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August 2016

Handout on Health: Back

Pain

This publication is for people who have

back pain, as well as family members,

friends, and others who want to find out

more about it. The publication 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 publication, you may wish to

discuss them with your doctor.

What Is Back Pain?

Back 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 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?

What Are the Risk Factors for

Back Pain?

What Are the Causes of Back

Pain?

Can Back Pain Be Prevented?

When Should I See a Doctor for

Pain?

Which Type of Doctor Should I

See?

How Is Back Pain Diagnosed?

We want to hear from you

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What Is the Difference Between

Acute and Chronic Pain?

How Is Back Pain Treated?

What Kind of Research Is Being

Done?

For More Information

Keywords

Illustrations

Side View of Spine

Normal Vertebra (Cross-Section)

How Common Is Back Pain?

In a 3-month period, more than

one-fourth of U.S. adults experience at

least 1 day of back pain. It is one of our

society’s most common medical

problems.

What Are the Risk Factors for

Back Pain?

Although 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.

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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 disks that cushion the vertebrae, the

individual bones that make up the spine.

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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,

such as ankylosing spondylitis, a form of

arthritis that affects the spine, 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.

The presence of other diseases: Many

diseases can cause or contribute to back

pain. These include various forms of

arthritis, such as osteoarthritis and

rheumatoid arthritis, 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 and/or leg due to pressure on a

nerve.) Furthermore, smoking can slow

healing, prolonging pain for people who

have had back injuries, back surgery, or

broken bones.

What Are the Causes of Back

Pain?

It 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.

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Perhaps the most common mechanical

cause of back pain is a condition called

intervertebral disk degeneration, which

simply means that the disks 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 disks,

which are also called herniated disks.

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. Less

commonly, back pain may be caused by

more severe injuries that result from

accidents or falls.

Acquired conditions and diseases:

Many medical problems can cause or

contribute to back pain. They include

scoliosis, a curvature of the spine that

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, a condition

of widespread muscle pain and fatigue.

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

disks that cushion the vertebrae, which is

called diskitis. 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

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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.

Can Back Pain Be Prevented?

One of the best things you can do to

prevent many types of back pain is to

exercise regularly and keep your back

muscles strong. Four specific types of

exercises are described in the section

How Is Back Pain Treated? 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 weightbearing 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.

When Should I See a Doctor for

Pain?

In most cases, it is not necessary to see

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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 is 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.

How Is Back Pain Diagnosed?

Diagnosing 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.

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.

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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.

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

three-dimensional image from a series of

two-dimensional pictures that it takes of

your back.

Blood tests: Although blood tests are not

used generally in diagnosing the cause of

back pain, your doctor may order them in

some cases.

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.

What Is the Difference Between

Acute and Chronic Pain?

Pain that hits you suddenly—after falling

from a ladder, being tackled on the

football field, or lifting a load that is 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 longer than 3 months is considered

chronic. Chronic pain is much less

common than acute pain.

How Is Back Pain Treated?

Treatment for back pain generally

depends on what kind of pain you

experience: acute or chronic.

Acute Back Pain

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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.

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.

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

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may be helpful for certain specific causes

of back pain. (Check with your doctor

before starting a new exercise routine.)

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.

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.

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 disks and actually

do more harm than good. In

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addition, avoid high-impact

activities if you have disk disease.

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.1

1All medicines can have side effects.

Some medicines and side effects are

mentioned in this publication. Some side

effects may be more severe than others.

You should review the package insert that

comes with your medicine and ask your

health care provider or pharmacist if you

have any questions about the possible

side effects.

Analgesics: Analgesic

medications are those designed

specifically to relieve pain. They

include over-the-counter

acetaminophen and aspirin, as

well as prescription narcotics.

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.

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. A subclass of NSAIDs called

COX-2 inhibitors, are available

only with a prescription. It’s

important to work with your doctor

to choose the one that’s safest

and most effective for you.2

2 Warning: Side effects of NSAIDs

include stomach problems; skin

rashes; high blood pressure; fluid

retention; and liver, kidney, and

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heart problems. 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. NSAIDs

should only be used at the lowest

dose possible for the shortest

time needed.

Other medications: Muscle

relaxants and certain

antidepressants have also been

prescribed for chronic back pain,

but their usefulness is

questionable. If the cause of back

pain is an inflammatory form of

arthritis, medications used to treat

that specific form of arthritis may

be helpful against the pain.

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 disk 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.

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.

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

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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.

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.

Some of the diagnoses that may need

surgery include:

Herniated disks: In this potentially

painful problem, the hard outer coating of

the disks, which are the circular pieces of

connective tissue that cushion the bones

of the spine, are damaged, allowing the

disks’ jelly-like center to leak, irritating

nearby nerves. This causes severe

sciatica and nerve pain down the leg. A

herniated disk is sometimes called a

ruptured disk.

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

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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.

Diskogenic low back pain

(degenerative disk disease): Most

people’s disks degenerate over a lifetime,

but in some, this aging process can

become chronically painful, severely

interfering with their quality of life.

Following are some of the most

commonly performed back surgeries:

For herniated disks:

Laminectomy/diskectomy: 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 disk is then

removed through the incision, which may

extend two or more inches.

Microdiskectomy: As with traditional

diskectomy, this procedure involves

removing a herniated disk or damaged

portion of a disk 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 disk through the incision. The

smaller incision may reduce pain and the

disruption of tissues, and it reduces the

size of the surgical scar.

Laser surgery: Technological advances

in recent decades have led to the use of

lasers for operating on patients with

herniated disks accompanied by lower

back and leg pain. During this procedure,

the surgeon inserts a needle in the disk

that delivers a few bursts of laser energy

to vaporize the tissue in the disk. 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 diskectomy is still being debated.

For spinal stenosis:

Laminectomy: When narrowing of the

spine compresses the nerve roots,

causing pain or affecting sensation,

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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 tissue rejection,

which happens when your immune

system attacks the donor tissue. 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.

Regardless of how spinal fusion is

performed, the fused area of the spine

becomes immobilized.

For vertebral osteoporotic fractures:

Vertebroplasty: When back pain is

caused by a compression fracture of a

vertebra caused by 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

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vertebra to relieve pain and stabilize the

spine.3 The procedure is generally

performed on an outpatient basis under a

mild anesthetic.

3Used only if standard care, rest, corsets

and braces, and analgesics fail.

Kyphoplasty: Much like vertebroplasty,

kyphoplasty is used to relieve pain and

stabilize the spine following fractures

caused by 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.

For diskogenic low back pain

(degenerative disk disease):

Intradiskal electrothermal therapy

(IDET): One of the least invasive

therapies for low back pain involves

inserting a heating wire through a small

incision in the back and into a disk. An

electrical current is then passed through

the wire to strengthen the collagen fibers

that hold the disk together. The procedure

is done on an outpatient basis, often

under local anesthesia. The effectiveness

of IDET is not clear.

Spinal fusion: When the degenerated

disk is painful, the surgeon may

recommend removing it and fusing the

disk 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. 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.

Disk replacement: When a disk is

herniated, one alternative to a

diskectomy, in which the disk is simply

removed, is removing the disk and

replacing it with a synthetic disk.

Replacing the damaged one with an

artificial one restores disk height and

movement between the vertebrae.

Artificial disks come in several designs.

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What Kind of Research Is Being

Done?

The National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS) supports research to better

understand and treat back pain.

One major focus of research in recent

years has been on the relative efficacy

and cost effectiveness of surgical versus

nonsurgical treatment of conditions

associated with low back and leg pain. A

multi-year, multicenter study called the

Spine Patient Outcomes Research Trial

(SPORT) compared the most commonly

used standard surgical and nonsurgical

treatments for patients with the three

most common diagnoses for which spine

surgery is performed: intervertebral disk

herniation, spinal stenosis, and

degenerative spondylisthesis.

Early findings from the study showed

that, in general, otherwise healthy people

who have surgery for one of these three

conditions are likely to fare better than

those who receive nonoperative care.

(However, long-term follow-up suggests

that the advantages of surgery decrease

with time for spinal stenosis.)

SPORT investigators also found that

people who are reluctant to have surgery

may also recover with nonoperative

treatments if their conditions are not

progressing and their pain is tolerable.

And, importantly, delaying or avoiding

surgery does not cause additional

damage in most cases.

NIAMS-supported research in back pain

is ongoing. Goals of research are to:

understand the mechanisms of

back pain

identify ways to prevent back pain

improve surgical and nonsurgical

treatments for back pain

prevent disability in people who

suffer from back pain.

More information on research is available

from the following websites:

NIH Clinical Research Trials

and You was designed to help

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people learn more about clinical

trials, why they matter, and how to

participate. Visitors to the website

will find information about the

basics of participating in a clinical

trial, first-hand stories from clinical

trial volunteers, explanations from

researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers

up-to-date information for locating

federally and privately supported

clinical trials for a wide range of

diseases and conditions.

NIH RePORTER is an electronic

tool that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years

and access publications (since

1985) and patents resulting from

NIH funding.

PubMed is a free service of the

U.S. National Library of Medicine

that lets you search millions of

journal citations and abstracts in

the fields of medicine, nursing,

dentistry, veterinary medicine, the

health care system, and

preclinical sciences.

For More Information

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about

available resources in your language or

another language, please visit our

website or contact the NIAMS Information

Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

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National Institute of Neurological

Disorders and Stroke

National Institutes of Health

Website: http://www.ninds.nih.gov

National Center for Complementary

and Integrative Health

National Institutes of Health

Website: https://nccih.nih.gov/

Agency for Healthcare Research and

Quality Office of Communications and

Knowledge Transfer

Website: http://www.ahrq.gov

National Institute for Occupational

Safety and Health

Website: http://www.cdc.gov/niosh

American Academy of Orthopaedic

Surgeons

Website: http://www.aaos.org (con

información en español)

North American Spine Society

Website: http://www.spine.org

American College of Rheumatology

Website: http://www.rheumatology.org

Arthritis Foundation

Website: http://www.arthritis.org

American Chiropractic Association

Website: http://www.amerchiro.org

American Osteopathic Association

Website: http://www.osteopathic.org/

Key Words

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

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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.

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 come about

suddenly or gradually; it generally lasts

for 3 months or longer.

Disk. A circular piece of cushioning

tissue situated between each vertebrae of

the spine. Each disk has a strong outer

cover and a soft jelly-like filling.

Diskectomy. The surgical removal of a

herniated disk. A diskectomy 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

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 disk. A potentially painful

problem in which the hard outer coating

of the disk is damaged, allowing the

disk’s jelly-like center to leak and cause

irritation to adjacent nerves.

Intradiskal electrothermal therapy

(IDET). A treatment for herniated disks in

which a wire is inserted into the disk

through a small incision in the back. An

electrical current is then passed through

wire to modify and strengthen the

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collagen fibers that hold the disk together.

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

cement-like 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.

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 disk, 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

or 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

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disks, 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.

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.

Tissue rejection. Tissue rejection occurs

when a person’s immune system attacks

donor tissue, such as donor bone tissue

used for spinal fusion surgery.

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.

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in

the preparation and review of the original

version of this booklet: James Kang,

M.D., University of Pittsburgh, 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

.

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

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information sources. Additional

information can be found on the NIAMS

website 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

website at www.niams.nih.gov/bone.

For Your Information

This publication contains information

about medications used to treat the

health condition discussed here. When

this publication was developed, we

included the most up-to-date (accurate)

information available. Occasionally, new

information on medication is released.

For updates and for any questions about

any medications you are taking, please

contact

U.S. Food and Drug

Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about

statistics, please contact

Centers for Disease Control

and Prevention, National Center

for Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted.

Readers are encouraged to duplicate and

distribute as many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis

and Musculoskeletal and Skin

Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

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Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website:

https://www.niams.nih.gov

NIH Publication No. 16–5282

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