U.S. Department of Health and

 Human Services

National Institutes of Health

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases

HANDOUT ON HEALT h

Back Pain
This booklet is not copyrighted. Readers are 

encouraged to duplicate and distribute as many copies 

as needed.

Additional copies of this booklet are available from the 

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases, NIAMS/National Institutes of Health, 

1 AMS Circle, Bethesda, MD 20892–3675, and on the 

NIAMS Web site at www.niams.nih.gov.

For Your Information

This publication contains information about medications 

used to treat the health condition discussed here. When 

this booklet was printed, we included the most up-todate (accurate) information available. Occasionally, new 

information on medication is released.

For updates and for any questions about any 

medications you are taking, please contact the U.S. 

Food and Drug Administration at 1–888–INFO–

FDA (1–888–463–6332, a toll-free call) or visit its 

Web site at www.fda.gov.

For updates and questions about statistics, please 

contact the Centers for Disease Control and 

Prevention’s National Center for Health Statistics 

toll free at 1–800–232–4636 or visit its Web site at 

www.cdc.gov/nchs.
Contents

What Is Back Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . 1

How Common Is Back Pain? . . . . . . . . . . . . . . . . . . 1

What Are the Risk Factors for Back Pain? . . . . . . . 2

What Are the Causes of Back Pain? . . . . . . . . . . . . . 5

Can Back Pain Be Prevented? . . . . . . . . . . . . . . . . . . 7

When Should I See a Doctor for Pain? . . . . . . . . . . . 8

Which Type of Doctor Should I See? . . . . . . . . . . . . 8

How Is Back Pain Diagnosed? . . . . . . . . . . . . . . . . . 9

What Is the Difference Between Acute and 

Chronic Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

How Is Back Pain Treated? . . . . . . . . . . . . . . . . . . . 12

Nonsurgical treatments . . . . . . . . . . . . . . . . . . . 13

Surgical treatments . . . . . . . . . . . . . . . . . . . . . . 23

What Kind of Research Is Being Done? . . . . . . . . . 29

For More Information . . . . . . . . . . . . . . . . . . . . . . 33

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Illustrations

Side View of Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Normal Vertebra (Cross-Section) . . . . . . . . . . . . . . 3

1

Back Pain

This booklet is for people who have back pain, as well 

as family members, friends, and others who want to 

find out more about it. The booklet describes causes, 

diagnosis, and treatments, and research efforts to learn 

more about back pain, many of which are supported by 

the National Institute of Arthritis and Musculoskeletal 

and Skin Diseases (NIAMS) and other components of 

the U.S. Department of Health and Human Services’ 

National Institutes of Health (NIH). If you have 

further questions after reading this booklet, you may 

wish to discuss them with your doctor. 

What Is Back Pain?

B ack pain is an all-too-familiar problem that can range from a dull, constant ache to a sudden, 

sharp pain that leaves you incapacitated. It can come 

on suddenly – from an accident, a fall, or lifting 

something too heavy – or it can develop slowly, 

perhaps as the result of age-related changes to the 

spine. Regardless of how back pain happens or how it 

feels, you know it when you have it. And chances are, 

if you don’t have back pain now, you will eventually.

How Common Is Back Pain?

A t some point, back pain affects an estimated 8 in 10 people. It is one of our society’s most common 

medical problems.
What Are the Risk Factors for Back Pain?

A lthough anyone can have back pain, a number of factors increase your risk. They include:

Age: The first attack of low back pain typically occurs 

between the ages of 30 and 40. Back pain becomes 

more common with age.

Fitness level: Back pain is more common among people 

who are not physically fit. Weak back and abdominal 

muscles may not properly support the spine. “Weekend 

2

Cervical

(7)

Thoracic

(12)

Lumbar

(5) Intervertebral

disc

Vertebra

Sacrum

Coccyx

Cauda 

equina

Side View of Spine
warriors” – people who go out and exercise a lot after 

being inactive all week – are more likely to suffer painful 

back injuries than people who make moderate physical 

activity a daily habit. Studies show that low-impact 

aerobic exercise is good for the discs that cushion the 

vertebrae, the individual bones that make up the spine.

Diet: A diet high in calories and fat, combined with 

an inactive lifestyle, can lead to obesity, which can put 

stress on the back.

Heredity: Some causes of back pain, including disc 

disease, may have a genetic component.

Race: Race can be a factor in back problems. African 

American women, for example, are two to three 

times more likely than white women to develop 

spondylolisthesis, a condition in which a vertebra of 

the lower spine – also called the lumbar spine – slips 

out of place.

3

Spinal canal

Facet joint

Disc

Nerve

root

Normal Vertebra (Cross-Section)
The presence of other diseases: Many diseases can cause 

or contribute to back pain. These include various forms 

of arthritis, such as osteoarthritis, rheumatoid arthritis, 

and ankylosing spondylitis, and cancers elsewhere in 

the body that may spread to the spine.

Occupational risk factors: Having a job that requires 

heavy lifting, pushing, or pulling, particularly when 

this involves twisting or vibrating the spine, can 

lead to injury and back pain. An inactive job or 

a desk job may also lead to or contribute to pain, 

especially if you have poor posture or sit all day 

in an uncomfortable chair.

Cigarette smoking: Although smoking may not 

directly cause back pain, it increases your risk of 

developing low back pain and low back pain with 

sciatica. (Sciatica is back pain that radiates to the 

hip or leg due to pressure on a nerve.) For example, 

smoking may lead to pain by blocking your body’s 

ability to deliver nutrients to the discs of the lower 

back. Or repeated coughing due to heavy smoking 

may cause back pain. It is also possible that smokers 

are just less physically fit or less healthy than 

nonsmokers, which increases the likelihood that they 

will develop back pain. Furthermore, smoking can 

slow healing, prolonging pain for people who have 

had back injuries, back surgery, or broken bones.

4
What Are the Causes of Back Pain?

I

t is important to understand that back pain is a 

symptom of a medical condition, not a diagnosis 

itself. Medical problems that can cause back pain 

include the following:

Mechanical problems: A mechanical problem is a 

problem with the way your spine moves or the way you 

feel when you move your spine in certain ways. Perhaps 

the most common mechanical cause of back pain is 

a condition called intervertebral disc degeneration, 

which simply means that the discs located between 

the vertebrae of the spine are breaking down with age.

As they deteriorate, they lose their cushioning ability.

This problem can lead to pain if the 

back is stressed. Other mechanical 

causes of back pain include spasms, 

muscle tension, and ruptured discs, 

which are also called herniated discs.

Injuries: Spine injuries such as 

sprains and fractures can cause 

either short-lived or chronic pain.

Sprains are tears in the ligaments that 

support the spine, and they can occur 

from twisting or lifting improperly.

Fractured vertebrae are often the 

result of osteoporosis, a condition 

that causes weak, porous bones. Less 

commonly, back pain may be caused 

by more severe injuries that result 

from accidents or falls.

5

It is important 

to understand 

that back pain 

is a symptom 

of a medical 

condition, not a 

diagnosis itself.
Acquired conditions and diseases: Many medical 

problems can cause or contribute to back pain. They 

include scoliosis, which causes curvature of the spine 

and does not usually cause pain until middle age; 

spondylolisthesis; various forms of arthritis, including 

osteoarthritis, rheumatoid arthritis, and ankylosing 

spondylitis; and spinal stenosis, a narrowing of the 

spinal column that puts pressure on the spinal cord 

and nerves. Although osteoporosis itself is not painful, 

it can lead to painful fractures of the vertebrae. Other 

causes of back pain include pregnancy; kidney stones 

or infections; endometriosis, which is the buildup 

of uterine tissue in places outside the uterus; and 

fibromyalgia, which causes fatigue and widespread 

muscle pain.

Infections and tumors: Although they are not 

common causes of back pain, infections can cause 

pain when they involve the vertebrae, a condition 

called osteomyelitis, or when they involve the discs 

that cushion the vertebrae, which is called discitis.

Tumors also are relatively rare causes of back pain.

Occasionally, tumors begin in the back, but more 

often they appear in the back as a result of cancer that 

has spread from elsewhere in the body.

Although the causes of back pain are usually physical, 

emotional stress can play a role in how severe pain 

is and how long it lasts. Stress can affect the body in 

many ways, including causing back muscles to become 

tense and painful.

6
Can Back Pain Be Prevented?

O ne of the best things you can do to prevent back pain is to exercise regularly and keep your back muscles 

strong. Four specific types of exercises are described 

in “How Is Back Pain Treated?” (page 12). All may 

help you avoid injury and pain. Exercises that increase 

balance and strength can decrease your risk of falling 

and injuring your back or breaking bones. Exercises 

such as tai chi and yoga – or any weight-bearing exercise 

that challenges your balance – are good ones to try.

Eating a healthy diet also is important. For one 

thing, eating to maintain a healthy weight – or to lose 

weight, if you are overweight – helps you avoid putting 

unnecessary and injury-causing stress and strain on 

your back. To keep your spine strong, as with all bones, 

you need to get enough calcium and vitamin D every 

day. These nutrients help prevent osteoporosis, which 

is responsible for a lot of the bone fractures that lead to 

back pain. Calcium is found in dairy products; green, 

leafy vegetables; and fortified products, like orange 

juice. Your skin makes vitamin D when you are in 

the sun. If you are not outside much, you can obtain 

vitamin D from your diet: nearly all milk and some 

other foods are fortified with this nutrient. Most adults 

don’t get enough calcium and vitamin D, so talk to your 

doctor about how much you need per day, and consider 

taking a nutritional supplement or a multivitamin.

Practicing good posture, supporting your back properly, 

and avoiding heavy lifting when you can may all help 

you prevent injury. If you do lift something heavy, keep 

your back straight. Don’t bend over the item; instead, 

lift it by putting the stress on your legs and hips.

7
When Should I See a Doctor for Pain?

I

n most cases, it is not necessary to see a doctor for 

back pain because pain usually goes away with 

or without treatment. However, a trip to the doctor 

is probably a good idea if you have numbness or 

tingling, if your pain is severe and doesn’t improve 

with medication and rest, or if you have pain after a 

fall or an injury. It is also important to see your doctor 

if you have pain along with any of the following 

problems: trouble urinating; weakness, pain, or 

numbness in your legs; fever; or unintentional weight 

loss. Such symptoms could signal a serious problem 

that requires treatment soon.

Which Type of Doctor Should I See?

Many different types of doctors treat back pain, from family physicians to doctors who specialize 

in disorders of the nerves and musculoskeletal system.

In most cases, it’s best to see your primary care 

doctor first. In many cases, he or she can treat the 

problem. In other cases, your doctor may refer you 

to an appropriate specialist.

8
How Is Back Pain Diagnosed?

D iagnosing the cause of back pain requires a medical history and a physical exam. If necessary, your doctor 

may also order medical tests, which may include x rays.

During the medical history, your doctor will ask questions 

about the nature of your pain and about any health 

problems you and close family members have or have had.

Questions might include the following:

n Have you fallen or injured your back recently?

n Does your back feel better – or hurt worse – when 

you lie down?

n Are there any activities or positions that ease or 

aggravate pain?

n Is your pain worse or better at a certain time of day?

n Do you or any family members have arthritis or 

other diseases that might affect the spine?

n Have you had back surgery or back pain before?

n Do you have pain, numbness, or tingling down 

one or both legs?

During the physical exam, your doctor may:

n watch you stand and walk 

n check your reflexes to look for slowed or heightened 

reflexes, either of which might suggest nerve problems

n check for fibromyalgia by examining your back 

for tender points, which are points on the body 

that are painful when pressure is applied to them

n check for muscle strength and sensation

n check for signs of nerve root irritation.

9
Often a doctor can find the cause of your pain with 

a physical and medical history alone. However, 

depending on what the history and exam show, your 

doctor may order medical tests to help find the cause.

Following are some tests your doctor may order:

X rays: Traditional x rays use low levels of radiation 

to project a picture onto a piece of film (some newer 

x rays use electronic imaging techniques). They are 

often used to view the bones and bony structures in 

the body. Your doctor may order an x ray if he or she 

suspects that you have a fracture or osteoarthritis or 

that your spine is not aligned properly.

Magnetic resonance imaging (MRI): MRI uses a 

strong magnetic force instead of radiation to create 

an image. Unlike an x ray, which shows only bony 

structures, an MRI scan produces clear pictures of 

soft tissues, too, such as ligaments, 

tendons, and blood vessels. Your 

doctor may order an MRI scan if he 

or she suspects a problem such as an 

infection, tumor, inflammation, or 

pressure on a nerve. An MRI scan, 

in most instances, is not necessary 

during the early phases of low back 

pain unless your doctor identifies 

certain “red flags” in your history 

and physical exam. An MRI scan 

is needed if the pain persists more 

than 3 to 6 weeks or if your doctor 

feels there may be a need for surgical consultation.

Because most low back pain goes away on its own, 

getting an MRI scan too early may sometimes create 

confusion for the patient and the doctor.

10

Diagnosing 

the cause of 

back pain 

requires a 

medical history 

and physical exam.
Computed tomography (CT) scan: A CT scan allows 

your doctor to see spinal structures that cannot be 

seen on traditional x rays. A computer creates a threedimensional image from a series of two-dimensional 

pictures that it takes of your back. Your doctor 

may order a CT scan to look for problems including 

herniated discs, tumors, or spinal stenosis.

Blood tests: Although blood tests are not used 

generally in diagnosing the cause of back pain, your 

doctor may order them in some cases. Blood tests that 

might be used include the following:

n Complete blood count (CBC), which could point 

to problems such as infection or inflammation

n Erythrocyte sedimentation rate (also called 

sed rate), a measure of inflammation that 

may suggest infection. The presence of 

inflammation may also suggest some forms 

of arthritis or, in rare cases, a tumor.

It is important to understand that medical tests alone 

may not diagnose the cause of back pain. In fact, 

experts say that up to 90 percent of all MRI scans 

of the spine show some type of abnormality, and 

sometimes the x rays and CT scans of people without 

pain show problems. Similarly, even some healthy 

pain-free people can have elevated sed rates.

Only with a medical history and exam – and 

sometimes medical tests – can a doctor diagnose the 

cause of back pain. Many times, the precise cause of 

back pain is never known. In these cases, it may be 

comforting to know that most back pain gets better 

whether or not you find out what is causing it.

11
What Is the Difference Between Acute and 

Chronic Pain? 

P ain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting 

a load that is just too heavy, for example – is acute 

pain. Acute pain comes on quickly and often leaves 

just as quickly. To be classified as acute, pain should 

last no longer than 6 weeks. Acute pain is the most 

common type of back pain.

Chronic pain, on the other hand, may come on either 

quickly or slowly, and it lingers a long time. In general, 

pain that lasts more than 3 months is considered chronic.

Chronic pain is much less common than acute pain.

How Is Back Pain Treated?

T reatment for back pain generally depends on what kind of pain you experience: acute or chronic.

Acute Back Pain

Acute back pain usually gets better on its own and 

without treatment, although you may want to try 

acetaminophen, aspirin, or ibuprofen to help ease 

the pain. Perhaps the best advice is to go about your 

usual activities as much as you can with the assurance 

that the problem will clear up. Getting up and moving 

around can help ease stiffness, relieve pain, and 

have you back doing your regular activities sooner.

Exercises or surgery are not usually advisable for acute 

back pain.

12
Chronic Back Pain

Treatment for chronic back pain 

falls into two basic categories: the 

kind that requires an operation 

and the kind that does not. In the 

vast majority of cases, back pain 

does not require surgery. Doctors 

will nearly always try nonsurgical 

treatments before recommending 

surgery. In a very small percentage 

of cases – when back pain is caused 

by a tumor, an infection, or a nerve 

root problem called cauda equina 

syndrome, for example – prompt 

surgery is necessary to ease the pain 

and prevent further problems.

Following are some of the more 

commonly used treatments for chronic back pain.

Nonsurgical treatments

Hot or cold: Hot or cold packs – or sometimes a 

combination of the two – can be soothing to 

chronically sore, stiff backs. Heat dilates the blood 

vessels, both improving the supply of oxygen that the 

blood takes to the back and reducing muscle spasms.

Heat also alters the sensation of pain. Cold may 

reduce inflammation by decreasing the size of blood 

vessels and the flow of blood to the area. Although 

cold may feel painful against the skin, it numbs deep 

pain. Applying heat or cold may relieve pain, but it 

does not cure the cause of chronic back pain.

13

Getting up and 

moving around 

can help ease 

stiffness, relieve 

pain, and have 

you back doing 

your regular 

activities sooner.
Exercise: Although exercise is usually not advisable 

for acute back pain, proper exercise can help ease 

chronic pain and perhaps reduce the risk of it 

returning. The following four types of exercise are 

important to general physical fitness and may be 

helpful for certain specific causes of back pain:

Flexion: The purposes of flexion exercises, which 

are exercises in which you bend forward, are to 

(1) widen the spaces between the vertebrae, thereby 

reducing pressure on the nerves; (2) stretch muscles 

of the back and hips; and (3) strengthen abdominal 

and buttock muscles. Many doctors think that 

strengthening the muscles of the abdomen will 

reduce the load on the spine. One word of caution: 

If your back pain is caused by a herniated disc, 

check with your doctor before performing flexion 

exercises because they may increase pressure within 

the disc, making the problem worse.

Extension: With extension exercises, you bend 

backward. They may minimize radiating pain, 

which is pain you can feel in other parts of the 

body besides where it originates. Examples of 

extension exercises are leg lifting and raising the 

trunk, each exercise performed while lying prone.

The theory behind these exercises is that they open 

up the spinal canal in places and develop muscles 

that support the spine.

14
15

Stretching: The goal of stretching exercises, as 

their name suggests, is to stretch and improve the 

extension of muscles and other soft tissues of the 

back. This can reduce back stiffness and improve 

range of motion.

Aerobic: Aerobic exercise is 

the type that gets your heart 

pumping faster and keeps your 

heart rate elevated for a while.

For fitness, it is important to get 

at least 30 minutes of aerobic 

(also called cardiovascular) 

exercise three times a week.

Aerobic exercises work the large 

muscles of the body and include 

brisk walking, jogging, and 

swimming. For back problems, 

you should avoid exercise that 

requires twisting or vigorous 

forward flexion, such as aerobic dancing and 

rowing, because these actions may raise pressure in 

the discs and actually do more harm than good. In 

addition, avoid high-impact activities if you have 

disc disease. If back pain or your fitness level make 

it impossible to exercise 30 minutes at a time, try 

three 10-minute sessions to start with and work up 

to your goal. But first, speak with your doctor or 

physical therapist about the safest aerobic exercise 

for you.

Speak with 

your doctor or 

physical therapist 

about the safest 

aerobic exercise 

for you.
Medications: A wide range of medications are used 

to treat chronic back pain. Some are available over 

the counter. Others require a doctor’s prescription.

The following are the main types of medications used 

for back pain.

Analgesics: Analgesic medications are those 

designed specifically to relieve pain. They include 

over-the-counter acetaminophen (Tylenol)1 and 

aspirin, as well as prescription narcotics, such 

as oxycodone with acetaminophen (Percocet) 

or hydrocodone with acetaminophen (Vicodin).

Aspirin and acetaminophen are the most commonly 

used analgesics; narcotics should only be used for 

a short time for severe pain or pain after surgery.

People with muscular back pain or arthritis pain 

that is not relieved by medications may find topical 

analgesics helpful. These creams, ointments, and 

salves are rubbed directly onto the skin over the 

site of pain. They use one or more of a variety of 

ingredients to ease pain. Topical analgesics include 

such products as Zostrix, Icy Hot, and Bengay.

NSAIDs: Nonsteroidal anti-inflammatory 

drugs (NSAIDs) are drugs that relieve pain and 

inflammation, both of which may play a role in 

some cases of back pain. NSAIDs include the 

nonprescription products ibuprofen (Motrin, Advil), 

16

1

 Brand names included in this booklet are provided as examples only, 

and their inclusion does not mean that these products are endorsed by 

the National Institutes of Health or any other Government agency.

Also, if a particular brand name is not mentioned, this does not mean 

or imply that the product is unsatisfactory.
17

ketoprofen (Actron, Orudis KT), and naproxen 

sodium (Aleve). More than a dozen others, including 

a subclass of NSAIDs called COX-2 inhibitors, are 

available only with a prescription.

All NSAIDs work similarly – by blocking substances 

called prostaglandins that contribute to inflammation 

and pain. However, each NSAID is a different chemical, 

and each has a slightly different effect on the body.

2

Side effects of all NSAIDs can include stomach upset 

and stomach ulcers, heartburn, diarrhea, and fluid 

retention; however, COX-2 inhibitors are designed to 

cause fewer stomach ulcers. For unknown reasons, 

some people seem to respond better to one NSAID than 

another. It’s important to work with your doctor to 

choose the one that’s safest and most effective for you.

Other medications: Muscle relaxants and certain 

antidepressants have also been prescribed for chronic 

back pain, but their usefulness is questionable.

2 Warning: NSAIDs can cause stomach irritation or, less often, they can 

affect kidney function. The longer a person uses NSAIDs, the more 

likely he or she is to have side effects, ranging from mild to serious.

Many other drugs cannot be taken when a patient is being treated with 

NSAIDs because NSAIDs alter the way the body uses or eliminates 

these other drugs. Check with your health care provider or pharmacist 

before you take NSAIDs. Also, NSAIDs sometimes are associated 

with serious gastrointestinal problems, including ulcers, bleeding, and 

perforation of the stomach or intestine. People age 65 and older and 

those with any history of ulcers or gastrointestinal bleeding should use 

NSAIDs with caution.
Traction: Traction involves using pulleys and weights 

to stretch the back. The rationale behind traction is to 

pull the vertebrae apart to allow a bulging disc to slip 

back into place. Some people experience pain relief while 

in traction, but that relief is usually temporary. Once 

traction is released, the stretch is not sustained and back 

pain is likely to return. There is no scientific evidence 

that traction provides any long-term benefits for people 

with back pain.

Corsets and braces: Corsets and braces 

include a number of devices, such 

as elastic bands and stiff supports 

with metal stays, that are designed 

to limit the motion of the lumbar 

spine, provide abdominal support, 

and correct posture. Although these 

may be appropriate after certain 

kinds of surgery, there is little, if any, 

evidence that corsets and braces help 

treat chronic low back pain. In fact, 

by keeping you from using your back 

muscles, they may actually cause more 

problems than they solve by causing 

lower back muscles to weaken from 

lack of use.

Behavioral modification: Developing a healthy attitude 

and learning to move your body properly while you 

do daily activities – particularly those involving heavy 

lifting, pushing, or pulling – are sometimes part of the 

treatment plan for people with back pain. Other behavior 

changes that might help pain include adopting healthy 

habits, such as exercise, relaxation, and regular sleep, and 

dropping bad habits, such as smoking and eating poorly.

18

Develop a 

healthy attitude 

and learn to 

move your body 

properly while 

you do daily 

activities.
19

Injections: When medications and other nonsurgical 

treatments fail to relieve chronic back pain, doctors 

may recommend injections for pain relief. Following 

are some of the most commonly used injections, 

although some are of questionable value:

Nerve root blocks: If a nerve is inflamed or 

compressed as it passes from the spinal column 

between the vertebrae, an injection called a nerve 

root block may be used to help ease the resulting 

back and leg pain. The injection contains a steroid 

medication or anesthetic and is administered to the 

affected part of the nerve. Whether the procedure 

helps or not depends on finding and injecting 

precisely the right nerve.

Facet joint injections: The facet joints are those 

where the vertebrae connect to one another, 

keeping the spine aligned. Although arthritis in 

the facet joints themselves is rarely the source of 

back pain, the injection of anesthetics or steroid 

medications into facet joints is sometimes tried 

as a way to relieve pain. The effectiveness of these 

injections is questionable. One study suggests 

that this treatment is overused and ineffective.

Trigger point injections: In this procedure, an 

anesthetic is injected into specific areas in the back 

that are painful when the doctor applies pressure 

to them. Some doctors add a steroid medication to 

the injection. Although the injections are commonly 

used, researchers have found that injecting 

anesthetics or steroids into trigger points provides no 

more relief than “dry needling” (inserting a needle 

and not injecting a medication).
Prolotherapy: One of the most talked about 

procedures for back pain, prolotherapy is a 

treatment in which a practitioner injects a 

sugar solution or other irritating substance into 

trigger points along the periosteum (the tough, 

fibrous tissue covering the bones) to trigger an 

inflammatory response that promotes the growth 

of dense, fibrous tissue. The theory behind 

prolotherapy is that such tissue growth strengthens 

the attachment of tendons and ligaments whose 

loosening has contributed to back pain. As 

yet, studies have not verified the effectiveness of 

prolotherapy. The procedure is used primarily by 

chiropractors and osteopathic doctors.

Complementary and alternative treatments: When 

back pain becomes chronic or when medications 

and other conventional therapies do not relieve it, 

many people try complementary and alternative 

treatments. Although such therapies won’t cure 

diseases or repair the injuries that cause pain, some 

people find them useful for managing or relieving 

pain. Following are some of the most commonly 

used complementary therapies.

Manipulation: Spinal manipulation refers to 

procedures in which professionals use their hands 

to mobilize, adjust, massage, or stimulate the 

spine or surrounding tissues. This type of therapy 

is often performed by osteopathic doctors and 

chiropractors. It tends to be most effective in people 

with uncomplicated pain and when used with other 

therapies. Spinal manipulation is not appropriate if 

you have a medical problem such as osteoporosis, 

spinal cord compression, or inflammatory arthritis 

(such as rheumatoid arthritis) or if you are taking 

20
21

blood-thinning medications such as warfarin 

(Coumadin) or heparin (Calciparine, Liquaemin).

Transcutaneous electrical nerve stimulation 

(TENS): TENS involves wearing a small box 

over the painful area that directs mild electrical 

impulses to nerves there. The theory is that 

stimulating the nervous system can modify 

the perception of pain. Early studies of TENS 

suggested it could elevate the levels of endorphins, 

the body’s natural pain-numbing chemicals, 

in the spinal fluid. But subsequent studies of its 

effectiveness against pain have produced 

mixed results.

Acupuncture: This ancient 

Chinese practice has been 

gaining increasing acceptance 

and popularity in the United 

States. Acupuncture is based on 

the theory that a life force called 

Qi (pronounced chee) flows 

through the body along certain 

channels, which if blocked can 

cause illness. According to the 

theory, the insertion of thin 

needles at precise locations along 

these channels by practitioners 

can unblock the flow of Qi, relieving pain and 

restoring health.

Although few Western-trained doctors would 

agree with the concept of blocked Qi, some believe 

that inserting and then stimulating needles (by 

twisting or passing a low-voltage electrical current 

through them) may foster the production of the 

Acupuncture 

has been gaining 

increasing 

acceptance and 

popularity in the 

United States.
body’s natural pain-numbing chemicals, such as 

endorphins, serotonin, and acetylcholine.

A consensus panel convened by the National 

Institutes of Health (NIH) in 1997 concluded that 

there is clear evidence this treatment is effective for 

some pain conditions, including postoperative dental 

pain. Although there is less convincing evidence to 

support using acupuncture for back pain and some 

other pain conditions, the panel concluded that 

acupuncture may be effective when used as part of 

a comprehensive treatment plan for low back pain, 

fibromyalgia, and several other conditions.

Acupressure: As with acupuncture, the theory 

behind acupressure is that it unblocks the flow 

of Qi. The difference between acupuncture 

and acupressure is that no needles are used in 

acupressure. Instead, a therapist applies pressure 

to points along the channels with his or her hands, 

elbows, or even feet. (In some cases, patients are 

taught to do their own acupressure.) Acupressure 

has not been well studied for back pain.

Rolfing: A type of massage, rolfing involves 

using strong pressure on deep tissues in the back 

to relieve tightness of the fascia, a sheath of 

tissue that covers the muscles, that can cause or 

contribute to back pain. The theory behind rolfing 

is that releasing muscles and tissues from the fascia 

enables the back to align itself properly. So far, 

the usefulness of rolfing for back pain has not been 

scientifically proven.

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23

Surgical treatments

Depending on the diagnosis, surgery may either be the 

first treatment of choice – although this is rare – or 

it is reserved for chronic back pain for which other 

treatments have failed. If you are in constant pain or 

if pain reoccurs frequently and interferes with your 

ability to sleep, to function at your job, or to perform 

daily activities, you may be a candidate for surgery.

In general, two groups of people may require surgery 

to treat their spinal problems. People in the first group 

have chronic low back pain and sciatica, and they are 

often diagnosed with a herniated disc, spinal stenosis, 

spondylolisthesis, or vertebral fractures with nerve 

involvement. People in the second group are those 

with only predominant low back pain (without leg 

pain). These are people with discogenic low back pain 

(degenerative disc disease), in which discs wear with 

age. Usually, the outcome of spine surgery is much 

more predictable in people with sciatica than in those 

with predominant low back pain.

Some of the diagnoses that may need surgery include:

Herniated discs: In this potentially painful problem, 

the hard outer coating of the discs, which are the 

circular pieces of connective tissue that cushion the 

bones of the spine, are damaged, allowing the discs’ 

jelly-like center to leak, irritating nearby nerves. This 

causes severe sciatica and nerve pain down the leg. A 

herniated disc is sometimes called a ruptured disc.
Spinal stenosis: Spinal stenosis is the narrowing of 

the spinal canal, through which the spinal cord and 

spinal nerves run. It is often caused by the overgrowth 

of bone caused by osteoarthritis of the spine.

Compression of the nerves caused by spinal stenosis 

can lead not only to pain, but also to numbness in the 

legs and the loss of bladder or bowel control. Patients 

may have difficulty walking any distance and may 

have severe pain in their legs along with numbness 

and tingling.

Spondylolisthesis: In this condition, a vertebra of the 

lumbar spine slips out of place. As the spine tries to 

stabilize itself, the joints between the slipped vertebra 

and adjacent vertebrae can become enlarged, pinching 

nerves as they exit the spinal column. Spondylolisthesis 

may cause not only low back pain but also severe 

sciatica leg pain.

Vertebral fractures: These fractures are caused by 

trauma to the vertebrae of the spine or by crumbling 

of the vertebrae resulting from osteoporosis. This 

causes mostly mechanical back pain, but it may also 

put pressure on the nerves, creating leg pain.

Discogenic low back pain (degenerative disc disease):

Most people’s discs degenerate over a lifetime, but 

in some, this aging process can become chronically 

painful, severely interfering with their quality of life.

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25

Following are some of the most commonly performed 

back surgeries:

For Herniated Disc

Laminectomy/discectomy: In this operation, part 

of the lamina, a portion of the bone on the back of 

the vertebrae, is removed, as well as a portion of a 

ligament. The herniated disc is then removed through 

the incision, which may extend two or more inches.

Microdiscectomy: As with traditional discectomy, 

this procedure involves removing a herniated disc or 

damaged portion of a disc through an incision in the 

back. The difference is that the incision is much smaller 

and the doctor uses a magnifying microscope or lenses 

to locate the disc through the incision. The smaller 

incision may reduce pain and the disruption of tissues, 

and it reduces the size of the surgical scar. It appears to 

take about the same amount of time to recuperate from 

a microdiscectomy as from a traditional discectomy.

Laser surgery: Technological advances in recent 

decades have led to the use of lasers for operating on 

patients with herniated discs accompanied by lower 

back and leg pain. During this procedure, the surgeon 

inserts a needle in the disc that delivers a few bursts 

of laser energy to vaporize the tissue in the disc. This 

reduces its size and relieves pressure on the nerves.

Although many patients return to daily activities 

within 3 to 5 days after laser surgery, pain relief may 

not be apparent until several weeks or even months 

after the surgery. The usefulness of laser discectomy is 

still being debated.
For Spinal Stenosis

Laminectomy: When narrowing of the spine 

compresses the nerve roots, causing pain or affecting 

sensation, doctors sometimes open up the spinal 

column with a procedure called a laminectomy. In a 

laminectomy, the doctor makes a large incision down 

the affected area of the spine and removes the lamina 

and any bone spurs, which are overgrowths of bone, 

that may have formed in the spinal canal as the result 

of osteoarthritis. The procedure is major surgery that 

requires a short hospital stay and physical therapy 

afterwards to help regain strength and mobility.

For Spondylolisthesis

Spinal fusion: When a slipped vertebra leads to the 

enlargement of adjacent facet joints, surgical treatment 

generally involves both laminectomy (as described above) 

and spinal fusion. In spinal fusion, two or more vertebrae 

are joined together using bone grafts, screws, and rods 

to stop slippage of the affected vertebrae. Bone used for 

grafting comes from another area of the body, usually 

the hip or pelvis. In some cases, donor bone is used.

Although the surgery is generally successful, either type 

of graft has its drawbacks. Using your own bone means 

surgery at a second site on your body. With donor bone, 

there is a slight risk of disease transmission or rejection.

In recent years, a new development has eliminated those 

risks for some people undergoing spinal fusion: proteins 

called bone morphogenic proteins are being used to 

stimulate bone generation, eliminating the need for grafts.

The proteins are placed in the affected area of the spine, 

often in collagen putty or sponges.

26
27

Regardless of how spinal fusion is 

performed, the fused area of the 

spine becomes immobilized.

For Vertebral Osteoporotic Fractures3

Vertebroplasty: When back pain is 

caused by a compression fracture 

of a vertebra due to osteoporosis or 

trauma, doctors may make a small 

incision in the skin over the affected 

area and inject a cement-like 

mixture called polymethylacrylate 

into the fractured vertebra to 

relieve pain and stabilize the spine. The procedure is 

generally performed on an outpatient basis under a 

mild anesthetic.

Kyphoplasty: Much like vertebroplasty, kyphoplasty 

is used to relieve pain and stabilize the spine following 

fractures due to osteoporosis. Kyphoplasty is a twostep process. In the first step, the doctor inserts a 

balloon device to help restore the height and shape 

of the spine. In the second step, he or she injects 

polymethylacrylate to repair the fractured vertebra.

The procedure is done under anesthesia, and in some 

cases it is performed on an outpatient basis.

Regardless of how 

spinal fusion is 

performed, the 

fused area of the 

spine becomes 

immobilized.

3

 Used only if standard care, rest, corsets and braces, and analgesics fail.
For Discogenic Low Back Pain (Degenerative 

Disc Disease)

Intradiscal electrothermal therapy (IDT): One of 

the newest and least invasive therapies for low back 

pain involves inserting a heating wire through a small 

incision in the back and into a disc. An electrical 

current is then passed through the wire to strengthen 

the collagen fibers that hold the disc together. The 

procedure is done on an outpatient basis, often under 

local anesthesia. The usefulness of IDT is debatable.

Spinal fusion: When the degenerated disc is painful, the 

surgeon may recommend removing it and fusing the disc 

to help with the pain. This fusion can be done through 

the abdomen, a procedure known as anterior lumbar 

interbody fusion, or through the back, called posterior 

fusion. Theoretically, fusion surgery should eliminate the 

source of pain; the procedure is successful in about 60 

to 70 percent of cases. Fusion for low back pain or any 

spinal surgeries should only be done as a last resort, and 

the patient should be fully informed of risks.

Disc replacement: When a disc is herniated, one 

alternative to a discectomy – in which the disc is simply 

removed – is removing the disc and replacing it with 

a synthetic disc. Replacing the damaged one with 

an artificial one restores disc height and movement 

between the vertebrae. Artificial discs come in several 

designs. Although doctors in Europe had performed disc 

replacement for more than a decade, the procedure had 

been experimental in the United States until the Food and 

Drug Administration approved the Charité artificial disc 

for use (http://www.fda.gov/cdrh/pdf4/p040006.html).

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What Kind of Research Is Being Done?

T he National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is 

currently supporting a number of studies to better 

understand and treat back pain. Goals of current 

research include the following:

To compare the effectiveness of surgery versus 

nonsurgical treatment for low back pain. Although 

the percentage of people having spinal surgery in 

the United States has increased sharply over time, 

there is not much information on whether back 

surgery is better than nonsurgical treatments. One 

study is comparing the most commonly used surgical 

treatments to the most commonly used nonsurgical 

treatments for three common back problems: herniated 

discs of the lumbar spine, spinal stenosis, and spinal 

stenosis from spondylolisthesis. The study, being 

conducted at 12 medical centers, will follow patients 

for at least 24 months after treatment to determine the 

medical and cost-effectiveness of treatments.

To identify the best treatments for certain patients 

with low back pain. Just as certain treatments are 

effective for some back problems and not others, 

the same treatment may be effective for some people 

and not others – even if those people have the same 

medical problem. Researchers at several centers will 

study more than 3,000 patients who have one of three 

common causes of back pain – herniated discs, spinal 

stenosis, and spondylolisthesis – and who respond well 

to specific treatments. Extensive testing and surveys 

will allow doctors to identify the best treatments for 

these patients.
To test the effectiveness of lumbar fusion and other 

treatments for disc-derived pain. Discogenic pain is low 

back pain due to the wearing away of a disc between 

the vertebrae. Although treatment for this condition 

is often lumbar spinal fusion, its effectiveness, as well 

as that of other treatments, has not been established.

A new study will compare the results of spinal fusion 

with those of nonsurgical care for patients with similar 

disc degeneration. Researchers will also try to find out 

(1) what distinguishes people who choose surgery from 

those who do not; (2) the consequences of common 

complications of spinal fusion surgery and how often 

they occur; (3) what predicts a good response to surgical 

therapy but not to other treatments; and (4) what are the 

characteristics and outcomes of patients who have repeat 

back surgery for this condition.

To measure the frequency of complications in lumbar 

fusion surgery. Lumbar spinal fusion is a commonly 

performed procedure for several back problems, 

including disc degeneration, spondylolisthesis, 

spinal stenosis, and scoliosis, but the procedure can 

have complications. A new study will follow 1,000 

people who have spinal fusion for one of these 

diagnoses to find out (1) how often complications 

occur after surgery, (2) how the rates of specific 

serious complications vary with different types 

of lumbar fusion, (3) the consequences of specific 

types of complications, and (4) the characteristics of 

treatments or patients that predict particularly severe 

complications. The information will help doctors better 

assess the benefits versus the risks of the procedure.

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31

To better understand the relationship between the loss of 

motor control and low back pain. Compared to people 

without back problems, those with low back pain show 

losses in motor control, including problems with trunk 

muscle response and posture. Some researchers believe 

that losses in motor control may predispose people to 

falls that result in back pain. Other 

researchers think losses in motor 

control may result from damage 

sustained by tissue during a fall.

To explore the relationship between 

motor control loss and back pain, 

scientists will study varsity athletes 

to determine whether poor motor 

control of the lumbar spine increases 

the risk of low back injury. They will 

also study changes in the lumbar 

spine motor control of people with 

low back pain after they complete 

rehabilitation programs that 

emphasize motor control training.

To develop and evaluate a psychosocial program for 

people with acute low back pain. Acute low back pain is 

a common problem that affects people’s abilities to work 

and function, and it contributes to high health care costs.

There are few studies, however, that prove whether or 

not a treatment truly reduces limitation and prevents 

the recurrence of pain. One new project will develop a 

program to enhance the social support and self-efficacy 

of people with acute low back pain. After developing 

and testing the program, researchers will evaluate its 

effectiveness by comparing the results of 160 participants 

with those of 160 people receiving usual care.

NIAMS is 

currently 

supporting a 

number of studies 

to better 

understand and 

treat back pain.
To evaluate the nervous system mechanisms of low back 

pain. Scientists think that when a disc ruptures, material 

leaking from its jelly-like filling leads to inflammation 

and the release of chemicals that irritate cells within 

the spinal canal. Scientists believe that the effects of 

these chemicals on the nerve endings in discs and 

adjacent tissue lead to low back pain, while the effects 

on dorsal nerve roots lead to sciatica. One study will 

test these ideas using a variety of techniques. A better 

understanding of pain mechanisms related to herniated 

discs will allow researchers to develop better treatments.

To evaluate an Internet-based patient education 

program. Patient education can play an important 

role in managing back pain. Yet taking part in an 

educational program can be difficult and timeconsuming for some people, particularly if they live far 

from an area where such a program is offered. A study, 

conducted with patients recruited from Silicon Valley 

employers and the Internet, will test the effectiveness 

of an Internet-based education program. Participants 

will receive a book and videotape, and they will interact 

with other program participants through a moderated 

Internet discussion group. Patient assessments will also 

be conducted through the Internet.

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33

For More Information

National Institute of Arthritis and Musculoskeletal and 

Skin Diseases (NIAMS)

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892–3675

Phone: 877–22–NIAMS (226–4267) (free of charge)

TTY: 301–565–2966

Fax: 301–718–6366

E-mail: NIAMSinfo@mail.nih.gov

www.niams.nih.gov

National Institute of Neurological Disorders 

and Stroke (NINDS)

NIH Neurological Institute

P.O. Box 5801

Bethesda, MD 20824

Phone: 301–496–5751 or 

800–352–9424 (free of charge)

TTY: 301–468–5981

www.ninds.nih.gov
National Center for Complementary and 

Alternative Medicine

National Institutes of Health

P.O. Box 7923

Gaithersburg, MD 20898–7923

Phone: 888–644–6226 (free of charge)

TTY: 866–464–3615 (free of charge)

Fax: 866–464–3616 (free of charge)

E-mail: info@nccam.nih.gov

www.nccam.nih.gov

Agency for Healthcare Research and Quality

Office of Communications and Knowledge Transfer

540 Gaither Road, Suite 2000

Rockville, MD 20850

Phone: 301–427–1364

www.ahrq.gov

National Institute for Occupational Safety and Health

4676 Columbia Parkway 

Cincinnati, OH 45226

Phone: 800–CDC–INFO (232–4636) (free of charge)

TTY: 888–232–6348

E-mail: cdcinfo@cdc.gov

www.cdc.gov/niosh

American Academy of Orthopaedic Surgeons (AAOS)

P.O. Box 2058

Des Plaines, IL 60017

Phone: 800–824–BONE (2663) (free of charge)

www.aaos.org

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35

North American Spine Society (part of AAOS)

7075 Veterans Boulevard

Burr Ridge, IL 60527

Phone: 630–230–3600 or 

866–960–6277 (free of charge)

Fax: 630–230–3700

E-mail: info@spine.org

www.spine.org

American College of Rheumatology (ACR)/Association 

of Rheumatology Health Professionals

1800 Century Place, Suite 250

Atlanta, GA 30345–4300

Phone: 404–633–3777

Fax: 404–633–1870

www.rheumatology.org 

Arthritis Foundation

P.O. Box 7669

Atlanta, GA 30357–0669

Phone: 404–872–7100 or

800–283–7800 (free of charge) or call your local 

chapter (to find your local chapter, check your phone 

directory or visit the foundation’s Web site).

www.arthritis.org 

American Chiropractic Association

1701 Clarendon Boulevard

Arlington, VA 22209

Phone: 703–276–8800 or 

800–621–1773 (free of charge)

Fax: 703–243–2593

www.amerchiro.org
American Osteopathic Association

142 East Ontario Street

Chicago, IL 60611

Phone: 312–202–8000 or 

800–621–1773 (free of charge)

Fax: 312–202–8200

www.osteopathic.org

Glossary

Acupuncture – an ancient Chinese practice that involves 

inserting thin needles at various sites on the body to relieve 

pain or influence other body processes. Today, doctors use 

acupuncture for problems as diverse as addiction, morning 

sickness, and back pain.

Acute pain – the most common type of back pain. Acute 

pain often begins suddenly – after a fall or injury, for 

example – and lasts no longer than 6 weeks.

Analgesics – medications designed to relieve pain.

Analgesics used for back pain include both prescription 

and over-the-counter products. Some are made to be 

taken orally, and others are rubbed onto the skin.

Ankylosing spondylitis – a form of arthritis that affects the 

spine, the sacroiliac joints, and sometimes the hips and 

shoulders. In severe cases, the joints of the spine fuse and 

the spine becomes rigid.

Cauda equina syndrome – a condition in which the nerves 

that control the bowels and bladder are pinched as they 

leave the spine. Unless treated promptly, the condition can 

lead to the loss of bowel or bladder function.

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37

Cervical spine – the upper portion of the spine closest to 

the skull. The cervical spine comprises seven vertebrae.

Chronic pain – the least common type of back pain.

Chronic pain may begin either quickly or slowly; it 

generally lasts for 3 months or more.

Disc – a circular piece of cushioning tissue situated 

between each of the spine’s vertebrae. Each disc has a 

strong outer cover and a soft jelly-like filling.

Discectomy – the surgical removal of a herniated disc. A 

discectomy can be performed in a number of different 

ways, such as through a large incision in the spine or 

through newer, less invasive procedures using magnifying 

microscopes, x rays, small tools, and even lasers.

Facet joints – the joints where the vertebrae of the spine 

connect to one another. Arthritis of the facet joints is 

believed to be an uncommon cause of back pain.

Fibromyalgia – a condition of widespread muscle pain, 

fatigue, and tender points on the body. Fibromyalgia is 

one cause of low back pain.

Herniated disc – a potentially painful problem in which 

the hard outer coating of the disc is damaged, allowing the 

disc’s jelly-like center to leak and cause irritation to adjacent 

nerves.

Intradiscal electrothermal therapy (IDT) – a treatment 

for herniated discs in which a wire is inserted into the disc 

through a small incision in the back. An electrical current 

is then passed through wire to modify and strengthen the 

collagen fibers that hold the disc together.
38

Kyphoplasty – a procedure for vertebral fractures in which 

a balloon-like device is inserted into the vertebra to help 

restore the height and shape of the spine and a cementlike substance is injected to repair and stabilize it.

Laminectomy – the surgical removal of the lamina (the 

back of the spinal canal) and spurs inside the canal that 

are pressing on nerves within the canal. The procedure is a 

major surgery requiring a large incision and a hospital stay.

Lumbar spine – the lower portion of the spine. The lumbar 

spine comprises five vertebrae.

Osteoarthritis – a disease in which the cartilage that 

cushions the ends of the bones at the joints wears away, 

leading to pain, stiffness, and bony overgrowths, called 

spurs. It is the most common form of arthritis and 

becomes more likely with age.

Osteoporosis – a condition in which the bones become 

porous and brittle and break easily.

Prolotherapy – a treatment for back pain in which a 

practitioner injects a sugar solution or other irritating 

substance into trigger points along the periosteum 

(tough, fibrous tissue covering the bones) to trigger an 

inflammatory response that promotes the growth of 

dense, fibrous tissue. The theory behind prolotherapy 

is that such tissue growth strengthens the attachment of 

tendons and ligaments whose loosening has contributed 

to back pain.
39

Rolfing – a type of massage that uses strong pressure on 

deep tissues in the back to relieve tightness of the fascia (a 

sheath of tissue that covers the muscles) that can cause or 

contribute to back pain.

Rheumatoid arthritis – a disease that occurs when the 

body’s immune system attacks the tissue that lines the 

joints, leading to joint pain, inflammation, instability, and 

misshapen joints.

Sacroiliac joints – the joints where the spine and pelvis 

attach. The sacroiliac joints are often affected by types 

of arthritis referred to as spondyloarthropathies.

Sciatica – pain felt down the back and outer side of 

the thigh. The usual cause is a herniated disc, which 

is pressing on a nerve root.

Scoliosis – a condition in which the spine curves to 

one side as a result of congenital malformations, 

neuromuscular disorders, injury, infection, or tumors.

Spinal fusion – the surgical joining of two more vertebrae 

together, usually with bone grafts and hardware. The 

resulting fused vertebrae are stable but immobile. Spinal 

fusion is used as a treatment for spondylolisthesis, 

scoliosis, herniated discs, and spinal stenosis.

Spinal stenosis – the narrowing of the spinal canal 

(through which the spinal cord runs), often by the 

overgrowth of bone caused by osteoarthritis of the spine.
40

Spondyloarthropathy – a form of arthritis that primarily 

affects the spine and sacroiliac joints.

Spondylolisthesis – a condition in which a vertebra of the 

lumbar (lower) spine slips out of place.

Transcutaneous electrical nerve stimulation (TENS) –

a treatment designed to relieve pain by directing mild 

electrical impulses to nerves in the painful area of the body.

Vertebrae – the individual bones that make up the 

spinal column.

Vertebroplasty – a minimally invasive surgical procedure 

that involves injecting a cement-like mixture into a 

fractured vertebra to relieve pain and stabilize the spine.

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Acknowledgments

NIAMS gratefully acknowledges the assistance of 

James Kang, M.D., University of Pittsburgh, PA; 

Jeffrey Katz, M.D., Brigham and Women’s Hospital, 

Boston, MA; William Lauerman, M.D., Georgetown 

University, Washington, DC; and James Panagis, 

M.D., M.P.H., NIAMS, NIH, Bethesda, MD, in the 

preparation and review of this booklet. Special thanks 

also go to the other individuals who reviewed this 

publication and provided valuable assistance.

The mission of the National Institute of Arthritis 

and Musculoskeletal and Skin Diseases (NIAMS), 

a part of the U.S. Department of Health and Human 

Services’ National Institutes of Health (NIH), is 

to support research into the causes, treatment, and 

prevention of arthritis and musculoskeletal and skin 

diseases; the training of basic and clinical scientists 

to carry out this research; and the dissemination of 

information on research progress in these diseases. 

The NIAMS Information Clearinghouse is a public 

service sponsored by the Institute that provides health 

information and information sources. Additional 

information can be found on the NIAMS Web site 

at www.niams.nih.gov. Information on bone and its 

disorders can be obtained from the NIH Osteoporosis 

and Related Bone Diseases ~ National Resource 

Center by calling (toll free) 800–624–BONE (2663) 

or by visiting its Web site at www.niams.nih.gov/bone.
U.S. Department of Health and

Human Services

Public Health Service

National Institutes of Health

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases

NIH Publication No. 05–5282

September 2005