisthesis.Suddenly arising soreness causes a reflex spasm of the piriformis muscle, namely, the sciatic nerve passes in its thickness or under it, which is formed by the fibers of the spinal nerves emanating from the spinal canal.

Thus, pain in the buttock can have two sources – compression of the roots of the spinal nerves in the spine and compression of the sciatic nerve trunk by the piriformis muscle. Other causes of piriformis syndrome include:

  • Injury of the piriformis muscle – when it falls on the buttocks, it is bruised, hematoma formation, painful spasm – all this contributes to irritation of the sciatic nerve in its thickness;
  • The consequences of trauma – the damage heals, but the muscle fibers in the area of ​​injury are replaced by a connective tissue scar, which compresses the sciatic nerve – and pain syndrome forms again;
  • Inflammation – myositis of the piriformis muscle – can also cause pain in the buttock;
  • Neoplasms, bone tuberculosis, osteomyelitis, arthritis or arthrosis of the hip joint can cause reactive inflammation of the piriformis muscle and pain.

The pain is often one-sided, but sometimes both sides are affected. At the same time, it is quite pronounced, radiating to the back of the thigh, lower leg and foot. Sensitivity disorders of the skin on the leg are usually not detected, sometimes there may be a slight tingling sensation. But the patient tries to take care of the leg, it is uncomfortable for him to sit on the sore side – as a rule, the person keeps the leg in an elevated position and is not able to sit up straight.

Diagnosis of piriformis syndrome

In addition to examining, checking tendon reflexes, posture and gait, the doctor prescribes instrumental research methods for the patient.Among them, the most informative is the radiography of the spine in the lumbar region, as well as the joints of the sacrum with the pelvic bones. In addition, comprehensive results can be obtained with magnetic resonance imaging of the lumbar and sacral region. Radioisotope scanning is used in case of suspicion of an oncological process or infection in the area of ​​the piriformis muscle and nearby organs.

A clear confirmation of piriformis syndrome is the diagnostic injection of an anesthetic solution into the muscle, which can be done under X-ray or computed tomography control.If the pain syndrome disappears after the injection, then the diagnosis is made without a doubt.

Piriformis Syndrome Treatment

Treatment for pain in the buttock is conservative and complex. It is necessary to use drug therapy, which includes:

  • Non-steroidal anti-inflammatory drugs – diclofenac, indomethacin, ibuprofen and others;
  • Severe pain syndrome can be reduced by taking or administering analgesics;
  • Muscle relaxants are used in case of severe muscle spasm;
  • Drugs that improve microcirculation – help reduce inflammation.

In addition to drug therapy, local methods of exposure are successfully used:

  • Manual therapy – special techniques allow you to restore the elasticity of the piriformis muscle;
  • Physiotherapy is necessary for better relieving spasm, stretching the piriformis muscle, developing and strengthening it;
  • Physiotherapy – helps to improve trophism, relieve spasm, remove lactic acid and other products of pathological metabolism;
  • Acupuncture, Botox injection and other techniques.

What is intercostal neuralgia and how to get rid of it?

Sharp shooting chest pain, involuntary muscle twitching, local numbness – all this can easily be mistaken for angina pectoris, renal colic, or even an impending heart attack. Foreshadowing a terrible diagnosis, it is scary to go to the doctor, and there is not enough strength to endure the pain – you have to sit on painkillers.


Under the frightening symptoms, intercostal neuralgia can hide – an unpleasant pathology, but amenable to treatment.Despite this, neuralgia should not be perceived as one of the characteristics of the body. This is not the norm. This is a problem that needs to be taken seriously.

Let’s analyze the term “neuralgia” in parts: “neuron” is translated from Greek as “nerve”, and “algos” – “pain”. In our case, the nerve not only hurts, it also deceives. The fact is that the source of this very pain is not the receptors (it is they who capture the pain signal and send it to the brain), but the transmitting substance – the nerve itself.It turns out that pain is born within the nervous system itself.

To understand the mechanism of pain in intercostal neuralgia, you need to remember the anatomy. A person has 12 pairs of ribs. A nerve emerging from the spinal canal runs along each of them. It is easy to guess that these nerves are called intercostal nerves. When they are irritated or pinched, neuralgia occurs.

It can hurt with neuralgia both in the chest and in the abdomen, – the lower pairs of nerves reach the anterior abdominal wall.Painful signals from the chest area are mistaken for signs of heart and lung pathologies. A spasm in the lower section is often confused with diseases of the liver, stomach and pancreas.

Another “trick” of the disease is associated with the structure of the nerves. Nerves are composed of centripetal, centrifugal and vegetative fibers. How the pathology manifests itself depends on which fibers are damaged. If centripetal fibers are hit, a person suffers from severe pain, centrifugal – shortness of breath occurs, vegetative – sweating increases.

Fact. According to the Federal State Budgetary Institution “State Research Center for Preventive Medicine” of the Ministry of Health of the Russian Federation (Moscow), 8.80% of men and women aged 35 to 64 suffer from intercostal neuralgia.

The primary source of all troubles is the person himself, or rather, his way of life. Indifference to sports and physical activity, inability to maintain posture, sleep in an uncomfortable position, love of intoxicating drinks – all this can lead to damage to the intercostal nerves.

Other causes of neuralgia include:

  1. Osteochondrosis . It is characterized by the destruction of the cartilage of the intervertebral discs. As a result, the nerve located in the intercostal space is pinched.
  2. Spine pathology . These include: trauma, inflammation, hernia, kyphosis, ankylosing spondylitis, oncology, reflex compression, etc.
  3. Cold, infection .Often, neuralgia occurs against the background of a weakened immune system. Herpes zoster (herpes zoster) can also provoke the development of the disease.
  4. Stress . According to medical research, strong emotional arousal can trigger the onset of neuralgia.
  5. Wearing the wrong size underwear . Women wearing tight bras are at risk. If the laundry is too tight, it can damage your nerves.
  6. Excessive thinness . Due to the thin layer of fat, the nerves are too close to the skin. The slightest injury – hello, neuralgia.
  7. Hypovitaminosis . A lack of vitamin B is bad for the condition of the nerve fibers.

Also, in the etiology of neuralgia, age-related changes, prolonged exhausting physical activity, interaction with toxic substances, vascular disorders, gastrointestinal diseases, diabetes mellitus, pleurisy, and multiple sclerosis play an important role.

Fact. The period of exacerbations is observed in winter, after heavy snowfalls. This is explained by two factors: hypothermia and increased physical activity.

“I hardly breathe” – this is what patients with intercostal neuralgia say in most cases. The disease is characterized by acute piercing pain. For a deep inhalation and exhalation, coughing, sneezing, swallowing food, strong laughter, the patient pays with an intolerable painful blow.

Attacks then subside, then intensify.Increase sharply when turning the body. The intercostal spaces are painful to touch. The pain is especially acute in the area from 5 to 9 ribs. As a rule, the pain is girdle, but it can only bother on one side. The most common form is left neuralgia.

Over time, the attacks become less intense, the pain goes away. Do not hope that the pathology itself goes away with pain.Neuralgia is insidious: she loves to lead by the nose. The absence of pain speaks of necrosis of the nerve root and does not bode well for a happy end. Soon it will seem to the patient that there is a huge stone on his chest, and the “shooting” lower back will make him forget about any peace. The disease will go into a neglected form, and it will be much more problematic to cure it.

Fact . Pain caused by intercostal neuralgia ranks third on the intensity scale. For comparison: the same intensity of pain is caused by renal colic.

The accompanying symptoms of intercostal neuralgia include:

  • redness or pale skin color in the area of ​​the affected nerve;
  • local numbness, slight tingling;
  • fever, increased sweating;
  • convulsions.

Intercostal neuralgia is disguised as a variety of ailments.

We will tell you how to exclude the “worst”, so as not to worry once again:

  • Angina, heart attack . Malfunctions in the “motor” are accompanied by short-term chest pain, changes in heart rate and pressure surges. When the position of the body changes, the symptoms do not increase, they are relieved by cardiac medications, for example, nitroglycerin.
  • Gastritis, ulcer .The pain caused by abnormalities of the gastrointestinal tract is usually associated with food intake – it becomes more intense after eating and when you feel hungry. Concomitant symptoms: nausea, stomach discomfort, upset stools.
  • Pneumonia and pleurisy. Like intercostal neuralgia, pneumonia and pleurisy are characterized by painful spasms when coughing, turning and bending the body. But pneumonia and pleurisy are characterized by a number of other symptoms: weakness, high fever, wet cough, shortness of breath.

Fact . Intercostal neuralgia makes its victim instinctively take an antalgic posture – the patient tries to move, tilting the body to the “healthy” side. Thanks to these actions, the space between the ribs increases, and the nerves on the “sick” side are freed from excessive pressure.

If the symptoms described above are found, the best solution would be to make an appointment with a neurologist.With a strong attack, self-administration of an anesthetic is allowed. Then you should consult a doctor, if you are completely twisted – call an ambulance.

To make a diagnosis, as a rule, the doctor needs to analyze the patient’s complaints and conduct palpation in the area where spasms occur.

To clarify the diagnosis, additional examinations are carried out:

  • electroneurography – shows if the nerve is injured;
  • CT and MRI – allow to exclude the presence of hernia and neoplasms;
  • X-ray – makes it possible to examine the spine and chest;
  • echocardiogram – allow to exclude cardiac pathologies;
  • blood test – allows you to exclude inflammation.

Having identified the ailment and determining its cause, the doctor builds a treatment regimen for intercostal neuralgia.

How to relieve a seizure at home?

It is impossible to endure, but taking pills at random is scary. What to do?

There are several ways to relieve an attack of severe pain at home:

  1. Kuznetsov Applicator .It is also called yoga mat. It is a flexible plate with many spikes. To alleviate the condition, you need to lie on the needle applicator for 15-20 minutes.
  2. Sheet . To relieve pain, you need to bandage your chest with a sheet. A sheet is tied on the side opposite to the site of pain localization. A knot is made on the side so that the patient can lie on his back. The surface must be hard.
  3. Respiratory gymnastics .You need to take a deep breath, hold your breath and then exhale the air in small portions.
  4. Autogenic training . Starting position: sitting on a chair and clasping your elbows. The exercise consists of two phases: tension – trying to open the elbows, and relaxation.

The basis of therapy is complete rest, pain relief and removal of edema. During the period of exacerbation (1-3 days), it is advisable not to leave the bed for a long time.The patient needs to rest on a flat solid surface.

Refusal of tight-fitting, and even more squeezing clothing is another prerequisite for therapy. Taking medications is strictly according to the doctor’s prescription. In the “calm” phase, massage of the back and neck is shown, as well as exercise therapy.

Relieve pain and muscle spasms

The first step is to remove acute symptoms. You can’t do without medicines here. They need to be taken not only systematically, but also prophylactically, without giving the “lumbago” a chance to return.

To stop the symptoms that do not give a normal life, help:

  1. Analgesics . These are drugs whose principle of action is based on pain relief. Such drugs as Analgin, Sedalgin, Spazgan, Baralgin, Ketorol, Tempalgin, Pentalgin, Sedalgin help to relieve acute symptoms. It is recommended to take painkillers no more than 3-4 times a day.
  2. NSAID . The action of this drug group is aimed at combating inflammation.Also, NSAIDs dull pain. For intercostal neuralgia, the following are used: Ibuprofen, Diclofenac, Voltaren, Nimesil, Meloxicam, Ketoprofen, Indomethacin, Piroxicam, Celebrex, etc. The frequency of administration is 1-2 times a day, the course of treatment is no longer than a week.
  3. Muscle relaxants . They are used as an adjunct therapy to relieve spasms in the area of ​​the damaged nerve. Usually Midocalm, Sirdalud, Tizanidine, Baclofen, Clonazepam are prescribed. The frequency and duration of admission is assigned on an individual basis.

To improve blood circulation in a problem area, ointments with diclofenac and ibuprofen are used. They relieve inflammation and relieve pain. Bee venom-based products are well-reviewed.

When ordinary pain pills do not cope with their task, injections with a solution of novocaine or lidocaine patches are prescribed. If the disease does not go away for a long time, glucocorticosteroids, for example, Prednisolone, are used.If herpes is the cause of neuralgia, prescribe Famciclovir, Acyclovir. If stress – antidepressants. If necessary, sedatives are prescribed (valerian extract, Persen-Forte).

Do not forget that medical treatment must be carried out under the strict supervision of a physician. Playing doctor is dangerous: self-therapy can aggravate an already difficult condition.

Doctor’s advice .Oral intake of non-steroidal anti-inflammatory drugs can have a negative effect on the digestive tract. Therefore, it is recommended to give preference to injection (injections) and rectal (suppositories) forms of drug release.

Fight puffiness

Tissue swelling is a common problem with intercostal neuralgia. This greatly aggravates the patient’s condition, therefore, the edema must be eliminated, but quickly. As part of decongestant therapy, venotonic and diuretics are used (Lasix, Hypothiazide), as well as drugs that improve the transport of fluids at the tissue level in the affected area (Apizatron).

Fixing the nerve sheath

Symptoms were removed – good. Now we need to help the most important victim in this story – the damaged nerve.

B vitamins have the best effect on the nerve sheath:

  • B1 – normalizes the functioning of the nervous system, increases susceptibility to stress;
  • B6 – with its help, neurotransmitters are produced – substances with the help of which signals are transmitted between the cells of the nervous system.
  • B12 – participates in the process of restoring damaged nerves and the formation of myelinated nerve sheaths, which are responsible for the speed of impulse transmission.

The intake of ascorbic and nicotinic acid also has a good effect on the functioning of the nervous system and blood circulation.

If we talk about specific vitamin complexes, then these are Milgamma, Doppelgerts Ginkgo Biloba asset, Neurorubin, Neuromultivit.The most budgetary options are our Belarusian Neuromed and Borivit.

Physiotherapy

As for physiotherapy, the choice is huge. During an exacerbation, electrophoresis with lidocaine and UV irradiation are shown. During the subacute stage of the disease, microwave therapy and darsonvalization are recommended. If there are pathologies of the spine, infrared radiation, smearing with therapeutic mud and paraffin will be useful.

Exercises

Professor, doctor of medical sciences, kinesitherapist Sergei Mikhailovich Bubnovsky recommends doing exercises at home that open the chest and spine.

Pull Over. To complete the exercise, you will need dumbbells (2-8 kg), which can be replaced with any other weights (for example, a bottle of water). Starting position: lying on your back on a bench (bed or sofa) with your head at the very edge. The legs are straight or slightly bent at the knees. In the hands raised perpendicular to the surface of the floor, dumbbells.

As you exhale, your arms gently drop behind your head.The lower, the more the spine is stretched. A breath is taken. On exhalation, the arms also smoothly return to their original position. The number of repetitions is 10-15 times.

“Pull-ups in the doorway” . For classes, you need to install a horizontal bar in the doorway. Height enough to touch the bar with your fingertips while lying on the floor. Starting position: lying on your back on the floor.

You need to grab the crossbar and, bending your elbows, tighten the body until the chest touches the horizontal bar.This is done as you exhale. Then you need to return to the starting position. The exercise is performed with a break of 1 day.

“Push-ups between chairs” . Starting position: sitting on the floor between the chairs. Arms bent at the elbows are located on the edges of the seats. As you exhale, you need to push up from the chairs, straightening your elbows. Return to starting position.

Dr. Sergey Bubnovsky claims that by performing these simple exercises on a regular basis, you can get rid of neuralgia in the acute stage in 3 days, in a severe case – in a week.If you ignore exercise therapy, the disease will not recede for several months.

Massage

The manual action allows the muscles to relax, improves blood circulation. Most importantly, the size of the intervertebral foramen through which the nerve passes becomes larger.

Attention is focused on the chest and back area. First, the “healthy” side is worked out. They move to the “diseased” zone smoothly, the force of pressing is minimal.Techniques used: stroking, squeezing, kneading, rubbing. To enhance the effect, medicinal ointments are used. A session usually lasts about half an hour, the course of treatment is 8-10 sessions.

Patients respond positively to acupressure. The essence of the procedure is to influence biologically active points. Their location is indicated in the picture:

Reflexology

Acupuncture perfectly complements the acupressure massage.Thin needles are placed in a specific pattern along the spine. Screwing in the needles is quick and painless, until the end of the session the patient can only relax and rest.

The principle of acupuncture is based on the removal of muscle imbalance. Allows you to relieve unpleasant symptoms, get rid of numbness and restore the ability to breathe deeply. The procedure can be carried out even during an exacerbation.

Kinesio taping method

How to treat intercostal neuralgia without pills, injections and other “delights”? You can do without an abundant infusion of medications thanks to kinesio taping.This is a relatively new and rather simple method of treatment using elastic adhesive tape (tape).

The method was developed in the 70s of the last century by the Japanese sports medicine physician Kenzo Kase. It helps relieve muscle pain and fatigue, improves blood circulation and helps to eliminate inflammation.

Tapes are made from natural materials (cotton) and synthetics. The bands stretch up to 90% of their length, making them similar in elasticity to muscles.The adhesive on the strip is hypoallergenic, but it is still recommended to do a test before using it: stick a small piece on your wrist.

So, instructions on kinesio taping for dummies. Tapes are glued to the stretched skin. The free hand rises up. Take the deepest possible breath and stick the tape (without tension). As mentioned above, everything is very simple.

In the case of intercostal neuralgia, you will need 4 Y-shaped tapes, the diagram of their location is shown in the picture:

“Grandma’s” methods

Folk remedies are a great addition to mainstream treatment.No more. Before using them, it is advisable to consult a doctor. Do not forget that some medicinal herbs can cause allergies.

Here are some simple and effective recipes, for the preparation of which you do not have to look for mouse petals or the roots of the Methuselah tree:

  1. Saline . Two tablespoons of salt are poured over 500 ml of slightly heated water. Gauze or a piece of cloth is soaked in the solution, applied to the diseased area for two hours, insulated with a scarf or handkerchief.
  2. Burdock appliques . Along with plantain, burdock is popularly known as a pain relieving plant. A freshly torn leaf is applied to the body at night, warmed with a scarf or handkerchief.
  3. Geranium leaves . This houseplant has an analgesic effect. A green leaf is plucked and rubbed into the area of ​​concern.
  4. Willow broth . 10 g of chopped willow bark pour 200 ml of boiling water.Put on fire and boil for 20 minutes. The strained and cooled broth is ready for use. Application: 1 tbsp. before meals 4 times a day.
  5. Homemade cream . A few drops of lavender oil are added to natural honey. The resulting composition is rubbed into the problem area, after which it is tied with a warm scarf.
  6. Medicinal solution . In a dark glass bottle, iodine and glycerin are mixed in a 1: 1 ratio. Shake the container well.Then the cotton wool is moistened in the resulting mixture and the affected area is treated. It is possible to treat intercostal neuralgia at home with this solution within a month, using the remedy every other day.
  7. Orange and lemon balm tincture . Dry orange peel is crushed, lemon balm leaves are kneaded so that they let the juice out. Pour a spoonful of this mixture with a glass of boiling water and let it brew. Then add a teaspoon of valerian and honey to the infusion. The resulting composition is taken orally for a month.

Healing baths have a beneficial effect:

  1. Sage . 4 teaspoons of the plant are poured into a glass of boiling water. The broth is infused, filtered and added together with sea salt to the bathing water.
  2. From poplar or aspen branches . The branches are crushed, filled with water and brought to a boil. The resulting broth is infused, then filtered and added to the bath.The optimum water temperature for bathing is 40 degrees.
  3. Lavender-eucalyptus . They take a bath, add a few drops of lavender and eucalyptus oil, a glass of milk and a spoonful of natural honey to the water.

It is recommended to take therapeutic baths before going to bed, and after bathing, rub fir oil into painful places.

An hour spent on health care, as they say, adds several years to life.In order for the nerve fibers to be safe and sound, you need to dress warmly in winter, not get nervous once again and keep your back straight.

To prevent a deficiency of B vitamins, you need to include eggs, sunflower seeds, nutritional yeast, salmon fillets, chicken meat, beef, spinach, black beans in the diet.

People who spend the lion’s share of the day sitting on a chair are recommended to do the following set of exercises:

  • smoothly lower and raise the shoulders;
  • make circular movements with your head;
  • bend over alternately to the right and left side so as to touch the floor with your fingers;
  • bring the shoulder blades together and hold them together for 10-15 seconds;
  • tilt your head, bringing your chin to your chest, and return to its original position.

They say that all diseases are from the nerves. But this is only part of the truth. All organs and systems are interconnected, intercostal neuralgia is a vivid confirmation of this. Therefore, before you run to the pharmacy for medicines and cook decoctions, you need to carry out a differential diagnosis and make sure of your diagnosis. As already mentioned, neuralgia can be mistaken for a symptom of a number of diseases that are dangerous to health and life.

Doctors recommend getting a physical exam once a year.This will help to timely identify the imbalance in the body and avoid long-term treatment, which will cost a lot.

You can find a good neurologist in your area in our catalog.

Side back pain

Back pain is a pronounced symptom of malfunctions in the body.A shooting, aching, harsh or dull sensation may affect a specific part of the back, right or left side. There are many diseases that can cause back pain, you should not ignore this symptom or self-medicate. Patients often come to our clinic with a complaint of unilateral back pain, therefore, in this article, we have collected symptoms for a preliminary determination of the cause. Only a qualified doctor can identify the exact cause and prescribe an effective treatment.

Causes of pain from different sides of the back

Often the pain syndrome on the left or right side of the back indicates some kind of pathology. However, the reasons are often incorrect posture, excessive muscle tension, hypothermia. Therefore, it is impossible to independently determine why negative feelings have arisen.

Symptom on the right side

If it hurts in the right side in the lower back, this may indicate a malfunction in the digestive tract, genitourinary system, and the work of various organs.In this case, the location and nature of sensations are important.

Pain in the right side from the back may indicate impaired renal function. In this case, the concentration of pain is noted closer to the center and gives to the side. If negative sensations appear under the scapula, most often it is neurology (pinched nerve). With this symptom, an examination of the lungs is necessary to exclude the presence of pleurisy, cancers, or pneumonia.

Pain in the right side of the back under the rib has many causes, among which diseases of the liver, gallbladder, and pancreas can be distinguished.Feelings may be accompanied by additional signs in the form of nausea, fever, and not subside for several days. As a rule, these are signs of cholecystitis. At the same time, it hurts in the right side and gives it to the back. Another reason for negative sensations is diseases of the urinary system, spine, hernia.

Symptom on the left side

If there is pain in the left side of the back, its location is important. When pain is in the lumbar region, it can indicate mechanical damage, pathologies of the skeletal system, joints, infections, metabolic disorders and other diseases.

Neurogenic or psychogenic factors may be the cause. Unpleasant sensations on the left side of the back occur during heavy physical exertion, when a person leads a sedentary lifestyle, is in the same position for a long time. Usually, such negative manifestations go away on their own after a few hours.

What does back pain indicate?

Drawing pains on the left side of the back may appear with spondylolisthesis (displacement of the vertebrae), sharp – with hernia, lumbago, rheumatism, stitching – with urolithiasis.Sometimes the cause is inflammation of the sciatic nerve, piriformis syndrome, or a malfunction of the left kidney.

Sharp pain in the right side of the back may indicate the presence of acute cholecystitis. Sometimes they are given to the sternum, under the corresponding scapula. In addition, a number of other symptoms appear – nausea, fever, etc. Very often, on the right side, pain manifests itself in a number of respiratory pathologies. For example, with inflammation of the lungs, bronchi, “dry” pleurisy, air accumulation in the pleural cavity and other ailments.

Dull pain in the right side of the back appears with flatulence, pancreatitis. It is accompanied by additional discomfort. Pain on the right is sometimes manifested in diseases of the urinary system. For example, in violation of the outflow of urine, kidney stones, renal colic.

Severe back pain in the right side may indicate a spinal cord injury or nervous system disorder. The most common cause is curvature of the spine due to poor posture. Pain in the right side of the back in women often occurs during pregnancy.Also manifested in inflammation of the pelvic organs, cysts and ovarian tumors. Aching pain in the right side of the back appears with intervertebral hernia, spondylosis, hydronephrosis.

Diagnostics

So, one-sided back pain can occur as a result of various diseases. Therefore, only a thorough diagnosis will help identify the true cause. Back pain is a reason to contact two specialists at once. An osteopathic doctor will conduct a general examination to exclude injuries, obvious signs of infectious diseases, hernia, stenosis.If a neurological cause of pain is suspected, a neurologist is involved in the examination.

Also, biochemical and general analyzes of urine and blood are often taken to identify the inflammatory process. A biopsy is done if necessary.

Who should I contact?

If the pain is prolonged and intense, then the best solution is to see a doctor. Initially, it is necessary to undergo an examination by a therapist, who, after examination, directs to the necessary doctors. Based on a detailed diagnosis, the doctor prescribes a specific treatment program.

Self-medication is unacceptable, since an accurate diagnosis can be made only in a clinic.