B

back pain PAINthat arises from injury to the
structures of the spine. Most back pain involves
the soft tissue structures—muscles, ligaments, ten-
dons, and CARTILAGE. Back pain is very common,
affecting nearly every adult at some time in his or
her lifetime and is second only to HEADACHEas a
reason for missing work. Though most back pain
heals without residual consequences, chronic back
pain (back pain that continues beyond three to six
months) remains the leading cause of occupa-
tional disability.
Acute back pain develops suddenly, a conse-
quence of traumatic injury or surgery, and
improves when the underlying cause improves.
The low back (lumbar spine) and the neck (cervi-
cal spine) are the most vulnerable to traumatic
injury. Low back strain is a common injury often
related to overuse, incorrect lifting (including
lifting too much weight), and sudden twisting
movements. Cervical strain often results from
incorrect posture, especially prolonged sitting in
the same position, or whiplash-type trauma in
which the head moves suddenly and more rap-
idly than the body in a whipping fashion that
stretches muscles and ligaments. Chronic back
pain is pain that exists or continues when there is
no pathologic reason and more often affects the
low back.

Back PAIN with accompanying numb-

ness or weakness in the legs may indi-

cate damage to NERVEstructures. Neck

pain with FEVERor headache may indi-

cate serious INFECTION (ENCEPHALITIS or

MENINGITIS). These circumstances require

immediate medical evaluation.

Symptoms and Diagnostic Path

Back pain, whether acute or chronic, may be

sharp, dull, shooting, persistent, intermittent, or

achy in character. The nature and location of the

pain sometimes helps the doctor determine the

cause. Most back pain results from soft tissue

injury; unless there are neurologic symptoms,

such as weakness or numbness in the legs or arms,

the doctor may recommend a trial of conservative

treatment before progressing to diagnostic testing.

Pain that persists requires further diagnostic effort

that may include X-RAY, COMPUTED TOMOGRAPHY(CT)

SCAN, orMAGNETIC RESONANCE IMAGING(MRI). These

imaging procedures help the doctor visualize the

structure of the spine to determine whether there

is deterioration or other injury that could be press-

ing on spinal NERVEroots and other structures of

the back to produce pain.

Treatment Options and Outlook

Most acute back pain improves with conservative

treatment to relieve INFLAMMATION. Such treatment

may include alternating heat and cold to the area

of pain, ANALGESIC MEDICATIONSfor pain relief, NON-

STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) to

relieve inflammation and pain, and sometimes

MUSCLE RELAXANT MEDICATIONSwhen MUSCLEspasms

are a problem. Some doctors recommend a day or

two of relative inactivity to allow the back muscles

to rest and relax, though some studies show HEAL-

INGoccurs more rapidly in mild to moderate back

pain when people continue their regular activities

(except strenuous exercise or heavy lifting).

Treatment for chronic back pain depends on

what underlying reasons the doctor can identify

that could be accountable. Complementary meth-

ods such as ACUPUNCTURE, various types of MASSAGE

THERAPY, CHIROPRACTIC manipulation, and OSTEO-

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