The question:Sometimes my back hurts when I wake up in the morning. Could this be serious?
Your spine is like a series of building blocks, one vertebrae on top of another, and any misalignment may put undue stress on anatomical structures, including ligaments, muscles, discs and nerve roots. These can cause pain when injured, worn out or inflamed.
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After the common cold, back pain is the second most common reason that Americans seeks medical attention. Back pain affects almost 10 million people on any given day, and more than 80 percent of the U.S. population at some point in their lives. It is the most common cause of disability under age 45, and costs up to $200 billion per year for diagnosis, treatment, lost work days and disability.
Your physician’s task is to identify the small group of patients whose condition exhibits red flags, suggesting an ominous source of pain that requires in-depth evaluation. The three main goals of any back pain examination are:
- Exclusion of underlying conditions such as cancer or vascular disease. Examples of non-musculoskeletal causes of back pain include kidney stones, aneurysms, pancreatitis, urinary infections and shingles.
- Detection of neurologic emergencies requiring surgery that may result from nerve root or spinal cord compression, or trauma. These may be caused by herniated discs, fractured vertebrae or cancer that spreads to the spine.
- Identifying psychosocial factors influencing pain perception, such as depression, dependence on narcotic pain medication or legal liability issues.
During an exam, your physician should take your history and do a complete neurologic assessment, looking at your range of motion, strength, sensation, reflexes and gait.
The most common causes of back pain are muscle and ligament sprains and strains. Herniated discs, arthritis or spinal stenosis (narrowing of the spinal nerve canal and nerve root openings) may result in more severe or chronic pain, with radiation of the pain, numbness or tingling down the leg (sciatica). Your doctor might request further tests, like X-rays, a CT scan or an MRI, to determine what exactly is causing your pain.
You can manage your pain pretty easily with over-the-counter pain relievers such as acetaminophen or anti-inflammatory agents (ibuprofen or naproxen), or prescription muscle relaxers, a few days of bed rest and other methods like ice or heat, spinal manipulation or physical therapy.
The good news is that most back pain is self-limited, meaning that even if you do nothing, most of the time it'll go away on its own (just like if you sprained your ankle, for example). With some help from your physician or other health care provider (massage therapist, chiropractor, acupuncturist), the pain should subside in 6-8 weeks. As always, if you are unsure about what's causing your pain, seek guidance from your physician.