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Acute Low Back Pain

Symptoms, Causes and Treatment

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Updated November 11, 2008

Acute low back pain is the first stage of a back injury. But don't worry -- while it's certainly true that chronic pain can develop out of an episode of acute low back pain, with early treatment, it is possible to avoid a long term problem. Here are the basics about symptoms, causes and treatment of acute low back pain.

What is Acute Low Back Pain?

Acute low back pain means relatively short-term pain, stiffness and/or muscle tension anywhere in along the back, starting below the ribs and extending to just underneath the buttocks. The length of time you've had the pain distinguishes it from chronic back pain. Experts differ on its duration, but it's usually no more than 12 weeks. Like all types of back pain, symptoms tend to be subjective and often cannot easily be verified by exams or tests. Treatment is mainly focused on the pain itself.

Acute low back pain affects up to 45% of adults per year, yet only 5% see a doctor. Without the right amount of early treatment, acute low back pain may become a chronic condition, so it’s important to seek get help as soon as you can.

Are You At Risk for Acute Low Back Pain?

Adults between the ages of 35 and 55 are the most at risk for acute low back pain. Spending a lot of time in static positions, such as when you work all day at a computer, increases your chances. Other risk factors include heavy physical work, bending and/or twisting frequently (which can contribute to a disc herniation), and lifting.

Surprisingly, your personality, attitude and social situation also influence your chances of having acute low back pain. Specifically, if you have anxiety, depression and/or mental stress, your risk could be higher than normal. Studies also show that those who have insurance coverage (or are otherwise reimbursed for medical costs) are at a higher risk for acute low back pain.

Causes of Acute Low Back Pain

About 85% of acute low back pain cases are diagnosed as "non-specific," meaning the doctor doesn't know what causes it. As a patient, this may seem frustrating to you, but keep in mind that treatment can still help alleviate your problems.

Unless your doctor picks up on signs of a complicated health condition, x-rays and MRIs are not necessarily useful for coming up with a diagnosis. If the pain persists despite treatment, such tests may then help determine the cause.

About 4% of cases of acute low back pain are due to vertebral fractures and 1 to 3% to herniated disc. Other causes include spondylolysis, cauda equina syndrome, ankylosing spondylitis (a devastating form of spinal arthritis) and diseases not related to the spine at all.

Getting Your Acute Low Back Pain Checked by a Doctor

It’s a very good idea to get your back pain checked by a doctor as soon as you can. Early treatment may help you avoid a long-term problem.

When you go to the doctor for your back pain, she will conduct a medical interview (called a history) and a physical exam. The information she gathers at this appointment will help her diagnose your pain by placing you into one of three general categories: non-specific low back pain, nerve-related pain or other causes and red flags. Your treatment and any required testing will be determined based on your category.

Acute Low Back Pain Treatment

Treatment for acute low back pain starts with pain medication and advice. You should stay active, but modify the things you do to avoid further pain.

Over-the-counter (OTC) or prescription pain medications are usually tried first, and your doctor will instruct you on how to take care of your back. If this first line of defense doesn’t work, she may prescribe physical therapy, chiropractic care or other treatment.

Most primary doctors have limited training on back pain, and as such, you may get a hasty referral to a specialist, or find your care to be unsatisfactory. Don’t hesitate to ask your physician for a prescription for physical therapy or suggestions on alternative medicine and exercise.

More About Medications for Acute Low Back Pain

Proper pain medication for an acute low back problem is vital. Your doctor will probably suggest starting with an OTC drug such as Motrin or Aleve. For acute pain caused by injury (which most are), anti-inflammatories do double duty: they control inflammation while they reduce your pain. With the exception of Tylenol, OTC pain meds are anti-inflammatory.

Why is controlling the inflammation so important? If you can control inflammation in the acute phase, you are less likely to develop scar tissue later on. Excessive amounts of scar tissue can lead to a chronic back condition.

Experts strongly recommend against the use of narcotics to reduce acute low back pain, as it is usually not necessary and it carries a risk of addiction.

Recurring Back Pain

While it’s pretty easy to get rid of acute low back pain, it does tend to come back again. Researchers estimate that 50 to 80% of people who have an encounter with acute low back pain will have a recurrence within a year. Recurring back pain contributes to the development of a chronic condition.

Some of the things that increase the chance of a recurrence include previous history with back pain, including surgery, poor general health, dissatisfaction with your job, depression, a job that requires lifting, and the physical positions in which you spend most of your time.

How to Keep Acute Pain from Developing into Chronic Back Pain

If you’re not careful, acute back pain may lead to a disability. There are two different ways this could happen. First, if you don’t control inflammation and subsequent scar tissue, it may lead to decreased flexibility, muscle spasm and trigger points. Second, with time, your body can undergo permanent changes that make your nervous system erroneously amplify and distort sensations.

Anti-inflammatory pain medication and physical therapy early on are the treatments of choice for preventing a transition into chronic back pain.

Complementary and Alternative Medicine for Acute Low Back Pain

Many patients who fear re-injury avoid movement and exercise. But skipping your therapy puts you at risk for developing a chronic back problem. How can you address this when you are in pain? Complementary and alternative medicine (CAM) may be just the ticket.

CAM therapies include massage, yoga and other treatments. Some types of CAM focus on aligning the spine and pelvis, and require effort on your part. In others, such as chiropractic and acupuncture, a doctor provides a hands-on approach to your care. CAM offers a gentle way to relieve the pain. Ask your MD if CAM is appropriate for you.

Approximately 54% of people with back or neck pain have tried CAM. It is also effective for chronic low back pain.

Preventing Acute Low Back Pain

As the saying goes, the best treatment is prevention.

To prevent acute low back pain, keep your muscles flexible and strong, and learn how to align your spine and pelvis. Activities such as yoga, Pilates or other core strengthening systems can help you work your entire body, and will train your muscles to support your daily activities. Also, pay attention to proper body mechanics; they can go a long way toward preventing acute low back pain. For example, when you lift heavy objects, bend from the hips, not the back -- it will help protect your back. This is because your legs and hips are very strong in comparison to your spine.

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