Diagnosis

Your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. Your doctor might also ask you to rate your pain on a scale of zero to 10 and talk to you about how well you're functioning with your pain.

These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They can also help rule out more-serious causes of back pain.

If there is reason to suspect that a specific condition is causing your back pain, your doctor might order one or more tests:

  • X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. These images alone won't show problems with your spinal cord, muscles, nerves or disks.
  • MRI or CT scans. These scans generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
  • Blood tests. These can help determine whether you have an infection or other condition that might be causing your pain.
  • Bone scan. In rare cases, your doctor might use a bone scan to look for bone tumors or compression fractures caused by osteoporosis.
  • Nerve studies. Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment

Most acute back pain gets better with a few weeks of home treatment. However, everyone is different, and back pain is a complex condition. For many, the pain doesn't go away for a long period, but only a few have persistent, severe pain.

For acute back pain, over-the-counter pain relievers and the use of heat might be all you need. Bed rest isn't recommended.

Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don't avoid activity out of fear of pain. If home treatments aren't working after several weeks, your doctor might suggest stronger medications or other therapies.

Medications

Depending on the type of back pain you have, your doctor might recommend the following:

  • Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might relieve acute back pain. Take these medications only as directed by your doctor. Overuse can cause serious side effects. If OTC pain relievers don't relieve your pain, your doctor might suggest prescription NSAIDs.
  • Muscle relaxants. If mild to moderate back pain doesn't improve with OTC pain relievers, your doctor might also prescribe a muscle relaxant. Muscle relaxants can make you dizzy and sleepy.
  • Topical pain relievers. These are creams, salves or ointments you rub into your skin at the site of your pain.
  • Narcotics. Drugs containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don't work well for chronic pain, so your prescription will usually provide less than a week's worth of pills.
  • Antidepressants. Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline — have been shown to relieve some types of chronic back pain independent of their effect on depression.
  • Injections. If other measures don't relieve your pain, and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — or numbing medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

Education

There's no commonly accepted program to teach people with back pain how to manage the condition effectively. So education might involve a class, a talk with your doctor, written material or a video. Education emphasizes the importance of staying active, reducing stress and worry, and learning ways to avoid future injury.

Physical therapy and exercise

A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain.

As pain improves, the therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help keep pain from returning.

Surgery

Few people need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn't responded to other therapy.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Alternative medicine

A number of alternative treatments might ease symptoms of back pain. Always discuss the benefits and risks with your doctor before starting a new alternative therapy.

  • Chiropractic care. A chiropractor hand-manipulates your spine to ease your pain.
  • Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some people with low back pain report that acupuncture helps relieve their symptoms.
  • Transcutaneous electrical nerve stimulation (TENS). A battery-powered device placed on the skin delivers electrical impulses to the painful area. Studies have shown mixed results as to TENS' effectiveness.
  • Massage. If your back pain is caused by tense or overworked muscles, massage might help.
  • Yoga. There are several types of yoga, a broad discipline that involves practicing specific postures or poses, breathing exercises, and relaxation techniques. Yoga can stretch and strengthen muscles and improve posture, although you might need to modify some poses if they aggravate your symptoms.

Preparing for your appointment

If your back pain lasts for a few days without improvement, see your doctor. Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Key personal information, including mental or emotional stressors in your life
  • Your symptoms, and when they began
  • All medications, vitamins and other supplements you take, including doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you receive.

For back pain, questions to ask your doctor include:

  • What is the most likely cause of my back pain?
  • Do I need diagnostic tests?
  • What treatment approach do you recommend?
  • If you're recommending medications, what are the possible side effects?
  • I have other medical conditions. How can I best manage them together?
  • How long will I need treatment?
  • What self-care measures should I try?
  • What can I do to prevent a recurrence of back pain?

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • When did your back pain begin?
  • Have you ever injured your back?
  • Is the pain constant?
  • Does the pain affect your ability to function? If so, how much?
  • Do you have other signs or symptoms besides back pain?
  • Do you do heavy physical work?
  • Do you exercise regularly? What types of activities do you do?
  • How often do you feel depressed or anxious?
  • Do you sleep well?
  • What treatments or self-care measures have you tried so far? Has anything helped?
Aug. 04, 2018
References
  1. Back pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/back-pain. Accessed June 25, 2018.
  2. Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Accessed June 25, 2018.
  3. Chou R. Subacute and chronic low back pain: Nonsurgical interventional treatment. https://www.uptodate.com/contents/search. Accessed June 25, 2018.
  4. Knight CL, et al. Treatment of acute low back pain. https://www.uptodate.com/contents/search. Accessed June 25, 2018.
  5. Low back pain. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/low-back-pain/. Accessed June 25, 2018.
  6. Kongsted A, et al. Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data. The Spine Journal. 2015;15:885.