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Low back pain

Also listed as: Back pain - low

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Special Considerations
• Supporting Research

Low back pain affects 60 - 80% of the adult U.S. population. Low back problems affect the spine's flexibility, stability, and strength, which can cause pain, discomfort, and stiffness.

Signs and Symptoms

• Tenderness, pain, and stiffness in the lower back
• Pain that radiates into the buttocks or legs
• Difficulty standing erect or standing in one position for a long time
• Discomfort while sitting
• Weakness and leg fatigue while walking

What Causes It?

Low back pain is usually caused by strain from lifting, twisting, or bending. However, in some cases low back pain can be a sign of a more serious condition, such as an infection, a rheumatic or arthritic condition, or an ovarian cyst.

A ruptured or bulging disk, the strong, spongy, gel-filled cushions that lie between each vertebra, and compression fractures of the bones in the spine can also cause low back pain, especially in older women with osteoporosis.

Poor overall fitness, smoking, and general life dissatisfaction increase a person's risk for low back problems.

What to Expect at Your Provider's Office

Your doctor will ask you to stand, sit, and move. He or she will check your reflexes and perhaps your response to touch, slight heat, or a pinprick. Other tests may include strength testing on a treadmill, blood tests, x-rays, a magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan.

Treatment Options

Lifestyle changes can often help relieve and prevent low back pain. You can lower your risk of back problems by exercising, maintaining a healthy weight, and practicing good posture. Learning to bend and lift properly, sleeping on a firm mattress, sitting in supportive chairs, and wearing supportive shoes are other important factors.

For long-term back pain, your doctor may recommend stronger medications or surgery.

Medications used to treat low back pain include nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, muscle relaxants, and oral or epidural steroids that reduce inflammation.

Complementary and Alternative Therapies

Alternative therapies can be effective for easing muscle tension, correcting spinal imbalances, relieving discomfort, and averting long-term back problems by improving muscle strength and joint stability.

Nutrition

• B-complex: B1 (50 to 100 mg), B2 (50 mg), B3 (25 mg), B5 (100 mg), B6 (50 to 100 mg), B12 (100 to 1,000 mcg), folate (400 mcg per day) helps reduce stress and pain.
• Vitamin E (400 IU per day), vitamin C (250 to 500 mg twice daily)
• Calcium (1,500 to 2,000 mg) and magnesium (700 to 1,000 mg) to regulate muscle contraction and ease spasm
• Bromelain: (250 to 500 mg three times per day on an empty stomach) anti-inflammatory, works especially well with turmeric

Herbs

You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, 10 to 20 minutes for roots. Mix three to six of the following (one cup tea or 30 to 60 drops of tincture three to six times per day).

• Relaxants: Black haw (Viburnum prunifolium) relaxant; petasites (Petasites hybridus), acute muscle spasm, not for long-term use; valerian (Valeriana officinalis), antispasmodic, especially with sleeplessness; wild yam (Dioscorea villosa), antispasmodic, especially with joint pains and long-term stress; turmeric anti-inflammatory, especially with digestive problems; Jamaica dogwood (Piscidia piscipula), relaxant
• Pain relief: White willow bark (Salix alba), anti-inflammatory and analgesic; devil's claw (Harpagophytum procumbens), analgesic, anti-inflammatory; St. John's wort (Hypericum perforatum), anti-inflammatory
• Circulatory stimulants: rosemary leaves (Rosmarinus officinalis), especially with digestive problems; gingko (Ginkgo biloba), especially with poor circulation
• Topical treatment may be helpful for acute problems. Mix 1 to 2 drops of essential oil or 5 to 10 drops of tincture into 1 tbsp. vegetable oil, and rub into the affected area. St. John's wort for nerve pain; leopard's bane (Arnica montana) anti-inflammatory, external use only; lobelia (Lobelia inflata) antispasmodic

Homeopathy

Some of the most common remedies for this condition are listed below:

• Aesculus for dull pain with muscle weakness
• Arnica montana, especially with pain as a result of trauma
• Colocynthis for weakness and cramping in the small of the back
• Gnaphalium for sciatica that alternates with numbness
• Lycopodium for burning pain, especially with gas or bloating
• Rhus toxicodendron for stiffness and pain in the small of the back

Hydrotherapy

Contrast hydrotherapy may help. Alternate hot and cold applications. Alternate 3 minutes hot with 1 minute cold. Repeat three times to complete one set. Do two to three sets per day.

Castor Oil Packs

Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. Repeat this procedure for 3 consecutive days.

Acupuncture

Reviews of scientific studies have found some support for the use of acupuncture for low back pain. In addition, acupuncturists frequently report success in treating low back pain and the National Institutes of Health recommend acupuncture as a reasonable treatment option for this condition. An acupuncturist's management of low back pain often involves a comprehensive approach including specialized massage, application of warming herbal oils, and patient education.

Treating low back pain with acupuncture can be complex because many meridians (including the kidney, bladder, liver, and gallbladder) affect this area of the body. Local treatment to the painful areas and related sore points is often performed as well, with needles and/or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points).

Chiropractic

Spinal manipulation is among the most extensively studied and accepted form of treatment for acute low back pain. According to a comprehensive review conducted by the Agency for Healthcare Research and Quality, spinal manipulation and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two most effective treatments for acute low back pain. Of these, only spinal manipulation was judged to both relieve pain and restore function.

Spinal manipulation also appears to be effective for chronic low back pain, but the evidence is less conclusive. In one study, 174 individuals with chronic low back pain received either spinal manipulation or NSAID treatments. Both groups also learned strength training exercises. Participants in both groups improved significantly over time, but those who received spinal manipulation required less pain medication at a 1-year follow-up visit. In another study, individuals with chronic low back pain who were treated with spinal manipulation reported a significant reduction in pain compared to those in a control group who only received pamphlets about exercise and body mechanics. Pain relief continued even after the spinal manipulation treatments were completed.

Massage

Massage may helpful for the prevention and treatment of short and long-term back problems.

Special Considerations

Chronic low back problems can interfere with everyday activities, sleep, and concentration. Severe symptoms may affect mood and sexuality. While depression is usually not the cause of chronic low back pain, it often complicates treatment.

Supporting Research

Balch JF, Balch PA. Prescription for Nutritional Healing . 2nd ed. Garden City Park, NY: Avery Publishing Group; 1997:149-150.

Bartram T. Encyclopedia of Herbal Medicine . Dorset, England: Grace Publishers; 1995:238-239, 277-278.

Bigos S, Bowyer O, Braen G et al. Acute lower back problems in adults. Clinical Practice Guideline , Quick Reference Guide Number 14. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0643. December 1994.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Boston, Mass: Integrative Medicine Communications; 1998:81-82, 136-137, 183, 197, 222-223, 226-227, 230-231.

Bronfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV. Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial. J Manipulative Physiol Ther . 1996;19(9):570-582.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr . 1999;69(6):1086-1107.

Cherkin DC, Eisenberg D, Sherman KJ et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.

Chrubasik S, Eisenburg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract: a randomized double blind study. Am J Med . 2000;109:9-14

Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med . 1998;158:2235-2241.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines . Montvale, NJ: Medical Economics Co; 1998:662-663, 786-787, 871-872.

Hoirilis KT, Pfleger B, McDuffie FC, Cotsonis G, Elsangak O, Hinson R, Verzosa GT.

A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther 2004 Jul-Aug;27(6):388-398.

JAMA Patient Page. How much vitamin C do you need? JAMA . 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA . 1999;282(22):2118-2119.

Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (2nd report): schedule of administration and clinical effects in low back pain and tooth extraction. Acupunct Electrother Res . 1990;15:121-135.

Kruzel T. The Homeopathic Emergency Guide . Berkeley, Calif: North Atlantic Books; 1992:30-38.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA . 1999;281(15):1415-1453.

Mens JM. The use of medication in low back pain. Best Pract Res Clin Rheumatol 2005 Aug;19(4):609-621.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms . Albany, Calif: Hahnemann Clinic Publishing; 1993:36-39, 59-61.

Mowrey D. The Scientific Validation of Herbal Medicine . New Canaan, Conn: Keats Publishing; 1986:223-227.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine . 2nd ed. Rocklin, Calif: Prima Publishing; 1998:338.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm   on September 24, 2001.

ShermanKJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB, Eisenberg DM. Complementary and alternative medicine medical therapies for chronic low back pain: What treatments are patients willing to try? BMC Complement Altern Med 2004; Jul 19;4:9.

Smith L, Oldman AD, McQuay HJ, Moore RA. Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain.  Pain . 2000;86:119-132.

Snider RK, ed. Essentials of Musculoskeletal Care . Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997.

Triano JJ, McGregor M, Hondras MA, Brennan PC. Manipulative therapy versus education programs in chronic low back pain. Spine . 1995; 20:948-955.

Van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain: a systematic review within the framework of the Cochrane Collaboration back review group. Spine . 1999;24(11):1113-1123.

Werbach M. Nutritional Influences on Illness . New Canaan, Conn: Keats Publishing Inc.; 1988: 342-345.

• Review Date: 10/17/2005
• Reviewed By: A.D.A.M. editorial, previously reviewed by: Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login Chiropractic College, Maryland Heights, MO; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New York, NY; Eric Wellons, MD, Department of Surgery, Union Memorial Hospital, Baltimore, MD; Terry Yochum, DC, Rocky Mountain Chiropractic Center, Arvada, CO; David Zeiger, DO, ABFP, HealthWorks/Integrative Medical Clinic, Chicago, IL; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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