Low Back Pain
Table of Contents
If you have lower back pain, you are not alone. Nearly everyone at
some point has back pain that interferes with work, routine daily
activities, or recreation. Americans spend at least $50 billion each
year on low back pain, the most common cause of job-related disability
and a leading contributor to missed work. Back pain is the second most
common neurological ailment in the United States — only headache is more
common. Fortunately, most occurrences of low back pain go away within a
few days. Others take much longer to resolve or lead to more serious
Acute or short-term low back pain generally lasts from a few
days to a few weeks. Most acute back pain is mechanical in nature — the
result of trauma to the lower back or a disorder such as arthritis. Pain
from trauma may be caused by a sports injury, work around the house or
in the garden, or a sudden jolt such as a car accident or other stress
on spinal bones and tissues. Symptoms may range from muscle ache to
shooting or stabbing pain, limited flexibility and/or range of motion,
or an inability to stand straight. Occasionally, pain felt in one part
of the body may “radiate” from a disorder or injury elsewhere in the
body. Some acute pain syndromes can become more serious if left
Chronic back pain is measured by duration — pain that persists
for more than 3 months is considered chronic. It is often progressive
and the cause can be difficult to determine.
What structures make up the back?
The back is an intricate structure of bones, muscles, and other
tissues that form the posterior part of the body’s trunk, from the neck
to the pelvis. The centerpiece is the spinal column, which not only
supports the upper body’s weight but houses and protects the spinal cord
— the delicate nervous system structure that carries signals that
control the body’s movements and convey its sensations. Stacked on top
of one another are more than 30 bones — the vertebrae — that form the
spinal column, also known as the spine. Each of these bones contains a
roundish hole that, when stacked in register with all the others,
creates a channel that surrounds the spinal cord. The spinal cord
descends from the base of the brain and extends in the adult to just
below the rib cage. Small nerves (“roots”) enter and emerge from the
spinal cord through spaces between the vertebrae. Because the bones of
the spinal column continue growing long after the spinal cord reaches
its full length in early childhood, the nerve roots to the lower back
and legs extend many inches down the spinal column before exiting. This
large bundle of nerve roots was dubbed by early anatomists as the cauda
equina, or horse’s tail. The spaces between the vertebrae are maintained
by round, spongy pads of cartilage called intervertebral discs that
allow for flexibility in the lower back and act much like shock
absorbers throughout the spinal column to cushion the bones as the body
moves. Bands of tissue known as ligaments and tendons hold the vertebrae
in place and attach the muscles to the spinal column.
Starting at the top, the spine has four regions:
- the seven cervical or neck vertebrae (labeled C1–C7),
- the 12 thoracic or upper back vertebrae (labeled T1–T12),
- the five lumbar vertebrae (labeled L1–L5), which we know as the
lower back, and
- the sacrum and coccyx, a group of bones fused together at the
base of the spine.
The lumbar region of the back, where most back pain is felt, supports
the weight of the upper body.
As people age, bone strength and muscle elasticity and tone tend to
decrease. The discs begin to lose fluid and flexibility, which decreases
their ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts something too heavy
or overstretches, causing a sprain, strain, or spasm in one of the
muscles or ligaments in the back. If the spine becomes overly strained
or compressed, a disc may rupture or bulge outward. This rupture may put
pressure on one of the more than 50 nerves rooted to the spinal cord
that control body movements and transmit signals from the body to the
brain. When these nerve roots become compressed or irritated, back pain
Low back pain may reflect nerve or muscle irritation or bone lesions.
Most low back pain follows injury or trauma to the back, but pain may
also be caused by degenerative conditions such as arthritis or disc
disease, osteoporosis or other bone diseases, viral infections,
irritation to joints and discs, or congenital abnormalities in the
spine. Obesity, smoking, weight gain during pregnancy, stress, poor
physical condition, posture inappropriate for the activity being
performed, and poor sleeping position also may contribute to low back
pain. Additionally, scar tissue created when the injured back heals
itself does not have the strength or flexibility of normal tissue.
Buildup of scar tissue from repeated injuries eventually weakens the
back and can lead to more serious injury.
Occasionally, low back pain may indicate a more serious medical
problem. Pain accompanied by fever or loss of bowel or bladder control,
pain when coughing, and progressive weakness in the legs may indicate a
pinched nerve or other serious condition. People with diabetes may have
severe back pain or pain radiating down the leg related to neuropathy.
People with these symptoms should contact a doctor immediately to help
prevent permanent damage.
Nearly everyone has low back pain sometime. Men and women are equally
affected. It occurs most often between ages 30 and 50, due in part to
the aging process but also as a result of sedentary life styles with too
little (sometimes punctuated by too much) exercise. The risk of
experiencing low back pain from disc disease or spinal degeneration
increases with age.
Low back pain unrelated to injury or other known cause is unusual in
pre-teen children. However, a backpack overloaded with schoolbooks and
supplies can quickly strain the back and cause muscle fatigue. The U.S.
Consumer Product Safety Commission estimates that more than 13,260
injuries related to backpacks were treated at doctors’ offices, clinics,
and emergency rooms in the year 2000. To avoid back strain, children
carrying backpacks should bend both knees when lifting heavy packs,
visit their locker or desk between classes to lighten loads or replace
books, or purchase a backpack or airline tote on wheels.
Conditions that may cause low back pain and require treatment by a
physician or other health specialist include:
Bulging disc (also called protruding, herniated, or ruptured
disc). The intervertebral discs are under constant pressure. As
discs degenerate and weaken, cartilage can bulge or be pushed into the
space containing the spinal cord or a nerve root, causing pain. Studies
have shown that most herniated discs occur in the lower, lumbar portion
of the spinal column.
A much more serious complication of a ruptured disc is cauda
equina syndrome, which occurs when disc material is pushed into the
spinal canal and compresses the bundle of lumbar and sacral nerve roots.
Permanent neurological damage may result if this syndrome is left
Sciatica is a condition in which a herniated or ruptured disc
presses on the sciatic nerve, the large nerve that extends down the
spinal column to its exit point in the pelvis and carries nerve fibers
to the leg. This compression causes shock-like or burning low back pain
combined with pain through the buttocks and down one leg to below the
knee, occasionally reaching the foot. In the most extreme cases, when
the nerve is pinched between the disc and an adjacent bone, the symptoms
involve not pain but numbness and some loss of motor control over the
leg due to interruption of nerve signaling. The condition may also be
caused by a tumor, cyst, metastatic disease, or degeneration of the
sciatic nerve root.
Spinal degeneration from disc wear and tear can lead to a
narrowing of the spinal canal. A person with spinal degeneration may
experience stiffness in the back upon awakening or may feel pain after
walking or standing for a long time.
Spinal stenosis related to congenital narrowing of the bony
canal predisposes some people to pain related to disc disease.
Osteoporosis is a metabolic bone disease marked by progressive
decrease in bone density and strength. Fracture of brittle, porous bones
in the spine and hips results when the body fails to produce new bone
and/or absorbs too much existing bone. Women are four times more likely
than men to develop osteoporosis. Caucasian women of northern
European heritage are at the highest risk of developing the condition.
Skeletal irregularities produce strain on the vertebrae and
supporting muscles, tendons, ligaments, and tissues supported by spinal
column. These irregularities include scoliosis, a curving of the
spine to the side; kyphosis, in which the normal curve of the
upper back is severely rounded; lordosis, an abnormally
accentuated arch in the lower back; back extension, a bending
backward of the spine; and back flexion, in which the spine bends
Fibromyalgia is a chronic disorder characterized by widespread
musculoskeletal pain, fatigue, and multiple “tender points,”
particularly in the neck, spine, shoulders, and hips. Additional
symptoms may include sleep disturbances, morning stiffness, and anxiety.
Spondylitis refers to chronic back pain and stiffness caused
by a severe infection to or inflammation of the spinal joints. Other
painful inflammations in the lower back include osteomyelitis
(infection in the bones of the spine) and sacroiliitis
(inflammation in the sacroiliac joints).
A thorough medical history and physical exam can usually identify any
dangerous conditions or family history that may be associated with the
pain. The patient describes the onset, site, and severity of the pain;
duration of symptoms and any limitations in movement; and history of
previous episodes or any health conditions that might be related to the
pain. The physician will examine the back and conduct neurologic tests
to determine the cause of pain and appropriate treatment. Blood tests
may also be ordered. Imaging tests may be necessary to diagnose tumors
or other possible sources of the pain.
A variety of diagnostic methods are available to confirm the cause of
low back pain:
X-ray imaging includes conventional and enhanced methods that
can help diagnose the cause and site of back pain. A conventional
x-ray, often the first imaging technique used, looks for broken
bones or an injured vertebra. A technician passes a concentrated beam of
low-dose ionized radiation through the back and takes pictures that,
within minutes, clearly show the bony structure and any vertebral
misalignment or fractures. Tissue masses such as injured muscles and
ligaments or painful conditions such as a bulging disc are not visible
on conventional x-rays. This fast, noninvasive, painless procedure is
usually performed in a doctor’s office or at a clinic.
Discography involves the injection of a special contrast dye
into a spinal disc thought to be causing low back pain. The dye outlines
the damaged areas on x-rays taken following the injection. This
procedure is often suggested for patients who are considering lumbar
surgery or whose pain has not responded to conventional treatments.
Myelograms also enhance the diagnostic imaging of an x-ray. In this
procedure, the 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.
Computerized tomography (CT) is a quick and painless process
used when disc rupture, spinal stenosis, or damage to vertebrae is
suspected as a cause of low back pain. X-rays are passed through the
body at various angles and are detected by a computerized scanner to
produce two-dimensional slices (1 mm each) of internal structures of the
back. This diagnostic exam is generally conducted at an imaging center
Magnetic resonance imaging (MRI) is used to evaluate the
lumbar region for bone degeneration or injury or disease in tissues and
nerves, muscles, ligaments, and blood vessels. MRI scanning equipment
creates a magnetic field around the body strong enough to temporarily
realign water molecules in the tissues. Radio waves are then passed
through the body to detect the “relaxation” of the molecules back to a
random alignment and trigger a resonance signal at different angles
within the body. A computer processes this resonance into either a
three-dimensional picture or a two-dimensional “slice” of the tissue
being scanned, and differentiates between bone, soft tissues and
fluid-filled spaces by their water content and structural properties.
This noninvasive procedure is often used to identify a condition
requiring prompt surgical treatment.
Electrodiagnostic procedures include electromyography (EMG),
nerve conduction studies, and evoked potential (EP) studies. EMG
assesses the electrical activity in a nerve and can detect if muscle
weakness results from injury or 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. With nerve conduction studies the doctor
uses two sets of electrodes (similar to those used during an
electrocardiogram) that are placed on the skin over the muscles. The
first set gives the patient a mild shock to stimulate the nerve that
runs to a particular muscle. The second set of electrodes is used to
make a recording of the nerve’s electrical signals, and from this
information the doctor can determine if there is nerve damage. EP tests
also involve two sets of electrodes — one set to stimulate a sensory
nerve and the other set on the scalp to record the speed of nerve signal
transmissions to the brain.
Bone scans are used to diagnose and monitor infection,
fracture, or disorders in the bone. A small amount of radioactive
material is injected into the bloodstream and will collect in the bones,
particularly in areas with some abnormality. Scanner-generated images
are sent to a computer to identify specific areas of irregular bone
metabolism or abnormal blood flow, as well as to measure levels of joint
Thermography involves the use of infrared sensing devices to measure
small temperature changes between the two sides of the body or the
temperature of a specific organ. Thermography may be used to detect the
presence or absence of nerve root compression.
Ultrasound imaging, also called ultrasound scanning or
sonography, uses high-frequency sound waves to obtain images inside the
body. The sound wave echoes are recorded and displayed as a real-time
visual image. Ultrasound imaging can show tears in ligaments, muscles,
tendons, and other soft tissue masses in the back.
Most low back pain can be treated without surgery. Treatment involves
using analgesics, reducing inflammation, restoring proper function and
strength to the back, and preventing recurrence of the injury. Most
patients with back pain recover without residual functional loss.
Patients should contact a doctor if there is not a noticeable reduction
in pain and inflammation after 72 hours of self-care.
Although ice and heat (the use of cold and hot compresses)
have never been scientifically proven to quickly resolve low back
injury, compresses may help reduce pain and inflammation and allow
greater mobility for some individuals. As soon as possible following
trauma, patients should apply a cold pack or a cold compress (such as a
bag of ice or bag of frozen vegetables wrapped in a towel) to the tender
spot several times a day for up to 20 minutes. After 2 to 3 days of cold
treatment, they should then apply heat (such as a heating lamp or hot
pad) for brief periods to relax muscles and increase blood flow. Warm
baths may also help relax muscles. Patients should avoid sleeping on a
heating pad, which can cause burns and lead to additional tissue damage.
Bed rest — 1–2 days at most. A 1996 Finnish study found that
persons who continued their activities without bed rest following onset
of low back pain appeared to have better back flexibility than those who
rested in bed for a week. Other studies suggest that bed rest alone may
make back pain worse and can lead to secondary complications such as
depression, decreased muscle tone, and blood clots in the legs. Patients
should resume activities as soon as possible. At night or during rest,
patients should lie on one side, with a pillow between the knees (some
doctors suggest resting on the back and putting a pillow beneath the
Exercise may be the most effective way to speed recovery from
low back pain and help strengthen back and abdominal muscles.
Maintaining and building muscle strength is particularly important for
persons with skeletal irregularities. Doctors and physical therapists
can provide a list of gentle exercises that help keep muscles moving and
speed the recovery process. A routine of back-healthy activities may
include stretching exercises, swimming, walking, and movement therapy to
improve coordination and develop proper posture and muscle balance. Yoga
is another way to gently stretch muscles and ease pain. Any mild
discomfort felt at the start of these exercises should disappear as
muscles become stronger. But if pain is more than mild and lasts more
than 15 minutes during exercise, patients should stop exercising and
contact a doctor.
Medications are often used to treat acute and chronic low back
pain. Effective pain relief may involve a combination of prescription
drugs and over-the-counter remedies. Patients should always check with a
doctor before taking drugs for pain relief. Certain medicines, even
those sold over the counter, are unsafe during pregnancy, may conflict
with other medications, may cause side effects including drowsiness, or
may lead to liver damage.
- Over-the-counter analgesics, including nonsteroidal
anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are
taken orally to reduce stiffness, swelling, and inflammation and to
ease mild to moderate low back pain. Counter-irritants
applied topically to the skin as a cream or spray stimulate the
nerve endings in the skin to provide feelings of warmth or cold and
dull the sense of pain. Topical analgesics can also reduce
inflammation and stimulate blood flow. Many of these compounds
contain salicylates, the same ingredient found in oral pain
medications containing aspirin.
- Anticonvulsants — drugs primarily used to treat seizures
— may be useful in treating certain types of nerve pain and may also
be prescribed with analgesics.
- Some antidepressants, particularly tricyclic
antidepressants such as amitriptyline and desipramine, have been
shown to relieve pain (independent of their effect on depression)
and assist with sleep. Antidepressants alter levels of brain
chemicals to elevate mood and dull pain signals. Many of the new
antidepressants, such as the selective serotonin reuptake
inhibitors, are being studied for their effectiveness in pain
- Opioids such as codeine, oxycodone, hydrocodone, and
morphine are often prescribed to manage severe acute and chronic
back pain but should be used only for a short period of time and
under a physician’s supervision. Side effects can include
drowsiness, decreased reaction time, impaired judgment, and
potential for addiction. Many specialists are convinced that chronic
use of these drugs is detrimental to the back pain patient, adding
to depression and even increasing pain.
Spinal manipulation is literally a “hands-on” approach in
which trained specialists (such as chiropractors, osteopaths, and
massage therapists) use leverage and a series of exercises to adjust
spinal structures and restore back mobility. These specialists do not
prescribe drugs or use surgery in their treatment of low back pain.
When back pain does not respond to more conventional approaches,
patients may consider the following options:
Acupuncture involves the insertion of needles the width of a
human hair along precise points throughout the body. Practitioners
believe this process triggers the release of naturally occurring
painkilling molecules called peptides and keeps the body’s normal flow
of energy unblocked. Clinical studies are measuring the effectiveness of
acupuncture in comparison to more conventional procedures in the
treatment of acute low back pain.
Biofeedback is used to treat many acute pain problems, most
notably back pain and headache. Using a special electronic machine, the
patient is trained to become aware of, to follow, and to gain control
over certain bodily functions, including muscle tension, heart rate, and
skin temperature (by controlling local blood flow patterns). The patient
can then learn to effect a change in his or her response to pain, for
example, by using relaxation techniques. Biofeedback is often used in
combination with other treatment methods, generally without side
Interventional therapy can ease chronic pain by blocking nerve
conduction between specific areas of the body and the brain. Approaches
range from injections of local anesthetics, steroids, or narcotics into
affected soft tissues, joints, or nerve roots to more complex nerve
blocks and spinal cord stimulation. When extreme pain is involved, low
doses of drugs may be administered by catheter directly into the spinal
cord. Chronic use of steroid injections may lead to increased functional
Traction involves the use of weights to apply constant or
intermittent force to gradually “pull” the skeletal structure into
better alignment. Traction is not recommended for treating acute low
Transcutaneous electrical nerve stimulation (TENS) is
administered by a battery-powered device that sends mild electric pulses
along nerve fibers to block pain signals to the brain. Small electrodes
placed on the skin at or near the site of pain generate nerve impulses
that block incoming pain signals from the peripheral nerves. TENS may
also help stimulate the brain’s production of endorphins (chemicals that
have pain-relieving properties).
Ultrasound is a noninvasive therapy used to warm the body’s
internal tissues, which causes muscles to relax. Sound waves pass
through the skin and into the injured muscles and other soft tissues.
Minimally invasive outpatient treatments to seal fractures of the
vertebrae caused by osteoporosis include vertebroplasty and
kyphoplasty. Vertebroplasty uses three-dimensional imaging to help a
doctor guide a fine needle into the vertebral body. A glue-like epoxy is
injected, which quickly hardens to stabilize and strengthen the bone and
provide immediate pain relief. In kyphoplasty, prior to injecting the
epoxy, a special balloon is inserted and gently inflated to restore
height to the bone and reduce spinal deformity.
In the most serious cases, when the condition does not respond to
other therapies, surgery may relieve pain caused by back problems or
serious musculoskeletal injuries. Some surgical procedures may be
performed in a doctor’s office under local anesthesia, while others
require hospitalization. It may be months following surgery before the
patient is fully healed, and he or she may suffer permanent loss of
flexibility. Since invasive back surgery is not always successful, it
should be performed only in patients with progressive neurologic disease
or damage to the peripheral nerves.
- Discectomy is one of the more common ways to remove
pressure on a nerve root from a bulging disc or bone spur. During
the procedure the surgeon takes out a small piece of the lamina (the
arched bony roof of the spinal canal) to remove the obstruction
- 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 cause
narrowing of the space through which the spinal nerve exits and can
press on the nerve, resulting in pain, numbness, and weakness in an
arm or leg. Small pieces of bone over the nerve are removed through
a small slit, allowing the surgeon to cut away the blockage and
relieve the pressure on the nerve.
- IntraDiscal Electrothermal Therapy (IDET) uses thermal
energy to treat pain resulting from a cracked or bulging spinal
disc. A special needle is inserted via a catheter into the disc and
heated to a high temperature for up to 20 minutes. The heat thickens
and seals the disc wall and reduces inner disc bulge and irritation
of the spinal nerve.
- Nucleoplasty uses radiofrequency energy to treat patients
with low back pain from contained, or mildly herniated, discs.
Guided by x-ray imaging, a wand-like instrument is inserted through
a needle into the disc to create a channel that allows inner disc
material to be removed. The wand then heats and shrinks the tissue,
sealing the disc wall. Several channels are made depending on how
much disc material needs to be removed.
- Radiofrequency lesioning is a procedure using electrical
impulses to interrupt nerve conduction (including the conduction of
pain signals) for 6 to12 months. Using x-ray guidance, a special
needle is inserted into nerve tissue in the affected area. Tissue
surrounding the needle tip is heated for 90-120 seconds, resulting
in localized destruction of the nerves.
- Spinal fusion is used to strengthen the spine and prevent
painful movements. The spinal disc(s) 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
- Spinal laminectomy (also known as spinal decompression)
involves the removal of the lamina (usually both sides) to increase
the size of the spinal canal and relieve pressure on the spinal cord
and nerve roots.
Other surgical procedures to relieve severe chronic pain include
rhizotomy, in which the nerve root close to where it enters the
spinal cord is cut to block nerve transmission and all senses from the
area of the body experiencing pain; cordotomy, where bundles of
nerve fibers on one or both sides of the spinal cord are intentionally
severed to stop the transmission of pain signals to the brain; and
dorsal root entry zone operation, or DREZ, in which spinal neurons
transmitting the patient’s pain are destroyed surgically.
Recurring back pain resulting from improper body mechanics or other
nontraumatic causes is often preventable. A combination of exercises
that don't jolt or strain the back, maintaining correct posture, and
lifting objects properly can help prevent injuries.
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, such as resting a wrist
against the edge of a hard desk or repeated tasks using a hammering
motion), vibration, repetitive motion, and awkward posture. Applying
ergonomic principles — designing furniture and tools to protect the body
from injury — at home and in the workplace can greatly reduce the risk
of back injury and help maintain a healthy back. More companies and
homebuilders are promoting ergonomically designed tools, products,
workstations, and living space to reduce the risk of musculoskeletal
injury and pain.
The use of wide elastic belts that can be tightened to “pull in”
lumbar and abdominal muscles to prevent low back pain remains
controversial. A landmark study of the use of lumbar support or
abdominal support belts worn by persons who lift or move merchandise
found no evidence that the belts reduce back injury or back pain. The
2-year study, reported by the National Institute for Occupational Safety
and Health (NIOSH) in December 2000, found no statistically significant
difference in either the incidence of workers’ compensation claims for
job-related back injuries or the incidence of self-reported pain among
workers who reported they wore back belts daily compared to those
workers who reported never using back belts or reported using them only
once or twice a month.
Although there have been anecdotal case reports of injury reduction
among workers using back belts, many companies that have back belt
programs also have training and ergonomic awareness programs. The
reported injury reduction may be related to a combination of these or
Following any period of prolonged inactivity, begin a program of
regular low-impact exercises. Speed walking, swimming, or stationary
bike riding 30 minutes a day can increase muscle strength and
flexibility. Yoga can also help stretch and strengthen muscles and
improve posture. Ask your physician or orthopedist for a list of
low-impact exercises appropriate for your age and designed to strengthen
lower back and abdominal muscles.
- Always stretch before exercise or other strenuous physical
- Don’t slouch when standing or sitting. When standing, keep your
weight balanced on your feet. Your back supports weight most easily
when curvature is reduced.
- At home or work, make sure your work surface is at a comfortable
height for you.
- Sit in a chair with good lumbar support and proper position and
height for the task. Keep your shoulders back. 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 your back can provide some lumbar
support. If you must sit for a long period of time, rest your feet
on a low stool or a stack of books.
- Wear comfortable, low-heeled shoes.
- Sleep on your side to reduce any curve in your spine. Always
sleep on a firm surface.
- Ask for help when transferring an ill or injured family member
from a reclining to a sitting position or when moving the patient
from a chair to a bed.
- Don’t try to lift objects too heavy for you. Lift with your
knees, pull in your stomach muscles, and keep your head down and in
line with your straight back. Keep the object close to your body. Do
not twist when lifting.
- Maintain proper nutrition and diet to reduce and prevent
excessive weight, especially weight around the waistline that taxes
lower back muscles. A diet with sufficient daily intake of calcium,
phosphorus, and vitamin D helps to promote new bone growth.
- If you smoke, quit. Smoking reduces blood flow to the lower
spine and causes the spinal discs to degenerate.
The National Institute of Neurological Disorders and Stroke, a
component of the National Institutes of Health (NIH) within the U.S.
Department of Health and Human Services, is the nation’s leading federal
funder of research on disorders of the brain and nervous system and one
of the primary NIH components that supports research on pain and pain
mechanisms. Other institutes at NIH that support pain research include
the National Institute of Dental and Craniofacial Research, the National
Cancer Institute, the National Institute on Drug Abuse, the National
Institute of Mental Health, the National Center for Complementary and
Alternative Medicine, and the National Institute of Arthritis and
Musculoskeletal and Skin Diseases. Additionally, other federal
organizations, such as the Department of Veterans Affairs and the
Centers for Disease Control and Prevention, conduct studies on low back
Scientists are examining the use of different drugs to effectively
treat back pain, in particular daily pain that has lasted at least 6
months. Other studies are comparing different health care approaches to
the management of acute low back pain (standard care versus
chiropractic, acupuncture, or massage therapy). These studies are
measuring symptom relief, restoration of function, and patient
satisfaction. Other research is comparing standard surgical treatments
to the most commonly used standard nonsurgical treatments to measure
changes in health-related quality of life among patients suffering from
spinal stenosis. NIH-funded research at the Consortial Center for
Chiropractic Research encourages the development of high-quality
chiropractic projects. The Center also encourages collaboration between
basic and clinical scientists and between the conventional and
chiropractic medical communities.
Other researchers are studying whether low-dose radiation can
decrease scarring around the spinal cord and improve the results of
surgery. Still others are exploring why spinal cord injury and other
neurological changes lead to an increased sensitivity to pain or a
decreased pain threshold (where normally non-painful sensations are
perceived as painful, a class of symptoms called neuropathic pain),
and how fractures of the spine and their repair affect the spinal canal
and intervertebral foramena (openings around the spinal roots).
Also under study for patients with degenerative disc disease is
artificial spinal disc replacement surgery. The damaged disc is removed
and a metal and plastic disc about the size of a quarter is inserted
into the spine. Ideal candidates for disc replacement surgery are
persons between the ages of 20 and 60 who have only one degenerating
disc, do not have a systemic bone disease such as osteoporosis, have not
had previous back surgery, and have failed to respond to other forms of
nonsurgical treatment. Compared to other forms of back surgery, recovery
from this form of surgery appears to be shorter and the procedure has
The following organizations have information on lower back pain:
American Academy of Neurological and Orthopaedic Surgeons
2300 South Rancho Drive
Suite # 202
Las Vegas, NV 89102
American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008-3852
American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018-4262
American Academy of Physical Medicine and Rehabilitation
One IBM Plaza, Suite 2500
Chicago, IL 60611-3604
American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672
American Chiropractic Association
1701 Clarendon Boulevard
Arlington, VA 22209
American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
Tel: 916-632-0922 800-533-3231
American Pain Foundation
201 North Charles Street
Baltimore, MD 21201
Tel: 888-615-PAIN (7246) 410-783-7292
National Institute of Arthritis and Musculoskeletal and Skin
Diseases Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
For information on other 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)
P.O. Box 5801
Bethesda, MD 20824
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.
Reviewed July 26, 2003