More than eight in 10 people will experience back pain at some point in their lives. In most cases, the pain goes away over time. If your back pain is severe or does not improve, you may need medical care. Here are answers to some common questions about back pain and tips on when to seek help.
Why Does My Back Hurt?
There are various reasons why your back can hurt, including muscle pain, disc pain, joint pain, or nerve pain. In most cases, these are not harmful or dangerous. “There are some instances when pain can be a symptom of a more serious problem, such as a fracture, infection, or cancer affecting the spine,” said Anand B. Joshi, MD, MHA, a Duke physiatrist (physical medicine and rehabilitation doctor) who specializes in spine care. “Thankfully, these conditions are very rare and usually only affect people with special risk factors.”
When Should I See a Doctor for Back Pain?
When your back first starts to hurt, try taking an over-the-counter pain reliever (for example, aspirin, ibuprofen, or acetaminophen) and applying ice. You may need to take it easy for a while, but “It’s best to stay as active as possible, and to avoid bed rest,” said Dr. Joshi.
If your pain is severe, lasts several weeks, and keeps you from participating in normal, daily activities, see a doctor. You should seek medical care sooner if you have:
- Fever associated with back pain
- Back pain after trauma
- Loss of bladder or bowel function
- Loss of strength
- Unexplained weight loss associated with back pain
- Also, always be more cautious if you have special risk factors for cancer, infection, or fractures that may affect the spine.
What Doctor Should I See for Back Pain?
If your back pain is from a recent strain or mild injury, your primary care doctor can probably help. But if the pain is severe, ongoing, or accompanied by other symptoms such as numbness or tingling in your arms or legs, it may be time to see a back doctor. Start with someone who specializes in nonsurgical treatment for back pain. This can include a physiatrist, chiropractor, or orthopaedic physician assistant. They can evaluate your condition and offer appropriate treatment to help alleviate your pain. Depending on your circumstances, they might also refer you to another type of back specialist -- for example, a physical therapist, pain management specialist, or spine surgeon.
What Happens When I Visit a Back Doctor?
“We gather a full medical history of your back problems and perform detailed physical examinations,” said H. Michael Guo, MD, PhD, another Duke physiatrist who specializes in spine care. “That includes checking for tenderness, spine range of motion, strength, sensation, and reflexes. Depending on your symptoms, we may perform provocative tests to find out what triggers your pain. We may order imaging, such as X-rays, MRIs, or CT scans. We may order an electromyelogram, or EMG, which measures the electrical activity in your muscles, or a nerve conduction study, which can help identify nerve damage. We use all the information to help identify the cause of your back pain and recommend the most appropriate treatment for you.”
What If I Don’t Want Surgery for My Back Pain?
Fortunately, most people with back pain don’t need surgery. “We usually take a conservative approach first, using a wide variety of nonsurgical spine treatments,” said Dr. Guo. “For example, I might send you to physical therapy or chiropractic therapy. I might recommend medications such as anti-inflammatories, muscle relaxants, or some nerve-pain medications. We also offer injection therapy, including epidural injections, joint injections, and nerve blocks.” Chances are, one of these approaches will help reduce your pain and improve your function and quality of life.