Posted by & filed under Noah's Notes.

Earlier this year I suffered a fairly significant episode of low back pain due to a herniated disc.  Yes, I overdid it and I did not lift that air conditioner as carefully as I might have, so I accept full blame.  That didn’t make it any better when the spasms set in in the middle of the night! This was my most severe episode of back pain, but like almost all adults, I’ve had other episodes during my life, so this is a subject on which I write with true empathy.

So some important things you should know about low back pain:

  • It is very common. In fact it is the second most common reason people seek care with a doctor or other healthcare provider.
  • It is almost never serious, although serious conditions, like significant illness or cancer, can cause back pain. The vast majority of cases are straightforward and are related to muscle strain or spasm, or as in my recent case, a herniated disc.
  • Acute low back pain usually gets better on its own. Although the pain can be severe and debilitating, it is usually temporary and more than 90% of cases resolve by 6 weeks. When back pain becomes chronic (lasting more than 12 weeks) it can be more complicated to treat and can interfere with important functions of daily living. It is critical to understand that narcotic pain medicines have no role in treating chronic back pain, and if you have been started on them for acute low back pain, after a few weeks it is time to look at other therapies (a topic for another blog).
  • Treatment for acute low back pain is pretty straightforward. Stretching, physical therapy, chiropractic therapy, cold and heat therapy, massage and acupuncture can all help. Improving your posture, strengthening your core (especially your abdominal muscles), a healthy diet, weight loss, stress management, smoking cessation and good sleep habits can all contribute to a more speedy recovery.
  • Most of the time X Rays are not necessary. It’s even less frequent to need a CT scan or MRI. These tests are typically reserved for pain that lasts more than 6 weeks or in instances when symptoms or physical findings indicate a more serious cause of the pain.
  • There are warning signs of more serious disease. Fever, weight loss, other persistent symptoms, worsening pain after a few days, weakness in your legs or a loss of sensation should be evaluated by your primary care provider. If you have other serious medical conditions like diabetes or osteoporosis, or if you take prednisone or other medicines that suppress your immune system you should seek attention early on.
  • Surgery is seldom the answer. I wish I had a dollar for every patient I have seen who has had back surgery and continues to have pain. This isn’t because of poor surgeons or poor techniques. Rather, abnormal findings on a test like an MRI are very common as we age and may or not be the cause of a person’s back pain. Even most herniated discs will get better without surgery (mine did).
  • Most importantly, staying active, maintaining a healthy weight and a healthy lifestyle, using good back mechanics and exercising good judgment can help prevent back problems in the first place.
Noah Nesin, MD

Dr. Nesin, Vice President of Medical Affairs for PCHC, is a family doctor with 30 years of experience.

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